Clinical Study Of The Effect Of Different Disinfection Methods On The Prevention Of Intracranial Infection After External Ventricular Drainage

BackgroundExternal ventricular drainage(EVD) is one of the most common surgical procedures in the department of neurosurgery, this operation was completed early in 1744 by Le Cat Claude-Nicholas for the first time. Because of EVD to communicate with intracranial and extra cranial, the probability of postoperative intracranial infection in patients with EVD was increased and to further increase the morbidity and mortality of the patients. In addition, due to a large number of high level of antibiotic clinical application, and also increase the economic burden of patients.As recently reported in the literature to EVD postoperative intracranial infection incidence rate is about 5%-20%, the domestic recently reported in the literature of intracranial infection rate is about 8.3%-27.9%. Therefore, how to effectively prevent EVD postoperative intracranial infection is an important problem faced by neurosurgeonsObjectiveResearch the difference of different disinfection methods around the drainage pipe after EVD for prevention of postoperative intracranial infectionand and to explore its clinical significance.MethodsRetrospective analysis of our department from March 2014 to January 2016 after EVD and drainage time in 5-10 days of 76 patients,76 patients were all using pore cranial drilling, ventricle puncture for the frontal horn of lateral ventricle; Among the 36 patients with 75% alcohol disinfection, as the A group, the other 40 patients using 0.5% iodophor disinfection, B group; In group A,36 patients were divided into 3 subgroups according to the different time window after the external ventricular drainage,15 patients in group A1, was disinfected every 24 hours interval,11 patients in the A2 group, a 48 hour interval of disinfection,10 patients in A3 group, disinfection time interval of 72 hours, cases in each group use throat swab to wipe around the drainage pipe before and after disinfection and send bacteria culture; In group B,40 patients were divided into 3 subgroups according to the different time window after the external ventricular drainage,16 patients in group B1, for every 24 hours disinfection, B2 group,13 patients were treated with interval of 48 hours disinfection a, B3 group,11 patients interval 72 hours disinfection once, e cases in each group use throat swab to wipe around the drainage pipe before and after disinfection and send bacteria culture; according to the cases in the two groups of bacteria culture results and drainage after operation to extubation cases of intracranial infection number, analysis of bacterial growth before and after disinfection in each group and postoperative intracranial infection, to investigate the effect of different disinfection methods on preventing intracranial infection and its clinical significance.Results1. Whether the A1 group or B1 group, before disinfection, bacterial culture showed no bacterial growth, there was no significant difference in the number of patients with intracranial infection after extubation., both for 0 cases.2. A2 group of 11 patients, before disinfection, bacterial culture was positive in 4 cases, postoperative infection in 2 cases, the rate of intracranial infection was 18.2%; B2 group of 13 patients, before disinfection, bacterial culture was positive in 2 cases, postoperative infection in 1 cases, the rate of intracranial infection was7.7%.3. A3 group of 10 patients, before disinfection, bacterial culture was positive in 10 cases, postoperative infection in 3 cases, the rate of intracranial infection was 30%; B2 group of 11 patients, before disinfection, bacterial culture was positive in 9 cases, postoperative infection in 2 cases, the rate of intracranial infection was18.2%.4. Whether the A group or the B group, the bacterial culture results at each time point after operation showed, after the use of alcohol or iodophor disinfection then use the swab wipe tube around sent for bacterial culture, culture results showed that there were no bacterial growth.5.25 cases of bacterial culture positive in group A and group B, the culture of bacteria including staphylococcus aureus, staphylococcus aureus, escherichia coli, acinetobacter, acinetobacter, staphylococcus aureus was cultured in 24 patients, accounted for 96% of all bacterial culture positive cases.6. A group of 36 patients from the external ventricular drainage to pull out the catheter, the number of cases of intracranial infection is 5, the infection rate was 13.9%; B group of 40 patients from the external ventricular drainage to pull out the catheter, the number of cases of intracranial infection is 3, the infection rate was 7.5%.Conclusion1. The resident flora is Staphylococcus around the drainage pipe after external ventricular drainage; Before disinfection, there was no significant difference in bacterial culture between the two groups in the 24 groups, bacterial culture proved superior to the disinfection effect of iodine alcohol in patients at intervals of 48 hours and 72 hours; The results of bacterial culture showed no bacterial growth in the two groups after use iodophor disinfection or alcohol.2. The iodine group and alcohol group, there is no intracranial infection was occurred in 24 hours after operation, the infection rate was significantly lower than that reported by domestic and foreign; In the alcohol group and iodophor group, the infection rate of each case group was within the range of intracranial infection reported at home and abroad, but the infection rate of 48 hours interval is lower than the infection rate of 72 hours interval, and the iodine group infection rate was significantly lower than the alcohol group.