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Zero tolerance to shunt infections: can it be achieved?

Department of Neurosurgery, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK

Correspondence to:
Correspondence to:
Mr M S Choksey
Department of Neurosurgery, University Hospitals Coventry & Warwickshire NHS Trust, Walsgrave Hospital, Bridge Road, Coventry CV2 2DX, UK; munchi.choksey{at}wh-tr.wmids.nhs.uk

Method: 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.

Conclusion: A rigidly applied protocol and strict adherence to sterile technique can reduce shunt infections to a very low level.

Keywords: cerebrospinal fluid shunts; shunt infection; strict aseptic technique; topical antiseptics

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