Ventriculostomy and intracranial pressure monitoring: In search of a 0% infection rate

External ventriculostomy intracranial pressure (ICP) monitoring provides bedside practitioners with essential information about cranial dynamics as well as a means to maintain the balance within the cranium. Infection has been cited in the literature as the most common complication associated with ICP monitoring. This article reviews the research literature for the risk factors suggested to increase infection, presents data and practice guidelines from one institution where ICP monitors have been maintained infection free for more than 10 years, and summarizes the experiences of another institution where the 6-month infection rate of 55% associated with external ventriculostomy was reduced to 0% in the subsequent 6-month period. The actions taken by the multidisciplinary team to reduce the risk of infection are detailed. Recommendations for minimizing the risk of infection are made by the authors and are based on research studies and experience.