External ventricular drains (EVDs) are used to manage cerebrospinal fluid diversion in some of the most vulnerable critically ill patients in the Redwood City Neuro ICU. Historically, the ICU has maintained a <0.25% external ventricular drain infection rate. A cornerstone of maintaining the low infection rate is limiting the number of providers who manipulate the closed system. However, the limitation on trained staff was causing delays in critical monitoring of intracranial pressure (ICP).
ICU nurses recognized the need to develop more superusers to utilize sterile techniques to perform tasks that were previously only performed by physicians. Grace Malasan, BSN, RN, Lorraine Monegas, BSN, RN and Edward Cruz, RN, developed a customized procedure and competency checklist in collaboration with Kathryn Snow, DNP, RN, MS, SCRN, CNRN, Clinical Nurse Specialist. The staff nurses held multiple training sessions to emphasize sterile technique and perform return-demonstration of skills. There have been zero infections since the expansion of EVD skill training beginning October 2023 and throughout 2024.