The Impact of a Pediatric Shunt Surgery Checklist on Infection Rate at a Single Institution

Neurosurgery ◽  
2017 ◽  
Vol 83 (3) ◽  
pp. 508-520 ◽  
Author(s):  
Ryan P Lee ◽  
Garrett T Venable ◽  
Brandy N Vaughn ◽  
Jock C Lillard ◽  
Chesney S Oravec ◽  
...  
Keyword(s):  
Risk Reduction ◽  
Infection Rate ◽  
Absolute Risk ◽  
Compliance Rate ◽  
Shunt Infection ◽  
Shunt Surgery ◽  
Infection Rates ◽  
Protocol Implementation ◽  
The Impact ◽  
Shunt Infections

Abstract BACKGROUND Shunt infections remain a significant challenge in pediatric neurosurgery. Numerous surgical checklists have been introduced to reduce infection rates. OBJECTIVE To introduce an evidence-based shunt surgery checklist and its impact on our shunt infection rate. METHODS Between January 1, 2008 and December 31, 2015, pediatric patients who underwent shunt surgery at our institution were indexed in a prospectively maintained database. All definitive shunt procedures were included. Shunt infection was defined according to the Center for Disease Control and Prevention's National Hospital Safety Network surveillance definition for surgical site infection. Clinical and procedural variables were abstracted per procedure. Infection data were compared for the 4 year before and 4 year after protocol implementation. Compliance was calculated from retrospective review of our checklists. RESULTS Over the 8-year study period, 1813 procedures met inclusion criteria with a total of 37 shunt infections (2%). Prechecklist (2008-2011) infection rate was 3.03% (28/924) and decreased to 1.01% (9/889; P = .003) postchecklist (2012-2015), representing an absolute risk reduction of 2.02% and relative risk reduction of 66.6%. One shunt infection was prevented for every 50 times the checklist was used. Those patients who developed an infection after protocol implementation were younger (0.95 years vs 3.40 years (P = .027)), but there were no other clinical or procedural variables, including time to infection, that were significantly different between the cohorts. Average compliance rate among required checklist components was 97% (range 85%-100%). CONCLUSION Shunt surgery checklist implementation correlated with lower infection rates that persisted in the 4 years after implementation.

scholarly journals A standardized protocol to reduce cerebrospinal fluid shunt infection: The Hydrocephalus Clinical Research Network Quality Improvement Initiative

2011 ◽  
Vol 8 (1) ◽  
pp. 22-29 ◽  
Author(s):  
John R. W. Kestle ◽  
Jay Riva-Cambrin ◽  
John C. Wellons ◽  
Abhaya V. Kulkarni ◽  
William E. Whitehead ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Research ◽  
Risk Reduction ◽  
Infection Rate ◽  
Shunt Infection ◽  
Research Network ◽  
Shunt Surgery ◽  
Surgical Team ◽  
Standardized Protocol ◽  
Protocol Compliance

Object Quality improvement techniques are being implemented in many areas of medicine. In an effort to reduce the ventriculoperitoneal shunt infection rate, a standardized protocol was developed and implemented at 4 centers of the Hydrocephalus Clinical Research Network (HCRN). Methods The protocol was developed sequentially by HCRN members using the current literature and prior institutional experience until consensus was obtained. The protocol was prospectively applied at each HCRN center to all children undergoing a shunt insertion or revision procedure. Infections were defined on the basis of CSF, wound, or pseudocyst cultures; wound breakdown; abdominal pseudocyst; or positive blood cultures in the presence of a ventriculoatrial shunt. Procedures and infections were measured before and after protocol implementation. Results Twenty-one surgeons at 4 centers performed 1571 procedures between June 1, 2007, and February 28, 2009. The minimum follow-up was 6 months. The Network infection rate decreased from 8.8% prior to the protocol to 5.7% while using the protocol (p = 0.0028, absolute risk reduction 3.15%, relative risk reduction 36%). Three of 4 centers lowered their infection rate. Shunt surgery after external ventricular drainage (with or without prior infection) had the highest infection rate. Overall protocol compliance was 74.5% and improved over the course of the observation period. Based on logistic regression analysis, the use of BioGlide catheters (odds ratio [OR] 1.91, 95% CI 1.19–3.05; p = 0.007) and the use of antiseptic cream by any members of the surgical team (instead of a formal surgical scrub by all members of the surgical team; OR 4.53, 95% CI 1.43–14.41; p = 0.01) were associated with an increased risk of infection. Conclusions The standardized protocol for shunt surgery significantly reduced shunt infection across the HCRN. Overall protocol compliance was good. The protocol has established a common baseline within the Network, which will facilitate assessment of new treatments. Identification of factors associated with infection will allow further protocol refinement in the future.

