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Improving ventriculostomy management: risk and cost reduction through a multi-disciplinary approach

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posted on 2019-08-21, 00:00 authored by Melissa Angulo, Lauren Springer, Mandana Behbahani, Lolita Fagaragan, Snyder John Tabbilos, Ali Alaraj, Fernando D. Testai, Sepideh Amin-Hanjani
Object. Infection is a life-threatening complication of ventriculostomies. The purpose of this quality improvement project was to develop a cost-effective, evidence-based intervention to reduce ventriculostomy-associated infection (VAI) rates. Methods. In this retrospective study, patients undergoing ventriculostomy insertion between June 2008 and December 2016 were identified and charts reviewed. The study period between June 2008 and August 2010 constituted the baseline (phase 1) in which non-antibiotic coated ventriculostomies were utilized and cerebrospinal fluid (CSF) sampling was done daily. Then, two sequential interventions were implemented. Between September 2010 and January 2013, antibiotic-coated ventriculostomies (AC-V) were utilized (phase 2). Then, between February 2013 and December 2016, the frequency of CSF sampling was minimized to twice a week (phase 3). The rates of VAI and operational costs, or cost incurred for the EVD catheter, antibiotics, laboratory analysis, and CSF sampling supplies, were compared for each phase. Results. The average infection rate for phase 1 was 3.3 infections per 1,000 device days. The VAI rates for phases 2 and 3 were 1.6 and 0.8, respectively. The use of AC-Vs and reduced CSF sampling resulted in a VAI rate decrease of 75.8% (p=0.01). During 2014, there were no VAIs. The intervention produced an estimated $1.02 million in savings for the institution during phase 3. The average projected savings of this intervention was $175 per patient per day and reduced cost by 72%. Conclusion. The use of AC-Vs in combination with decreased frequency of CSF sampling was cost-saving and resulted in a significant reduction in device-related infections.

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Citation

Angulo, M., Springer, L., Behbahani, M., Fagaragan, L., Tabbilos, S. J., Alaraj, A., . . . Amin-Hanjani, S. (2019). Improving Ventriculostomy Management: Risk and Cost Reduction Through a Multidisciplinary Approach. World Neurosurgery, 122, E1259-E1265. doi:10.1016/j.wneu.2018.11.025

Publisher

Elsevier

Language

  • en

issn

1878-8750

Issue date

2019-02-01

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