Date of Award

4-2024

Degree Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Advisor

Dr. Edwin Mogere

Second Advisor

Dr. Stanley Mugambi

Third Advisor

Dr. Felix Riunga

Department

General Surgery (East Africa)

Abstract

Background: 

External Ventricular Drain insertion has been practised at the Aga Khan University Hospital for more than 15 years, with the initial use of plain catheters. Subsequently between 2016 and 2017 the use of Silver-impregnated external ventricular catheters was adopted in the hospital with the aim of reducing external ventricular catheter-related infections. There is a need to assess the effect of the Silver-impregnated external ventricular drain (EVD).

Objectives: 

The primary objective of the study was to determine the difference in the incidence of EVD related infections between the plain EVD and Silver-impregnated EVD at AKUHN in the duration between the year 2010 and 2021. The introduction of the Silver-impregnated EVD was between the year 2016 and 2017. The secondary objectives were to determine the difference in the length of hospital stay of patients who had placement of the plain and the Silver-impregnated EVD and to identify the risk factors associated with the development of EVD related infections.

Methodology: 

This is a retrospective case-control study with propensity score matching comparing EVD-related infections before and after the introduction of the Silver- impregnated EVD. The study included patients who had primary external ventricular drain placement for any indication between the year 2010 and 2021. The Silver-impregnated EVD was introduced between the year 2016 and 2017. The exclusion criteria include History of previous ventricular catheterization and intracranial infection preceding EVD insertion.

Results: 

The rate of infection was 14% in SI EVD group and 21% in the plain EVD group p=0.06. Relative to the duration of EVD days, the rate of infection 14.3/1000EVD days in the SI-EVD group vs 20.4/1000EVD days in the plain EVD group. However, there was no statistical significance p=0.39. The duration of hospital stay was slightly longer in the plain EVD group with a median duration of 22 days compared to 19 days in the Silver-impregnated EVD group, but this was not statistically significant with p=0.9. An inverse finding was noted in the duration of critical care stay with plain EVD group having a median duration of 13 days, compared to 16 days in the SI EVD group, p=0.3. The only factor that showed a statistically significant association with EVD related infection was duration of EVD implantation with p=0.022.

Conclusion: 

There was no statistically significant difference in the rate of EVD catheter related infections at AKUHN. The length of hospital stay did not show a significant change between the two groups of patients. The EVD duration of implantation was the only factor demonstrated to have statistically significant association with EVD CRI. The length of hospital stay did not show a significant change between the two groups of patients.

First Page

1

Last Page

48

Download

Included in

Surgery Commons

Share

COinS