Effect of a Bundle of Interventions on the Outcomes of Patients With Intracranial Devices (ICP Monitor e EVD)

NCT ID: NCT06412549

Last Updated: 2024-05-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

1300 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-06-01

Study Completion Date

2026-12-31

Brief Summary

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Non-randomized clinical trial conducted in the adult ICUs of Brazilian hospitals participating in the IMPACTO MR Platform, involving adult patients using an intracranial pressure monitoring catheter device or external ventricular drain.

The study will test the hypothesis that the intervention bundle, following ANVISA recommendations for care practices, will reduce the rates of central nervous system infections associated with ICP and EVD devices.

This reduction is expected to lead to more accurate diagnoses, decreased antibiotic usage, shortened ICU and hospital stays, and reduced hospital costs.

Detailed Description

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IMPACTO MR is a research platform that originated as a prospective and collaborative observational study collecting clinical, microbiological, and cost data from patients admitted to Brazilian adult ICUs during the three-year periods 2018-2020 and 2021-2023. Data were collected from all adult patients admitted to the ICUs of at least 61 hospitals selected for the platform. This project aims to collect data from approximately 20 participating hospitals that perform neurosurgical procedures involving external ventricular drain catheter implantation and intracranial pressure monitoring, with the goal of establishing national data on the prevalence of these conditions.

The first phase of the study will involve completing data collection for the prospective cohort conducted between 2022 and 2023. This cohort is part of the IMPACTO MR: Device-related central nervous system infections in adult intensive care units in Brazil - Action Plan Support Project Platform National Prevention and Control of Antimicrobial Resistance) with the same hospitals. This will represent the baseline incidence of central nervous system infections related to devices and care practices for patients with intracranial pressure monitoring catheters and external ventricular drains. The data will include information on risk factors, care processes, and clinical management in suspected central nervous system infections related to these devices.

In the second phase of the study, an intervention bundle will be implemented to prevent infections and improve care processes in these ICUs progressively. Diagnostic site visits will be conducted at hospitals to support the construction of this intervention bundle, and all participating hospitals will receive continuous training to facilitate measurement of results.

The intervention bundle will be based on ANVISA recommendations for controlling healthcare-associated infections. Currently, the recommendations are based on the care to be followed from pre-operative to post-operative stages, including the use of checklists with daily goals, recommendations for dressing care, catheter handling, and treatment in the presence of infection.

The intervention bundle will be developed by a minimum team of doctors and nurses from the coordinating hospital. After conducting a situational diagnosis, this team will develop care protocols, checklists with daily goals, and training materials for the participating centers.

Throughout the project, systematic feedback meetings will be held to monitor action plans, both remotely and, if necessary, in person.

The intervention will be implemented within each hospital until the proposed sample size is attained.

Conditions

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Central Nervous System Infections

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SEQUENTIAL

The first phase of the project included 554 participants (baseline sample) and the second phase included 746 participants (intervention sample). Totaling 1,300 patients with external ventricular drain and/or intracranial pressure monitoring catheter.
Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

NONE

Study Groups

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Baseline

Participants over 18 years of age admitted to the ICU in the selected hospitals during the study period, using intracranial pressure monitoring catheters and/or external ventricular drain. Baseline database obtained from the study "Device-related Central Nervous System Infections in Adult Intensive Care Units in Brazil (IMPACTO-SNC)", Carried out during the period from 2022 to 2023.

Group Type NO_INTERVENTION

No interventions assigned to this group

Intervention

Participants over 18 years old admitted to the ICU in the selected hospitals and trained in the intervention bundle during the study period, using intracranial pressure monitoring catheters and/or external ventricular shunt. Participants included in the period from 2024 to 2026

Group Type EXPERIMENTAL

Health care practices and routines

Intervention Type BEHAVIORAL

The scope of the project includes a diagnostic visit to participating hospitals, conducted by the coordinating center team, to understand existing protocols related to the management of invasive central nervous system devices (such as intracranial pressure monitoring catheters or external ventricular drains), as well as the physical infrastructure, human resources, and other precautions taken for the prevention and treatment of central nervous system infections. All recommendations in the intervention bundle for patient care will align with the guidelines of the National Health Surveillance Agency (ANVISA) and the best available scientific evidence for preventing infections associated with central nervous system devices.

* Provide the best care for patients with ICP and/or EVD, based on the best available evidence, with regard to the insertion and maintenance of catheters, as well as diagnosis and treatment in the presence of infection.
* Training of the multidisciplinary team.

Interventions

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Health care practices and routines

The scope of the project includes a diagnostic visit to participating hospitals, conducted by the coordinating center team, to understand existing protocols related to the management of invasive central nervous system devices (such as intracranial pressure monitoring catheters or external ventricular drains), as well as the physical infrastructure, human resources, and other precautions taken for the prevention and treatment of central nervous system infections. All recommendations in the intervention bundle for patient care will align with the guidelines of the National Health Surveillance Agency (ANVISA) and the best available scientific evidence for preventing infections associated with central nervous system devices.