A Multicenter Multinational Registry for Assessing Ventriculoperitoneal Shunt Infections for Hydrocephalus

Neurosurgery ◽  
2010 ◽  
Vol 67 (5) ◽  
pp. 1303-1310 ◽  
Author(s):  
Paul Steinbok ◽  
Ruth Milner ◽  
Deepak Agrawal ◽  
Elana Farace ◽  
Gilberto K K Leung ◽  
...  
Keyword(s):  
Infection Rate ◽  
Ventriculoperitoneal Shunt ◽  
De Novo ◽  
Controlled Trial ◽  
Shunt Infection ◽  
Infection Rates ◽  
Open Label ◽  
Shunt Infection Rate ◽  
Catheter Implantation ◽  
Shunt Infections

Abstract BACKGROUND: Reported infection rates after ventriculoperitoneal shunt surgery vary from 1 to 25%. Antibiotic-impregnated (AI) catheters may reduce shunt infection rates, but this is uncertain. OBJECTIVE: To establish a prospective shunt registry to evaluate short-term (3-month) infection rates associated with ventriculoperitoneal shunts and standard or AI catheters during surgical treatment of hydrocephalus. METHODS: A prospective, multicenter, noncontrolled, open-label registry investigated patients with de novo catheter implantation or catheter replacement of an existing ventriculoperitoneal shunt. The primary outcome was shunt infection. RESULTS: A total of 440 patients were entered into the registry at 10 sites: 3 in North America, 2 in Singapore, 4 in China and 1 in India. Seven patients were excluded. Of the 433 remaining patients, 314 had new shunts and 119 were revisions. Shunt infections occurred in 14 of 433 patients (3.2%) overall and in 2 of 37 infants (5.2%) younger than 1 year. AI catheters were used in 46 of 433 patients at 7 centers. The shunt infection rate was 0 of 46 for shunts with AI catheters and 14 of 387 (3.6%) without AI catheters. Infection rates were similar with AI catheters, adjusting for age and catheter type. CONCLUSION: The overall shunt infection rate was lower than in previous multicentered studies. The low infection rate and low rate of AI catheter use precludes any meaningful statement regarding the value of AI catheters in reducing the infection rate. Consideration should be given to performing a well designed, adequately powered, prospective randomized controlled trial to determine whether AI catheters reduce shunt infection rates.

scholarly journals The Effect of Vaccination Rates on the Infection of COVID-19 under the Vaccination Rate below the Herd Immunity Threshold

2021 ◽  
Vol 18 (14) ◽  
pp. 7491
Author(s):  
Yi-Tui Chen
Keyword(s):  
Infection Rate ◽  
Herd Immunity ◽  
The United States ◽  
Vaccination Rate ◽  
Infection Rates ◽  
Vaccination Rates ◽  
The United Kingdom ◽  
The World ◽  
Almost All ◽  
The Impact

Although vaccination is carried out worldwide, the vaccination rate varies greatly. As of 24 May 2021, in some countries, the proportion of the population fully vaccinated against COVID-19 has exceeded 50%, but in many countries, this proportion is still very low, less than 1%. This article aims to explore the impact of vaccination on the spread of the COVID-19 pandemic. As the herd immunity of almost all countries in the world has not been reached, several countries were selected as sample cases by employing the following criteria: more than 60 vaccine doses per 100 people and a population of more than one million people. In the end, a total of eight countries/regions were selected, including Israel, the UAE, Chile, the United Kingdom, the United States, Hungary, and Qatar. The results find that vaccination has a major impact on reducing infection rates in all countries. However, the infection rate after vaccination showed two trends. One is an inverted U-shaped trend, and the other is an L-shaped trend. For those countries with an inverted U-shaped trend, the infection rate begins to decline when the vaccination rate reaches 1.46–50.91 doses per 100 people.

The Effectiveness of Antibiotic-Coated Ventriculoperitoneal Shunts for Prevention of Shunt Infections in Patients with Myelomeningocele

2021 ◽  
pp. 1-4
Author(s):  
Bilal Ertuğrul ◽  
Metin Kaplan ◽  
Ömer Batu Hergünsel ◽  
Bekir Akgün ◽  
Sait Öztürk ◽  
...  
Keyword(s):  
Protective Effect ◽  
Statistical Difference ◽  
Shunt Infection ◽  
Infection Rates ◽  
Ventriculoperitoneal Shunts ◽  
Significant Statistical Difference ◽  
Shunt Infections

