Zero tolerance to shunt infections: can it be achieved?
- Correspondence to: Mr M S Choksey Department of Neurosurgery, University Hospitals Coventry & Warwickshire NHS Trust, Walsgrave Hospital, Bridge Road, Coventry CV2 2DX, UK; munchi.chokseywh-tr.wmids.nhs.uk
- Received 5 November 2002
- Accepted 1 May 2003
Abstract
Objective: To evaluate the rigid application of a technique of shunt placement aimed at the eradication of postoperative shunt infection in neurosurgical practice.
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.
