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Risk factors for cerebrospinal fluid shunt infections during an outbreak: a case-control study
A K McAlpine1, L J Sauve1, J C Collet1
1British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
Insights
An increase in cerebrospinal fluid (CSF) shunt infections at BCCH was investigated. Protocol changes, including limiting operating room traffic and enforcing mask use, successfully halted the outbreak without identifying specific modifiable risk factors.
Area of Science:
- Neurosurgery
- Infectious Disease Epidemiology
- Healthcare Quality Improvement
Background:
- Cerebrospinal fluid (CSF) shunt infections are rare, with few reported outbreaks.
- British Columbia Children's Hospital (BCCH) observed an unusual rise in CSF shunt infections between 2017-2018.
- This increase coincided with a relocation to new operating rooms and a change in shunt catheter type.
Purpose of the Study:
- To detail the detection and investigation of a CSF shunt infection outbreak.
- To identify risk factors associated with shunt infections during the outbreak period.
- To document interventions implemented to control the outbreak.
Main Methods:
- A retrospective case-control study design was employed.
- Patients undergoing new shunt insertion or revision were included in the analysis.
- Univariate logistic regression identified potential risk factors (P-value <0.2).
Main Results:
- Six cases of CSF shunt infection and 19 controls were analyzed.
- Causative organisms varied among cases; no single pathogen was identified.
- Potential risk factors included being a neonate and having gastrointestinal disease; no link to operating room or staff was found.
Conclusions:
- No modifiable risk factors were definitively linked to the CSF shunt infections.
- Implementation of enhanced surgical protocols led to the cessation of further outbreak-related infections.
- The study highlights the importance of protocol adherence in preventing shunt infections.
Background:
There are few published reports of cerebrospinal fluid (CSF) shunt infection outbreaks. In 2017-2018, British Columbia Children's Hospital (BCCH) experienced an increase in CSF shunt infections co-incident with a move to new operating rooms and a change in shunt catheters used.
Aims:
To describe how an outbreak was detected, investigations were undertaken to determine the cause, risk factors associated with CSF shunt infection during the outbreak, and changes implemented to attempt to control the outbreak.
Methods:
Retrospective case-control study. Population included patients who underwent new shunt insertion or revision. Univariate logistic regression models were fitted for each of the variables. Associations with P-values <0.2 were considered of potential interest for further investigation.
Findings:
There were six cases of CSF shunt infection and 19 controls. The causative organism was different in each case. The only risk factors that met the criteria for further investigation were being a neonate at the time of surgery [odds ratio (OR) 9.0, 95% confidence interval (CI) 0.7-125.3, P=0.10] and the presence of gastrointestinal disease (OR 3.8, 95% CI 0.5-26.2, P=0.18). No association was found with the operating room used or the surgical staff. In response to the outbreak, human traffic through the operating rooms was limited, rigid adherence to the wearing of surgical masks was enforced, and return to the previous CSF shunt catheters used was implemented.
Conclusion:
No modifiable risk factors were associated with CSF shunt infection. After implementation of surgical protocol changes, no further cases of CSF shunt infection linked to the outbreak were identified.
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