<b><i>Purpose:</i></b> Hydrocephalus is a common comorbidity among the newborns, with myelomeningocele (MMC) and ventriculoperitoneal (VP) shunts being frequently used for the treatment of such patients. In this study, we aimed to compare the effectiveness of antibiotic-free and antibiotic-coated shunts to reduce the rate of shunt infection in patients with hydrocephalus and accompanying MMC. <b><i>Methods:</i></b> 116 patients with hydrocephalus and MMC who were treated with VP shunts were included in the study. Shunt infection rates among antibiotic-free and antibiotic-coated shunts were compared. <b><i>Results:</i></b> Of the 116 patients included in the study, 39 had antibiotic-coated shunts and 77 had antibiotic-free shunts. Shunt infection developed in 4 of the 39 cases treated with antibiotic-coated shunts and in 5 of the 77 cases treated with shunts without antibiotics. No significant statistical difference was found between antibiotic-coated and antibiotic-free VP shunts in terms of shunt infection (<i>p</i> = 0.450, <i>p</i> &#x3e; 0.05). <b><i>Conclusion:</i></b> In patients with MMC, using VP shunts containing antibiotics was found not to have a protective effect in preventing shunt infection. Whether the sac is intact or ruptured does not affect this result.

scholarly journals Standardising intraoperative irrigation with 0.05% chlorhexidine gluconate in caesarean delivery to reduce surgical site infections: A single institution experience

2019 ◽  
Vol 30 (1-2) ◽  
pp. 24-33
Author(s):  
Theresa Mangold ◽  
Erin Kinzel Hamilton ◽  
Helen Boehm Johnson ◽  
Rene Perez
Keyword(s):  
Treatment Group ◽  
Surgical Site Infection ◽  
Infection Rate ◽  
Caesarean Delivery ◽  
Chlorhexidine Gluconate ◽  
Control Group ◽  
Antibiotic Administration ◽  
Site Infection ◽  
Infection Rates ◽  
The Impact

Background Surgical site infection is a significant cause of morbidity and mortality following caesarean delivery. Objective To determine whether standardising intraoperative irrigation with 0.05% chlorhexidine gluconate during caesarean delivery could decrease infection rates. Methods This was a process improvement project involving 742 women, 343 of whom received low-pressured 0.05% chlorhexidine gluconate irrigation during caesarean delivery over a one-year period. Infection rates were compared with a standard-of-care control group (399 women) undergoing caesarean delivery the preceding year. Results The treatment group infection rate met the study goal by achieving a lower infection rate than the control group, though this was not statistically significant. A significant interaction effect between irrigation with 0.05% chlorhexidine gluconate and antibiotic administration time existed, such that infection occurrence in the treatment group was not dependent on antibiotic timing, as opposed to the control group infection occurrence, which was dependent on antibiotic timing. Conclusion Intraoperative irrigation with 0.05% chlorhexidine gluconate during caesarean delivery did not statistically significantly reduce the rate of infections. It did render the impact of antibiotic administration timing irrelevant in prevention of surgical site infection. This suggests a role for 0.05% chlorhexidine gluconate irrigation in mitigating infection risk whether antibiotic prophylaxis timing is suboptimal or ideal.

scholarly journals Reduction in CSF shunt infection over a 10-year period associated with the application of concentrated topical antibiotic powder directly to surgical wounds prior to closure

2015 ◽  
Vol 16 (6) ◽  
pp. 648-661 ◽  
Author(s):  
Joshua M. Beckman ◽  
Ernest K. Amankwah ◽  
Lisa L. Tetreault ◽  
Gerald F. Tuite
Keyword(s):  
Multivariate Analysis ◽  
Infection Rate ◽  
Univariate Analysis ◽  
Shunt Infection ◽  
Shunt Surgery ◽  
Topical Antibiotic ◽  
Children's Hospital ◽  
Surgical Wounds ◽  
Children’S Hospital ◽  
Antibiotic Powder

OBJECT The application of concentrated topical antibiotic powder directly to surgical wounds has been associated with a reduction in wound infection in cardiac, spinal, and deep brain stimulator surgery. As a result of these findings, the corresponding author began systematically applying concentrated bacitracin powder directly to wounds during shunt surgery more than 5 years ago. The object of this study was to evaluate the effectiveness of concentrated bacitracin powder applied directly to wounds prior to closure during cranial shunt surgery and to evaluate the association between shunt infection and other risk factors. A single surgeon’s cranial shunt surgery experience, equally divided between periods during which antibiotic powder was and was not applied, was studied to assess the effect of concentrated bacitracin powder application on shunt infection rates. METHODS This retrospective cohort study included all patients who underwent a cranial shunting procedure at All Children’s Hospital performed by a single surgeon (G.F.T.) from 2001 to 2013. The surgeon applied bacitracin powder to all shunt wounds prior to closure between 2008 and 2013, whereas no antibiotic powder was applied to wounds prior to 2008. Both initial and revision shunting procedures were included, and all procedures were performed at a large children’s hospital (All Children’s Hospital). The primary outcome measure was shunt infection, which was defined using clinical criteria previously used by the Hydrocephalus Clinical Research Network. The association between bacitracin powder use and shunt infection was estimated using hazard ratios (HRs) and 95% CIs from Cox proportional hazard regression models. RESULTS A total of 47 infections out of 539 shunt operations occurred during the study period, resulting in an overall infection rate of 8.7%. Procedures performed before the use of concentrated bacitracin powder was instituted resulted in a 13% infection rate, whereas procedures performed after systematic use of bacitracin powder had been adopted experienced a 1% infection rate. Bacitracin powder use was associated with a reduced risk of shunt infection in univariate analysis (HR 0.11, 95% CI 0.03–0.34, p = 0.0002) and also in multivariate analysis (HR 0.12, 95% CI 0.04–0.41, p = 0.0006) when controlling for covariates that were associated with infection from the univariate analysis. The presence of a tracheostomy or a gastrostomy tube was also found to be independently associated with shunt infection in multivariate analysis (HR 3.15, 95% CI 1.05–9.50, p = 0.04, and HR 2.82, 95% CI 1.33–5.96, p = 0.007, respectively). CONCLUSIONS This study suggests, for the first time, that the systematic application of concentrated bacitracin powder to surgical wounds prior to closure during shunt surgery may be associated with a reduction in cranial shunt infection. This initial finding requires validation in a large prospective study before widespread application can be advocated.

The Impact of Observation Units on the Rate of Hospital-Acquired Infection

2013 ◽  
Vol 34 (12) ◽  
pp. 1318-1320
Author(s):  
Anna Dow Sheahan ◽  
Kent A. Sepkowitz
Keyword(s):  
Clostridium Difficile ◽  
Infection Rate ◽  
Infection Rates ◽  
Hospital Acquired Infection ◽  
Observation Units ◽  
Hospital Acquired ◽  
The Impact

Using Clostridium difficile as an example, we calculated the impact that reduced inpatient-day denominators resulting from implemen¬tation of hospital observation units would have on hospital-acquired infection rates. Using proposed scenarios of reduced inpatient-days, we estimated an increase in the hospital-acquired C. difficile infection rate of up to 12%.

scholarly journals P.150 Use of Antibacterial Envelopes for Prevention of Infection in Neuromodulation

2021 ◽  
Vol 48 (s3) ◽  
pp. S63-S63
Author(s):  
A Persad ◽  
S Ahmed ◽  
R Mercure-Cyr ◽  
K Waterhouse ◽  
A Vitali
Keyword(s):  
Risk Reduction ◽  
Infection Rate ◽  
Pulse Generator ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Historical Cohort ◽  
Cardiac Devices ◽  
Pump Placement ◽  
Substantial Risk ◽  
The Absolute

Background: Neuromodulation unit placement carries a historic infection rate as high as 12%. TYRX antibacterial envelopes (Medtronic Inc., Minneapolis, MN), which are absorbable mesh envelopes that elute minocycline and rifampin, have been used in implantable cardiac devices with substantial risk reduction for infection. Methods: We conducted a retrospective cohort study of consecutive implantable pulse generator (IPG) and intrathecal pump unit implantation with a TYRX antibacterial envelope©. This cohort was then compared to a historical cohort of consecutive patients undergoing IPG or pump placement or revision prior to the use of the envelopes. Results: In the pre-envelope cohort of 151 IPGs in 116 patients, the infection rate was 18/151 (11.9%). In the antibacterial envelope cohort of 233 IPGs in 185 patients, the infection rate was (2.1%). The absolute risk reduction was 4.6% (95% CI, 0.045-0.048), The pre-envelope cohort of 41 pumps in 39 patients, the infection rate was 6/41 (14.6%). In the antibacterial envelope cohort of 59 pumps in 54 patients, the infection rate was (1.7%). The absolute risk reduction was 12.9% (95% CI 1.6-24.3). Conclusions: Usage of an antibacterial envelope for neuromodulation has resulted in a lower infection rate at our center. Based on these results, we recommend the use of antimicrobial envelopes.

scholarly journals Implementation of an infection prevention bundle is associated with reduced surgical site infections in cranial neurosurgery

