Zero tolerance to shunt infections: can it be achieved?

Area of Science:

• Neurosurgery
• Infectious Disease Prevention

Background:

• Postoperative shunt infections are a significant complication in neurosurgical practice.
• Developing effective strategies to minimize infection risk is crucial for patient outcomes.

Purpose of the Study:

• To evaluate a stringent technique for shunt placement designed to prevent postoperative infections.
• To assess the efficacy of a standardized protocol in reducing shunt infection rates.

Main Methods:

• A rigorous protocol was applied to all shunt procedures, supervised by a senior neurosurgeon.
• Key elements included peri- and postoperative intravenous antimicrobials, strict aseptic technique, liberal use of topical antiseptics (Betadine), and hematoma avoidance.

Main Results:

• Out of 176 operations (93 primary, 33 revisions), only one infection occurred.
• The single infection was noted seven months postoperatively, secondary to appendicitis with peritonitis, with Streptococcus faecalis ascending from the abdominal cavity.

Conclusions:

• Strict adherence to a standardized protocol and aseptic technique can dramatically decrease shunt infection rates.
• The findings support the rigid application of this technique to achieve a very low level of postoperative shunt infections.