Efficacy of intraoperative irrigation with saline for preventing shunt infection

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The rate of infection following shunt procedures is unacceptably high. The authors have hypothesized that the key to reducing the shunt infection rate is in reducing bacteria in the operating field and wound. This hypothesis has been tested in a prospective nonrandomized controlled manner.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Data obtained in all patients undergoing shunt insertions or revisions for hydrocephalus performed between October 1, 2003, and June 12, 2009, were reviewed. Starting in August 2006, we began routinely irrigating the operating field and wound with saline solution from a syringe. Prior to this, we had not used any irrigation techniques, providing an adequate control group (Group A) for the effect of the irrigation technique. Prior to November 2007, we used saline containing amikacin for irrigation (Group B). After that date, we used saline only for irrigation (Group C).</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>A total of 150 shunt procedures were performed in 79 girls and 71 boys during the study period. The mean age of all patients was 44.0 ± 59.1 months. Groups A, B, and C comprised 61, 40, and 49 shunt procedures, respectively. There was no statistical difference in age among the 3 groups. Nine infections occurred within 90 days in the postoperative period. The overall infection rate was 6.0%. Eight infections occurred before introducing the irrigation procedure (infection rate 13.1%). One infection was noted after introducing irrigation (Group B [0.0%] + Group C [2.0%]; combined B and C infection rate = 1.1%). There was a statistical difference in the infection rate between Group A and Groups B and C combined (p = 0.003), Groups A and B (p = 0.021), and Groups A and C (p = 0.035). In contrast, no statistical difference was observed between Groups B and C (p &gt; 0.99). Six of the 9 infections were due to staphylococcal species.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>An irrigation technique used to reduce bacteria in the operating field and wound is effective for preventing shunt infection. Irrigation alone, and not antibiotics, contributed to the prophylaxis of shunt infection.</jats:p></jats:sec>

Contributing Factors to Surgical Site Infections

“…In some of the applicable studies, no difference has been noted in SSI rates with or without routine irrigation, 21 whereas in others, decreased infection rates have been reported with routine irrigation. 22 Similarly, some studies indicate no significant changes in SSIs with antibiotic irrigation, 22 whereas others demonstrate marked reductions in infection rates with this measure. 23 The effectiveness of irrigation in reducing SSIs remains unclear.…”

Postoperative Central Nervous System Infection After Neurosurgery in a Modernized, Resource-Limited Tertiary Neurosurgical Center in South Asia

“…36,37 Furthermore, coagulase-negative staphylococci are also common causative agents of these infections, and studies show that P. acnes infection may occur after cerebrospinal fluid (CSF) shunt placement, craniotomy, and other procedures. 14,8,13,30 Gram-negative bacteria more rarely cause PCNSIs although studies are now showing a possible shift in trends towards greater gram-negative PCNSIs. 34,32,31,27,25,20,19 The INICC reported in 2008 that there are greater rates of post-operative ICU infections in countries with limited resources.…”

Complications Associated with Surgical Treatment of Hydrocephalus

“…There have been investigations of the effect of more simple techniques, focusing on intraoperative sterile conditions such as intraoperative irrigation (Hayashi et al, 2008(Hayashi et al, , 2010, changing gloves before handling the shunt catheter (Sørensen et al, 2008, Rehman et al, 2010 or a double-gloving strategy (Tulipan & Cleves, 2006), and antimicrobial suture wound closure (Rozzelle et al, 2008). Where AIS is unavailable, we recommend the systemic administration of antibiotics, generous intraoperative irrigation and double-gloving.…”