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A no-touch technique protocol to diminish cerebrospinal fluid shunt infection
1Department of Neurosurgery and Pediatrics, University of Florida Health Science Center, Jacksonville 32209, USA.
Background:
Cerebrospinal fluid (CSF) shunts become infected primarily by bacterial organisms indigenous to the patient's skin flora, but bacteria from the operating room environment, hospital, or no obvious source may also infect a shunt. To decrease the incidence of shunt infection, a no-touch technique protocol was developed and utilized in a prospective manner.
Methods:
A before-after trial analysis was performed to compare the infection rates between patients who had CSF shunts placed using the no-touch technique protocol versus patients who had surgery without the protocol. Patients were stratified by age, etiology of hydrocephalus, type of shunt surgery, and presence of a contaminated skin wound, namely, tracheostomy, gastrostomy-jejunostomy, colostomy, or halo. The differences in infection rates were analyzed with the Fisher exact test with midpoint value correction, and standard statistical methods were used to calculate the 90% confidence interval odds ratio and number to treat.
Results:
The no-touch technique protocol resulted in a clinically significant threefold decrease in shunt infection rate from 9.1% to 2.9% (p = 0.058 at 0.10 level, odds ratio 0.305, confidence interval 0.084-1.11), and a near threefold decrease in the infection rate per patient from 11.3% to 3.9% (p = 0.032 at 0.10 level, odds ratio 0.243, confidence interval 0.065-0.906).
Conclusions:
The no-touch technique protocol as described herein is a useful method to decrease shunt infection. A larger prospective, randomized, multicenter clinical trial is encouraged to stringently assess the efficacy of the protocol.
Insights
A new no-touch technique protocol significantly reduced cerebrospinal fluid (CSF) shunt infections by threefold. This method offers a promising strategy to lower infection rates in patients undergoing shunt placement surgery.
Area of Science:
- Neurosurgery
- Infectious Disease Prevention
- Medical Device Technology
Background:
- Cerebrospinal fluid (CSF) shunts are susceptible to bacterial infections from skin flora, operating room environments, or other sources.
- High incidence of shunt infection necessitates strategies to improve patient safety and outcomes.
- A novel no-touch technique protocol was implemented to mitigate the risk of shunt infection.
Purpose of the Study:
- To evaluate the efficacy of a no-touch technique protocol in reducing the incidence of CSF shunt infections.
- To compare infection rates in patients who underwent shunt placement with versus without the no-touch technique.
Main Methods:
- A before-after trial design was employed to analyze infection rates.
- Patients were stratified based on age, hydrocephalus etiology, surgery type, and presence of contaminated wounds.
- Statistical analysis included the Fisher exact test and calculation of confidence intervals for odds ratios.
Main Results:
- The no-touch technique protocol demonstrated a threefold decrease in shunt infection rate, from 9.1% to 2.9% (p=0.058).
- Infection rate per patient decreased nearly threefold, from 11.3% to 3.9% (p=0.032).
- The protocol yielded an odds ratio of 0.305 for overall infection and 0.243 for infection per patient.
Conclusions:
- The no-touch technique protocol is an effective method for reducing CSF shunt infections.
- Further validation through larger, prospective, randomized, multicenter trials is recommended to confirm the protocol's efficacy.