Towards zero infection for ventriculoperitoneal shunt insertion in resource-limited settings: a multicenter prospective cohort study

Kalangu, K; Dzowa, Maximillian; Musara, Aaron; Ntalaja, Jeff; Badra, Aliou K

doi:10.1007/s00381-019-04357-z

Cited by 18 publications

(14 citation statements)

References 27 publications

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“…Apart from some variations in published protocols, all focussed on limited handling of the shunt hardware, on opening of the shunt packaging just in the moment of implantation, and avoidance of contact between the skin and shunt. 1,3,10,17,27,28 We applied all of these steps in our protocol: double gloves at the start, use of sterile transparent adhesive drapes to cover the skin, and taking off the outer pairs of gloves by all surgical team before touching the shunt hardware.…”

Section: Discussionmentioning

confidence: 99%

Is It Possible to Eliminate Postoperative Shunt Infections?: Results of a Modified Hydrocephalus Clinical Research Network Protocol

Elbaroody

Ezz

Eldessouky

et al. 2023

J Neurol Surg A Cent Eur Neurosurg

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Background Postoperative shunt infection is a nightmare in neurosurgical practice with additional morbidity and mortality. A lot of protocols have contributed to the reduction of ventriculoperitoneal shunt (VPS) infections but not eradication. The aim of the study was to evaluate the rigid application of a modified Hydrocephalus Clinical Research Network (HCRN) protocol in the prevention of postoperative shunt infection. Methods We retrospectively evaluated children with congenital hydrocephalus who underwent VPS insertion, and in whom the protocol was applied from June 2019 to January 2020. Follow-up ranged from 11 to 24 months. Results Thirty-seven procedures were performed including 35 primary shunt insertions and two revision surgeries. The median age was 5 months (range, 1–30 months), and 25 patients were males. The most common cause for VPS placement was congenital hydrocephalus without identifiable cause in 28 cases (80%). The endoscope-assisted technique was used in the insertion of the proximal end in six cases (17%). The mean follow-up was 19.4 months (11–24 months). The rate of shunt infection was 0% till the last follow-up. Conclusion The preliminary results showed an effective method for the prevention of postoperative shunt infections using the modified protocol. These initial findings need to be validated in a large prospective study before widespread application can be recommended.

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Section: Discussionmentioning

confidence: 99%

Is It Possible to Eliminate Postoperative Shunt Infections?: Results of a Modified Hydrocephalus Clinical Research Network Protocol

Elbaroody

Ezz

Eldessouky

et al. 2023

J Neurol Surg A Cent Eur Neurosurg

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“…In the studies conducted, infection rates were found to be higher in the neonatal period. The reasons for this are that their immune systems are not sufficiently developed, their skin is thin, they have additional congenital malformations, their hospital stay is long, and their shunt dysfunction rates are high (13).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Shunt Revisions in Pediatric Hydrocephalus Cases

Kurtulus¹,

Tekiner²,

Kul³

et al. 2022

esmj

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Introduction:Ventriculoperitoneal shunt surgery is one of the most commonly used methods in patients with hydrocephalus. This study aims to reveal the causes of complications and revision after shunt surgery and discuss measures that can be taken against these situations. Methods: We retrospectively reviewed the shunt revisions of 248 pediatric age groups who underwent ventriculoperitoneal shunt surgery due to hydrocephalus between 2000 and 2016.Results: Of the 248 patients, 127 (51.2%) were female and 121 (48.8%) were male. The mean age was 12 months. The most common etiologic cause was congenital hydrocephalus. 71 of 248 patients (28.6%) underwent revision surgery. More than one revision surgery was performed in 23 (% 32.4) of 71 patients who underwent revision surgery. Infection (21.7%) and ventricular catheter occlusion (17.1%) were the most frequent causes of revision surgery. Conclusion:The rate of revision surgery due to ventriculoperitoneal shunt surgery in pediatric patients is still high despite the development of diagnosis and treatment methods and many researches about it. Investigating preventable causes of revision surgeons may help to reduce high revision rates.

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“…The majority of literature on SSI prevention reports on data from adult patients. For specific procedures with a high risk of SSI in children, such as in cardiovascular and neurosurgery, it has been shown that intervention bundles can reduce the rate of SSI [17][18][19][20][21][22][23]. Nonetheless, there is little evidence on the influence of optimal individual preventive measures, for example surgical skin preparation agents, in children.…”

Section: Introductionmentioning

confidence: 99%

Systematic literature review on surgical site preparation in paediatric surgery

2022

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Background Surgical site infections (SSIs) in children represent a common and serious postoperative complication. Surgical skin preparation is an essential preventive measure in every surgical procedure. The most commonly used antiseptic agents for surgical skin preparation are chlorhexidine gluconate and iodophors in alcohol-based solutions. In adult patients the use of chlorhexidine-containing antiseptic solutions for preoperative skin preparation has been advocated to reduce SSI rates. Our objective was to conduct a systematic literature review on use of antiseptic agents for surgical skin preparation in children less than 16 years of age. Methods A systematic review of MEDLINE, EMBASE, CINAHL and CENTRAL was performed using both MeSH and free text terms and using the relevant Cochrane filter to identify full text randomized trials (RCTs) and comparative observational studies. Interventions of interest were the choice of main agent in antiseptic solutions (chlorhexidine/povidone-iodine/alcohol) compared with each other or with other antiseptic agents. Primary outcome was the reported rate of surgical site infections. Results In total 8 studies were included in the review; 2 RCTs and 6 observational studies. Observational studies generally did not primarily investigate the association of different antiseptics with subsequent SSI. The identified randomised controlled trials included only 61 children in total, and were of low quality. Consequently, we did not conduct a formal meta-analysis. Since the publication of a comprehensive systematic review of perioperative measures for the prevention of SSI in 2016, no randomized controlled trials comparing antiseptic agents for surgical skin preparation in paediatric surgery have been conducted. Conclusion Robust evidence on the optimal skin antisepsis to reduce SSIs in children is lacking. Direct extrapolation of effects from trials involving adults is not appropriate as physiologic characteristics and risk factors for SSIs differ between adults and children. It is therefore essential to conduct high quality RCT investigating interventions to identify optimal measures to reduce SSI rates in children. Trial registration Prospero registration (CRD42020166193).

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Towards zero infection for ventriculoperitoneal shunt insertion in resource-limited settings: a multicenter prospective cohort study

Cited by 18 publications

References 27 publications

Is It Possible to Eliminate Postoperative Shunt Infections?: Results of a Modified Hydrocephalus Clinical Research Network Protocol

Is It Possible to Eliminate Postoperative Shunt Infections?: Results of a Modified Hydrocephalus Clinical Research Network Protocol

Evaluation of Shunt Revisions in Pediatric Hydrocephalus Cases

Systematic literature review on surgical site preparation in paediatric surgery

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