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Ventriculoperitoneal Shunt Surgery in Pediatrics: Does Preoperative Skin Antisepsis with Chlorhexidine/Alcohol Reduce

Ahmed Shawky Ammar1, Hossam Elnoamany1, Hany Elkholy1

  • 1Department of Neurosurgery, Faculty of Medicine, Menoufia University, Shibin El Kom, Egypt.

Journal of Neurological Surgery. Part A, Central European Neurosurgery
|February 9, 2024
PubMed

Insights

Implementing a two-step skin antisepsis protocol using chlorhexidine/alcohol followed by povidone-iodine significantly reduces infection rates in pediatric ventriculoperitoneal shunt surgeries. This enhanced approach improves patient outcomes by lowering the risk of shunt failure.

Area of Science:

  • Pediatric Neurosurgery
  • Infectious Disease Prevention
  • Surgical Site Infections

Background:

  • Shunt infection is the most common complication and cause of failure in pediatric ventriculoperitoneal (VP) shunt insertions.
  • Meticulous surgical technique and skin preparation are crucial for preventing shunt infections.
  • This study evaluated the efficacy of a dual-step preoperative skin antiseptic protocol.

Purpose of the Study:

  • To assess the impact of a two-step preoperative skin antisepsis protocol on reducing infection rates in pediatric VP shunt surgery.
  • To compare the infection incidence between standard single-step and enhanced two-step antisepsis methods.

Main Methods:

  • A retrospective case-control study involving 80 pediatric patients with hydrocephalus.
  • Control group (n=40): single-step povidone-iodine and isopropyl alcohol antisepsis (Jan 2019-Jun 2020).
  • Study group (n=40): two-step antisepsis with chlorhexidine/alcohol followed by povidone-iodine (Jul 2020-Jan 2022).

Main Results:

  • Overall shunt infection rate was 13.7%.
  • Infection rates were significantly higher in preterm infants, and patients with prior shunt revision or infection.
  • The two-step antisepsis group showed a significantly lower infection rate (5%) compared to the control group (22.5%, p=0.023).

Conclusions:

  • A two-step preoperative skin antisepsis protocol, utilizing chlorhexidine/alcohol followed by povidone-iodine, significantly decreases infection rates in pediatric VP shunt procedures.
  • This enhanced protocol offers a promising strategy for improving surgical outcomes and reducing shunt failures in pediatric patients.
Abstract

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