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Evidence-based interventions to reduce shunt infections: a systematic review

Child's Nervous System volume 31, pages 541–549 (2015)Cite this article

Abstract

Purpose

Cerebrospinal fluid shunt infection is associated with patient morbidity and high cost. We conducted a systematic review of the current evidence of comprehensive surgical protocols or individual interventions designed to reduce shunt infection incidence.

Methods

A systematic review using PubMed and SCOPUS identified studies evaluating the effect of a particular intervention on shunt infection risk. Systemic prophylactic antibiotic or antibiotic-impregnated shunt efficacy studies were excluded. A total of 7429 articles were screened and 23 articles were included.

Results

Eight studies evaluated the effect of comprehensive surgical protocols. Shunt infection was reduced in all studies (absolute risk reduction 2.2–12.3 %). Level of evidence was low (level 4 in seven studies) due to the use of historical controls. Compliance ranged from 24.6 to 74.5 %. Surgical scrub with antiseptic foam and omission of a 5 % chlorhexidine gluconate preoperative hair wash were both associated with increased shunt infection. Twelve studies evaluated the effect of a single intervention. Only antibiotic-impregnated suture, a no-shave policy, and double gloving with glove change prior to shunt handling, were associated with a significant reduction in shunt infection. In a hospital with high methicillin-resistant staphylococcus aureus (MRSA) prevalence, a randomized controlled trial found that perioperative vancomycin rather than cefazolin significantly reduced shunt infection rates.

Conclusion

Despite wide variation in compliance rates, the implementation of comprehensive surgical protocols reduced shunt infection in all published studies. Antibiotic-impregnated suture, a no-shave policy, double gloving with glove change prior to device manipulation, and 5 % chlorhexidine hair wash were associated with significant reductions in shunt infection.

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Fig. 1

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Conflict of interest

AGM is a consultant for Spinal Modulation and Functional Neuromodulation. AGM has distribution rights related to intellectual property with ATI, Cardionomics and Enspire. RJW was supported by the Melvin Burkhardt chair in neurosurgical oncology and the Karen Colina Wilson research endowment within the Brain Tumor and Neuro-oncology Center at the Cleveland Clinic. None of the funders played a role in data collection, analysis, interpretation, or the writing or editing of the manuscript.

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Author notes

  1. Robert J. Weil

    Present address: Department of Neurosurgery, Geisinger Health System, Danville, PA, USA

Authors and Affiliations

  1. Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA

    Nehaw Sarmey & Andre G. Machado

  2. Department of Neurosurgery, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Varun R. Kshettry & Ghaith Habboub

  3. School of Medicine, Case Western Reserve University, Cleveland, OH, USA

    Michael F. Shriver

  4. Center for Neurological Restoration, Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA

    Andre G. Machado

  5. Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA

    Robert J. Weil

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  1. Nehaw Sarmey
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Correspondence to Varun R. Kshettry.

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Sarmey, N., Kshettry, V.R., Shriver, M.F. et al. Evidence-based interventions to reduce shunt infections: a systematic review. Childs Nerv Syst 31, 541–549 (2015). https://doi.org/10.1007/s00381-015-2637-2

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Keywords

  • Cerebrospinal fluid
  • Ventriculoperitoneal shunt
  • Surgical site infection
  • Quality
  • Neurosurgery