2019 ◽  
Vol 47 (2) ◽  
pp. E3 ◽  
Author(s):  
Samuel L. Rubeli ◽  
Donato D’Alonzo ◽  
Beate Mueller ◽  
Nicole Bartlomé ◽  
Hans Fankhauser ◽  
...  
Keyword(s):  
Risk Factors ◽  
Infection Rate ◽  
Infection Prevention ◽  
Tertiary Care ◽  
Postoperative Bleeding ◽  
Care Hospital ◽  
Infection Rates ◽  
Senior Faculty ◽  
Cutibacterium Acnes ◽  
The Impact

OBJECTIVEThe objective of this study was to quantify surgical site infection (SSI) rates after cranial neurosurgery in a tertiary care hospital, identify risk factors for SSI, and evaluate the impact of standardized surveillance and an infection prevention bundle (IPB).METHODSThe authors compared SSI rates during 7 months before and after the intervention. The IPB included standardized patient preparation, perioperative antibiotic/antiseptic use, barrier precautions, coaching of surgeons, and the implementation of a specialized technical operation assistant team.RESULTSThree hundred twenty-two unselected consecutive patients were evaluated before the IPB, and 296 were evaluated after implementation. Infection rates after 1 year decreased from 7.8% (25/322) to 3.7% (11/296, p = 0.03) with similar mortality rates (14.7% vs 13.8%, p = 0.8). The isolated bacteria included Staphylococcus aureus (42%), Cutibacterium acnes (22%), and coagulase-negative staphylococci (14%). Organ/space infections dominated with 67%, and mostly consisted of subdural empyema and meningitis/ventriculitis. Among the 36 SSIs, 13 (36%) occurred during hospitalization, and 29 (81%) within the first 3 months of follow-up. In multivariable analysis including established risk factors described in the literature, non-CNS neoplasia (odds ratio [OR] 3.82, 95% confidence interval [CI] 1.39–10.53), postoperative bleeding (OR 4.09, 1.44–11.62), operations performed by or under supervision of a senior faculty surgeon (OR 0.38, 0.17–0.84), and operations performed after the implementation of standardized surveillance and an IPB (OR 0.38, 0.17–0.85) significantly influenced the infection rate.CONCLUSIONSThe introduction of an IPB combined with routine surveillance and personal feedback was associated with a 53% reduced infection rate. The lower infection rates of senior faculty and the strong association between postoperative bleeding and infection underline the importance of both surgical experience as well as thorough supervision and coaching of younger surgeons.

scholarly journals Family factors and Helicobacter pylori infection in schoolchildren in the Republic of Tuva with a high prevalence of gastric cancer

2020 ◽  
Vol 23 (3) ◽  
pp. 165-170
Author(s):  
Tamara V. Polivanova ◽  
Vitaliy A. Vshivkov
Keyword(s):  
Infection Rate ◽  
Employment Status ◽  
Family Factors ◽  
Bacterial Invasion ◽  
Infection Rates ◽  
Cross Sectional ◽  
The Republic ◽  
Education And Employment ◽  
H Pylori ◽  
The Impact

Aim. To study the prevalence of H. pylori in Tuva schoolchildren with gastrointestinal manifestations and to assess the impact of the number of children in the family, education, and employment status of parents on its indices. Materials and methods. The study of H. pylori infection in 270 students aged 7-17 years (123 Caucasian, 147 Tuvans) with gastrointestinal complaints there was used morphological method, considering the affiliation of a microorganism to a CagA strain in the Republic of Tuva and evaluation of the influence of family factors on the level of bacterial invasion in children. The study groups were formed by random selection from among children with complaints in a cross-sectional clinical examination of 1535 schoolchildren. Statistical processing of the results was performed using the Pearson Chi-square criterion and logistic regression analysis - calculating the odds ratio (OR) and 95% confidence interval (CI). Results. The infection rate of H. pylori in Tuva schoolchildren accounted of 55.9%. Younger Tuvans had higher infection rates, indicating earlier bacterial infestation. In more than half of the cases in schoolchildren, the bacterium was identified to belong to the CagA strain, and in both ethnic populations. Among the factors considered, a positive influence of the mother’s higher education (0.33 (0.11-0.96), p = 0.043), and her social status (working profession: 3.87 (1.33-11.29), p = 0.014) on the infection rate was found in the population of Caucasians. The father’s education and employment status did not play a significant role. In the population of Tuvans, there was no association between the studied factors and the level of infection. Conclusion. In the Republic of Tuva, there is a high infection rate of H. pylori with the predominant belonging of the bacterium to the CagA strain, which is typical for territories with low sanitary and socio-economic living standards of the population. There are ethnic features of the influence of family factors on the infection rates of schoolchildren.

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