**3. Non-technological prevention measures**

In view of the morbidity, costs and difficulty in successful treatment of infected shunts and EVDs, prevention is a major goal. Great success has been achieved by institution of care "bundles," packages of procedures included in written protocols to which all personnel contribute and with which there is general consensus [19–21]. Infection rates usually fall, and spikes of infection can usually be attributed to a protocol violation [20]. The disadvantage of this approach is that infection rates tend to rise again due to habituation, or if the protocol lead moves on. More specific measures include reducing the duration of EVD use where possible, and tunneling the ventricular catheter a few centimetres away from the burr hole (or in some cases down to the abdominal wall [22].) Another innovation is the placement of a port in the subclavian region and the ventricular catheter tunnelled to connect with it [23]. The use of prophylactic antibiotics is controversial. They are used almost universally in shunt placement, but the evidence for their effectiveness is weak. In EVD, two regimens are used. One consists of a single

*Infections in Intracranial Pressure Management: Impact of New Technologies on Infection Rates DOI: http://dx.doi.org/10.5772/intechopen.110349*

dose of antibiotic given just before EVD insertion, and the IDSA Guidelines recommend this [24]. However, in some institutions the systemic antibiotics are continued throughout the duration of EVD use. While there is some evidence that the long regimen can reduce EVD infection, it is clearly associated with higher healthcare costs [25] and with severe, often lifethreatening infection with *Clostridioides difficile* [26, 27].
