title: Significant reduction of shunt infection rate in children below 1 year of age after implementation of a perioperative protocol.
abstract: BACKGROUND
  Shunt infection markedly impairs the clinical result of shunt surgery. The infection rate can be reduced by dedicated protocols. This study was undertaken to determine the efficacy of introducing a perioperative protocol for control of shunt infections.
  
  
  METHODS
  The shunt infection rate and risk factors for shunt infection were determined for two periods, namely the period 2001-2002 (Patient Material A), and the period 2005-2008 (Patient Material B). The perioperative protocol was introduced in 2005 before the second period.
  
  
  RESULTS
  The total patient material includes 901 patients, in whom 1,404 shunt procedures were performed during the study periods. While the overall infection rate dropped nonsignificantly from 6.5 % to 4.3 %, infection rate dropped markedly and significantly from 18.4 % to 5.7 % among the children younger than 1 year (p = 0.016). The significant risk factors for shunt infection were in Patient Material A age below 1 year (p < .001), and in Patient Material B premature birth (p = 0.045), postoperative cerebrospinal fluid (CSF) leakage (p < .001) and high American Society of Anaesthesiologists (ASA) score (p = 0.039). Of the protocol steps, only the lack of preoperative wash with 4 % clorhexidine gluconate (Hibiscrub®) showed a tendency of influencing the shunt infection rate (p = 0.051).
  
  
  CONCLUSIONS
  This study showed that implementation of a perioperative protocol markedly and significantly reduced shunt infection rate in children younger than 1 year, even though no significant overall reduction in shunt infection rate was found.
authors.affiliation: Department of Neurosurgery, Oslo University Hospital - Rikshospitalet, PB 4950 Nydalen, 0424, Oslo, Norway.
authors.forename: Jorunn
authors.initials: J
authors.lastname: Hommelstad
authors.forename: Anita
authors.initials: A
authors.lastname: Madsø
authors.forename: Per Kristian
authors.initials: PK
authors.lastname: Eide
mesh_terms: D000367:Age Factors; D000891:Anti-Infective Agents, Local; D019072:Antibiotic Prophylaxis / Q000379:methods; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000453:epidemiology / Q000517:prevention & control; D002710:Chlorhexidine / Q000031:analogs & derivatives; D019091:Critical Pathways / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D009664:Norway; D019990:Perioperative Care / Q000379:methods*; D058996:Quality Improvement / Q000458:organization & administration; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine