Rigid Standardization of Technique to Affect Outcome: Ventricular Shunt Infection Rate

Abstract

Introduction Infection continues to be a common problem in CSF diversion procedures in children with substantial morbidity. There is evidence that adherence to strict sterile technique in the OR can impact the rate of infection, but the impact may be short-lived (Hawthorne effect). We sought to change our infection rate by adhering to a strict set of rules for pre-, intra-, and postoperative management of CSF diversion procedures. Methods After 2004, a rigid protocol for ventricular shunt surgery was established at the Kosair Children's Hospital with OR staff, medical staff (neurosurgery and anesthesiology), and hospital administration enabled to enforce compliance. Preop (antibiotics, OR suite, room set-up), intraop (standardized extensive prep, double-gloving, frequent glove changes, tissue and shunt handling, room traffic, “two-foot rule”), and postop factors (wound care, leak surveillance) were considered. The data were collected prospectively by infection control personnel using pre-established defin...