Shamsa Al Sharji

Directorate General of Khoula Hospital,Oman.

Abstract Title:Evaluating the Impact of Nursing Protocols on EVD Infection Control in Adult Neurosurgery Patients with External Ventricular Drainage (EVD) at Directorate General of Khoula Hospital ICU (DGKH), Oman: A Cluster-Randomized Trial

Biography: Dr. Shamsa Abdullah Al Sharji completed her Adult Critical Care diploma at Oman Specialized Nursing Institute, Muscat, in 2014 and obtained her Master’s degree (MSc) in Advanced Healthcare Practice from Cardiff University, Cardiff, UK, in 2019. In August 2024, she was appointed as the Director of Nursing Affairs at the Directorate General of Khoula Hospital, Oman. Dr. Al Sharji's recent research has focused on evaluating the effectiveness of nursing-led protocols in infection control and assessing the impact of nurse-led nutrition monitoring on patient recovery and infection rates in the ICU. Her professional interests include nursing leadership, infection prevention, clinical governance, and quality improvement in healthcare settings. Details of presenting author to be mentioned in certificate: Name: Shamsa Abdullah Rashid Al Sharji Affiliation: Ministry of Health/ Directorate General of Khoula Hospital Country: Oman

Research Interest: Introduction: In neurosurgery, External Ventricular Drains (EVDs) are crucial in for managing conditions such as traumatic brain injury (TBI) and hydrocephalus, providing essential monitoring of intracranial pressure (ICP) through cerebrospinal fluid (CSF) diversion. However, the incidence of EVD-associated infections remains a pressing concern, with reported rates ranging from 5% to 45%. Effective infection control measures are crucial to mitigate these risks, particularly in low- and middle-income countries like Oman, where standardized protocols are often lacking. Objective: This study evaluates the efficacy of a structured nursing protocol designed to reduce EVD-related infections among adult neurosurgery patients at the Directorate General of Khoula Hospital in Oman, specifically targeting patients admitted from January 2024 to September 2024. Methods: A cluster-randomized trial was conducted from September 2024 to March 2025, involving patients in the ICU and general wards. The intervention group adhered to a specialized nursing protocol consisting of: (1) strict sterile insertion, maintenance, and removal techniques; (2) standardized dressing changes every 72 hours; (3) comprehensive infection control training for nursing staff; (4) meticulous documentation of EVD care; and (5) regular clinical audits with constructive feedback. The control group continued with standard nursing practices. Data were collected on infection incidence, compliance with the protocol, severity of infections, recovery times, length of stay, and 30-day mortality rates. Statistical Analysis: Minitab version 17.0 was utilized for statistical analysis. Categorical variables were assessed using chi-square tests, while continuous variables were analyzed using means and standard deviations. Paired t-tests evaluated differences in infection rates between groups, and logistic regression controlled for confounding factors such as comorbidities. A significance threshold of p = 0.05 was set, and relative risk reduction (RRR) with 95% confidence intervals (CIs) was calculated to assess the protocol's impact. Results: The study included 75 patients, mean age 43.20 ± 17.54 years, with a gender distribution of 39 (52%) female and 36 (48%) male. In this study, a total of 83 external ventricular drain (EVD) insertions were anticipated among the 75 patients over a duration of 802 days, reflecting an average of approximately 1.11 insertions per patient. The overall EVD infection rate was 13.3%, with the intervention group exhibiting a significantly lower rate of 8.9% compared to 20.0% in the control group. Compliance rates were high, with hand hygiene adherence at 89.7% and documentation at 93.1%. Remarkably, 6 out of 8 patients who developed infections resolved them in less than 20 days, indicating effective management practices. The Pearson Chi-Square test demonstrated a significant association between infection status and protocol adherence (χ² = 9.317, p = 0.009). Discussion: The implementation of the structured nursing protocol significantly reduced the incidence of EVD-related infections and enhanced recovery outcomes. These findings align with international standards for infection control, emphasizing the critical role of nursing interventions in minimizing complications associated with EVDs. The positive trend in survival rates and the reduction in hospital length of stay further support the need for continuous protocol refinement in neurosurgical settings. Conclusion: The findings suggest that structured nursing protocols for EVD management can lead to substantial reductions in infection rates and improved patient outcomes. This study underscores the importance of evidence-based practices and highlights the potential for enhanced patient safety in the neurosurgical population. Future research should focus on validating these findings across broader settings and exploring the cost-effectiveness of the implemented protocols.