Effect of Care Bundle Approaches on External Ventricular Drainage–Related Infection: Systematic Literature Review and Meta-Analysis

BACKGROUND AND OBJECTIVES: External ventricular drainage (EVD) care bundle approaches are associated with reduced infection rates after EVD insertion. However, awareness and standardization of such protocols remain limited, and the current literature is sparse and has a high variability in analysis. We conducted a systematic review and meta-analysis of appropriate studies to identify the key components of an effective EVD care bundle for reducing EVD-related infections (ERIs). METHODS: A systematic review of the literature was conducted to identify any studies presenting patient cohorts undergoing EVD placement and reporting the introduction of bundle care protocols including postoperative infection rates. Major scientific databases (PubMed/MEDLINE, EMBASE, and Scopus) were systematically searched for studies published up to December 31, 2024. Studies were screened, and data were extracted independently by 2 authors. RESULTS: Twenty-eight studies were included for analysis. ERI rates before and after the implementation of care bundle protocols were observed. Different care bundles were identified and categorized as follows: insertion bundles, manipulation bundles, dressing bundles, and others. Although the literature concerning the implementation of care bundles for ERI is deemed poor, our results show a significant reduction in the postoperative ERI rates; a meta-analysis of the studies comparing cohorts before and after the implementation of care bundle protocols reveals significant differences in the postoperative infection rate after EVD placement (odds ratio 3.70, 95% CI 2.89-4.74, P < .0001 for the overall effect, heterogeneity I 2 = 46%). CONCLUSION: Implementation of care bundle approaches for EVD insertion is associated with a significant reduction in ERIs. The implementation of care bundle approaches and the strict knowledge, training, and adherence to these protocols permit a standardization of the procedure and a better postoperative management diminishing complication rates. The available evidence supports the broader adoption of care bundle protocols as a new standard of care in clinical practice.