Significant reduction of shunt infection rate in children below 1 year of age after implementation of a perioperative protocol.

Abstract

BACKGROUND:

Shunt infection markedly impairs the clinical result of shunt surgery. The infection rate can be reduced by dedicated protocols. This study was undertaken to determine the efficacy of introducing a perioperative protocol for control of shunt infections.

METHOD:

The shunt infection rate and risk factors for shunt infection were determined for two periods, namely the period 2001-2002 (Patient Material A), and the period 2005-2008 (Patient Material B). The perioperative protocol was introduced in 2005 before the second period.

RESULTS:

The total patient material includes 901 patients, in whom 1,404 shunt procedures were performed during the study periods. While the overall infection rate dropped nonsignificantly from 6.5 % to 4.3 %, infection rate dropped markedly and significantly from 18.4 % to 5.7 % among the children younger than 1 year (p = 0.016). The significant risk factors for shunt infection were in Patient Material A age below 1 year (p < .001), and in Patient Material B premature birth (p = 0.045), postoperative cerebrospinal fluid (CSF) leakage (p < .001) and high American Society of Anaesthesiologists (ASA) score (p = 0.039). Of the protocol steps, only the lack of preoperative wash with 4 % clorhexidine gluconate (Hibiscrub®) showed a tendency of influencing the shunt infection rate (p = 0.051).

CONCLUSIONS:

This study showed that implementation of a perioperative protocol markedly and significantly reduced shunt infection rate in children younger than 1 year, even though no significant overall reduction in shunt infection rate was found.

• Authors: Jorunn Hommelstad, Anita Madsø, Per Kristian Eide
• Journal: Acta neurochirurgica (Acta Neurochir (Wien)) Vol. 155 Issue 3 Pg. 523-31 (Mar 2013) ISSN: 0942-0940 [Electronic] Austria
• PMID: 23224578 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Infective Agents, Local
• chlorhexidine gluconate
• Chlorhexidine

Topics

• Age Factors
• Anti-Infective Agents, Local
• Antibiotic Prophylaxis (methods)
• Cerebrospinal Fluid Leak
• Cerebrospinal Fluid Rhinorrhea (epidemiology, prevention & control)
• Chlorhexidine (analogs & derivatives)
• Critical Pathways (organization & administration)
• Cross-Sectional Studies
• Female
• Humans
• Infant
• Infant, Newborn
• Infant, Premature, Diseases (epidemiology, prevention & control)
• Male
• Norway
• Perioperative Care (methods)
• Quality Improvement (organization & administration)
• Risk Factors
• Surgical Wound Infection (epidemiology, prevention & control)