* Provide the best care for patients with ICP and/or EVD, based on the best available evidence, with regard to the insertion and maintenance of catheters, as well as diagnosis and treatment in the presence of infection.
* Training of the multidisciplinary team.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Adult patients with intracranial pressure monitoring catheters (intraventricular or intraparenchymal) and/or external ventricular drain.
* The patient can be included from the moment the catheter is implanted, without there being a minimum time for inclusion.

Exclusion Criteria

* Suspected or confirmed brain death.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Ministry of Health, Brazil

OTHER_GOV

Sponsor Role collaborator

Beneficência Portuguesa de São Paulo

OTHER

Sponsor Role lead

Responsible Party

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Viviane Cordeiro Veiga, MD, PhD

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Viviane Veiga, Phd

Role: PRINCIPAL_INVESTIGATOR

BP - A Beneficência Portuguesa de São Paulo

Renata Oliveira

Role: PRINCIPAL_INVESTIGATOR

Hospital Geral Clériston Andrade

Cássia Shinotsuka

Role: PRINCIPAL_INVESTIGATOR

Instituto Estadual do Cérebro Paulo Niemeyer

Thiago Lisboa

Role: PRINCIPAL_INVESTIGATOR

Hospital de Clinicas de Porto Alegre

Luciana Sanches

Role: PRINCIPAL_INVESTIGATOR

Hospital do Amor de Barretos

Lívia Medeiros

Role: PRINCIPAL_INVESTIGATOR

Hospital Pelópidas Silveira

Tássio Lavor

Role: PRINCIPAL_INVESTIGATOR

Hospital Getúlio Vargas

Débora Pinho

Role: PRINCIPAL_INVESTIGATOR

Hospital da Restauração

Cristiano Franke

Role: PRINCIPAL_INVESTIGATOR

Hospital de Pronto Socorro de Porto Alegre

Gabriela Teixeira

Role: PRINCIPAL_INVESTIGATOR

Hospital Universitário Cajuru

Eliane Silva

Role: PRINCIPAL_INVESTIGATOR

Hospital Universitário Onofre Lopes

Marcelo Romano

Role: PRINCIPAL_INVESTIGATOR

Hcor - Associação Beneficente Síria

Wilson Lovato

Role: PRINCIPAL_INVESTIGATOR

Hospital das Clínicas de Ribeirão Preto

Israel Maia

Role: PRINCIPAL_INVESTIGATOR

Instituto Baía Sul de Ensino e Pesquisa Irineu May Brodbeck

Priscila Gonçalves

Role: PRINCIPAL_INVESTIGATOR

Santa Casa de Misericordia de Passos

Flávia Machado

Role: PRINCIPAL_INVESTIGATOR

Hospital São Paulo

Glécia Rocha

Role: PRINCIPAL_INVESTIGATOR

Instituto Hospital de Base do Distrito Federal - IGESDF

Roberta Roepek

Role: PRINCIPAL_INVESTIGATOR

Hospital das Clínicas FMUSP

Central Contacts

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Viviane Veiga, Phd

Role: CONTACT

+55 11 99942-1721

Juliana Coelho, Phd

Role: CONTACT

+55 11 98971-5801

References

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Champey J, Mourey C, Francony G, Pavese P, Gay E, Gergele L, Manet R, Velly L, Bruder N, Payen JF. Strategies to reduce external ventricular drain-related infections: a multicenter retrospective study. J Neurosurg. 2018 Jun 22;130(6):2034-2039. doi: 10.3171/2018.1.JNS172486. Print 2019 Jun 1.

Reference Type BACKGROUND
PMID: 29932377 (View on PubMed)

Ramanan M, Lipman J, Shorr A, Shankar A. A meta-analysis of ventriculostomy-associated cerebrospinal fluid infections. BMC Infect Dis. 2015 Jan 8;15:3. doi: 10.1186/s12879-014-0712-z.

Reference Type BACKGROUND
PMID: 25567583 (View on PubMed)

Jin J, Akau Ola S, Yip CH, Nthumba P, Ameh EA, de Jonge S, Mehes M, Waiqanabete HI, Henry J, Hill A; International Society of Surgery (ISS) and the G4 Alliance International Standards and Guidelines for Quality Safe Surgery and Anesthesia (ISG-QSSA) Group. The Impact of Quality Improvement Interventions in Improving Surgical Infections and Mortality in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis. World J Surg. 2021 Oct;45(10):2993-3006. doi: 10.1007/s00268-021-06208-y. Epub 2021 Jul 3.

Reference Type BACKGROUND
PMID: 34218314 (View on PubMed)

Lord AS, Nicholson J, Lewis A. Infection Prevention in the Neurointensive Care Unit: A Systematic Review. Neurocrit Care. 2019 Aug;31(1):196-210. doi: 10.1007/s12028-018-0568-y.

Reference Type BACKGROUND
PMID: 29998427 (View on PubMed)

Karvouniaris M, Brotis A, Tsiakos K, Palli E, Koulenti D. Current Perspectives on the Diagnosis and Management of Healthcare-Associated Ventriculitis and Meningitis. Infect Drug Resist. 2022 Feb 28;15:697-721. doi: 10.2147/IDR.S326456. eCollection 2022.

Reference Type BACKGROUND
PMID: 35250284 (View on PubMed)

Other Identifiers

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6. NUP25000.1672362023-51

Identifier Type: -

Identifier Source: org_study_id

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