Significant reduction of shunt infection rate in children below 1 year of age after implementation of a perioperative protocol

Acta Neurochir (Wien). 2013 Mar;155(3):523-31. doi: 10.1007/s00701-012-1574-z. Epub 2012 Dec 8.


Background: Shunt infection markedly impairs the clinical result of shunt surgery. The infection rate can be reduced by dedicated protocols. This study was undertaken to determine the efficacy of introducing a perioperative protocol for control of shunt infections.

Method: The shunt infection rate and risk factors for shunt infection were determined for two periods, namely the period 2001-2002 (Patient Material A), and the period 2005-2008 (Patient Material B). The perioperative protocol was introduced in 2005 before the second period.

Results: The total patient material includes 901 patients, in whom 1,404 shunt procedures were performed during the study periods. While the overall infection rate dropped nonsignificantly from 6.5 % to 4.3 %, infection rate dropped markedly and significantly from 18.4 % to 5.7 % among the children younger than 1 year (p = 0.016). The significant risk factors for shunt infection were in Patient Material A age below 1 year (p < .001), and in Patient Material B premature birth (p = 0.045), postoperative cerebrospinal fluid (CSF) leakage (p < .001) and high American Society of Anaesthesiologists (ASA) score (p = 0.039). Of the protocol steps, only the lack of preoperative wash with 4 % clorhexidine gluconate (Hibiscrub®) showed a tendency of influencing the shunt infection rate (p = 0.051).

Conclusions: This study showed that implementation of a perioperative protocol markedly and significantly reduced shunt infection rate in children younger than 1 year, even though no significant overall reduction in shunt infection rate was found.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Anti-Infective Agents, Local
  • Antibiotic Prophylaxis / methods
  • Cerebrospinal Fluid Leak
  • Cerebrospinal Fluid Rhinorrhea / epidemiology
  • Cerebrospinal Fluid Rhinorrhea / prevention & control
  • Chlorhexidine / analogs & derivatives
  • Critical Pathways / organization & administration*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature, Diseases / epidemiology
  • Infant, Premature, Diseases / prevention & control
  • Male
  • Norway
  • Perioperative Care / methods*
  • Quality Improvement / organization & administration
  • Risk Factors
  • Surgical Wound Infection / epidemiology
  • Surgical Wound Infection / prevention & control*


  • Anti-Infective Agents, Local
  • chlorhexidine gluconate
  • Chlorhexidine