A concerted effort to prevent shunt infection

In an attempt to reduce the rate of shunt infection a new protocol for shunt surgery was introduced on July 1, 1988 at The Hospital for Sick Children in Toronto. The operations were done at the beginning of the day, operating room personnel were kept to a minimum, no visitors were allowed in the room, a staff neurosurgeon or neurosurgical fellow attended all operations and two doses of perioperative cloxacillin 50 mg/kg were given intravenously. From July 1, 1988 to June 30, 1989 there were 576 shunt procedures on the Neurosurgical Service and 22 (3.8%) of these resulted in a shunt infection. During the preceding year (July 1, 1987 to June 30, 1988) 581 shunt operations were performed, 75 (12.9%) of which resulted in an infection (chi 2 = 29.9, P < 0.001). It appears that the introduction of this protocol for shunt surgery has helped to reduce the risk of shunt infection from 12.9% to 3.8% (a reduction of 70.5%). The rate of infection occurring after shunt revisions was not significantly different from that occurring after new shunt insertions. When the individual factors in the protocol were analyzed, the use of antibiotics and a shorter duration of surgery appeared to be related to a lower shunt infection rate.