title: Zero tolerance to shunt infections: can it be achieved?
abstract: OBJECTIVE
  To evaluate the rigid application of a technique of shunt placement aimed at the eradication of postoperative shunt infection in neurosurgical practice.
  
  
  METHODS
  All shunt procedures were performed or closely supervised by the senior author (MSC). The essentials were the use of intravenous peri- and postoperative antimicrobials, rigid adherence to classical aseptic technique, liberal use of topical antiseptic (Betadine), and avoidance of haematomas.
  
  
  RESULTS
  Of 176 operations, 93 were primary procedures; 33 patients underwent revisions, some multiple. Only one infection occurred, seven months postoperatively, secondary to appendicitis with peritonitis. The infecting Streptococcus faecalis appeared to ascend from the abdominal cavity.
  
  
  CONCLUSIONS
  A rigidly applied protocol and strict adherence to sterile technique can reduce shunt infections to a very low level.
authors.affiliation: Department of Neurosurgery, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK. munchi.choksey@wh-tr.wmids.nhs.tr
authors.forename: M S
authors.initials: MS
authors.lastname: Choksey
authors.forename: I A
authors.initials: IA
authors.lastname: Malik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D000985:Antisepsis; D001064:Appendicitis / Q000150:complications; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D013293:Enterococcus faecalis / Q000472:pathogenicity; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000592:standards*; D010538:Peritonitis / Q000150:complications; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*