Only antibiotic-impregnated suture , a no-shave policy , and double gloving with glove change prior to shunt h and ling , were associated with a significant reduction in shunt infection .
In a hospital with high methicillin-resistant staphylococcus aureus ( MRSA ) prevalence , a r and omized controlled trial found that perioperative vancomycin rather than cefazolin significantly reduced shunt infection rates .
Conclusion Despite wide variation in compliance rates , the implementation of comprehensive surgical protocol s reduced shunt infection in all published studies .
Antibiotic-impregnated suture , a no-shave policy , double gloving with glove change prior to device manipulation , and 5 % chlorhexidine hair wash were associated with significant reductions in shunt infection
Purpose Cerebrospinal fluid shunt infection is associated with patient morbidity and high cost .
We conducted a systematic review of the current evidence of comprehensive surgical protocol s or individual interventions design ed to reduce shunt infection incidence .
A standardized protocol to reduce cerebrospinal fluid shunt infection: the Hydrocephalus Clinical Research Network Quality Improvement Initiative.
OBJECT Quality improvement techniques are being implemented in many areas of medicine . In an effort to reduce the ventriculoperitoneal shunt infection rate , a st and ardized protocol was developed and implemented at 4 centers of the Hydrocephalus Clinical Research Network ( HCRN ) . METHODS The protocol was developed sequentially by HCRN members using the current literature and prior institutional experience until consensus was obtained . The protocol was prospect ively applied at each HCRN center to all children undergoing a shunt insertion or revision procedure .  Infections were defined on the basis of CSF , wound , or pseudocyst cultures ; wound breakdown ; abdominal pseudocyst ; or positive blood cultures in the presence of a ventriculoatrial shunt . Procedures and infections were measured before and after protocol implementation . RESULTS Twenty-one surgeons at 4 centers performed 1571 procedures between June 1 , 2007 , and February 28 , 2009 . The minimum follow-up was 6 months . The Network infection rate decreased from 8.8 % prior to the protocol to 5.7 % while using the protocol ( p = 0.0028 , absolute risk reduction 3.15 % , relative risk reduction 36 % ) . Three of 4 centers lowered their infection rate . Shunt surgery after external ventricular drainage ( with or without prior infection ) had the highest infection rate . Overall protocol compliance was 74.5 % and improved over the course of the observation period . Based on logistic regression analysis , the use of  BioGlide catheters  ( odds ratio [ OR ] 1.91 , 95 % CI 1.19 - 3.05 ; p = 0.007 ) and the use of  antiseptic cream by any members of the surgical team ( instead of a formal surgical scrub by all members of the surgical team ; OR 4.53 , 95 % CI 1.43 - 14.41 ; p = 0.01 ) were associated with an increased risk of infection . CONCLUSIONS The st and ardized protocol for shunt surgery significantly reduced shunt infection across the HCRN . Overall protocol compliance was good . The protocol has established a common baseline within the Network , which will facilitate assessment of new treatments . Identification of factors associated with infection will allow further protocol refinement in the future
Only antibiotic-impregnated suture , a no-shave policy , and double gloving with glove change prior to shunt h and ling , were associated with a significant reduction in shunt infection .
In a hospital with high methicillin-resistant staphylococcus aureus ( MRSA ) prevalence , a r and omized controlled trial found that perioperative vancomycin rather than cefazolin significantly reduced shunt infection rates .
Conclusion Despite wide variation in compliance rates , the implementation of comprehensive surgical protocol s reduced shunt infection in all published studies .
Antibiotic-impregnated suture , a no-shave policy , double gloving with glove change prior to device manipulation , and 5 % chlorhexidine hair wash were associated with significant reductions in shunt infection
Purpose Cerebrospinal fluid shunt infection is associated with patient morbidity and high cost .
We conducted a systematic review of the current evidence of comprehensive surgical protocol s or individual interventions design ed to reduce shunt infection incidence .