External Ventricular Drain Management Practices in Thailand: Results of the EPRACT Study

OBJECTIVE: We explored the external ventricular drain (EVD) practices in Thailand. METHODS: We performed a survey-based study to describe EVD insertion, maintenance, quality improvement (QI) practices, and incidence of EVD infection. RESULTS: The study included 58 of 101 hospitals contacted (57.4% response rate), with >= 600 beds (44.8%) and dedicated neurocritical care units (53%). The reasons for EVD placement included aneurysmal subarachnoid hemorrhage, traumatic brain injury, and ventriculoperitoneal shunt malfunction or infection; 75.9% of the hospitals cared for <= 100 EVDs annually. In Thailand, nonantimicrobial EVD catheters (98.3%) were used most often. Most hospitals (56.9%) did not routinely sample the cerebrospinal fluid. Prophylactic daily antibiotic use was prevalent (62.1%). Most hospitals (77.6%) did not measure the intracranial pressure during intrahospital transport. EVD infection was a commonly (69%) tracked QI measure; however, up to one third of the hospitals did not track any EVD QI measure. Most hospitals (94.8%) had no written EVD insertion and maintenance protocols. Most hospitals (79.3%) reported an EVD infection rate of <= 5% in the previous year. The low EVD infection rate, high cost, and/or the lack of equipment could account for the low usage of antimicrobial catheters and intracranial pressure monitoring. CONCLUSIONS: The results of the present study have identified QI opportunities in EVD management in Thailand. The development of an EVD-related QI process, reliable tracking of EVD infection rates, adaptation of U.S. guidelines to create standardized EVD protocols, and examination of the association between EVD practices and clinical outcomes in low-to middle-income countries are urgently needed.