Reducing external drainage-related cerebrospinal fluid infections through implementation of a multidisciplinary protocol: Experience in a paediatric hospital

Objective. To assess the frequency of external cerebrospinal fluid (CSF) drain-related CNS infections before and after implementation of a protocol for their prevention. Design. Quasi-experimental study, with comparison of incidence before and after the implementation of the intervention. Setting and participants. Bambino Gesù Children's Hospital in Rome, Italy. Children receiving an external cerebrospinal fluid drain from 1 January 2013 to 31 March 2015. Main outcome measures. Drain-related infections. Results. Fifty-two patients were included in the study. Before protocol implementation, cumulative incidence was 14 per 100 drains. Incidence rate was 8/1,000 catheter-days. After protocol implementation, cumulative incidence and incidence rate were 6.7 per 100 drains and 4.6 per 1,000 catheter-days (p=0.61 and p=0.2 versus the pre-intervention period, respectively). Infected patients were significantly younger (median age: 16.5 days vs 13.4 months; p=0.026), had a significantly higher number of procedures (5 vs 1 procedure per patient; p