caa a22 4500 463181255 CHVBK 20180406164839.0 cr unu---uuuuu 170326e20071101xx s 000 0 eng 10.1007/s00381-007-0415-5 doi (NATIONALLICENCE)springer-10.1007/s00381-007-0415-5 Sterile surgical technique for shunt placement reduces the shunt infection rate in children: preliminary analysis of a prospective protocol in 115 consecutive procedures [Elektronische Daten] [Benoit Pirotte, Alphonse Lubansu, Michael Bruneau, Chakir Loqa, Nathalie Van Cutsem, Jacques Brotchi] Objective: The objective of this study was to evaluate whether the rigid application of a sterile protocol for shunt placement was applicable on a routine basis and allowed the reduction of shunt infections (SI) in children. Materials and methods: Since 2001, a rigid sterile protocol for shunt placement in children using neither antibiotic-impregnated catheters nor laminar airflow was prospectively applied at Erasme Hospital, Brussels, Belgium. For assessing the protocol efficacy before continuation, we preliminarily analyzed the results of the first 100 operated children (43 females, 57 males, 49 aged <12months; 115 consecutive shunt placement/revision procedures). All procedures were performed by the same senior surgeon, one assistant, one circulating nurse, one anesthesiologist. The sterile protocol was rigidly imposed to these four staff members: uniformed surgical technique; limited implant and skin edge manipulation; minimized human circulation in the room; scheduling surgery as first morning operation; avoiding postoperative cerebrospinal fluid (CSF) leak; double gloving; procedures of less than 30-min duration; systemic antibiotics prophylaxis. We analyzed separately: (1) children carrying an increased risk of SI (n = 38) due to preoperative external ventricular drainage, CSF leak, meningitis, glucocorticoids, chemotherapy; (2) children aged <12months; (3) procedures for shunt revision. Results: Errors in protocol application were recorded in 71/115 procedures. They were mainly done by non-surgical staff, decreased with time and were medically justified in some young children. Surprisingly, no SI occurred (follow-up, 4 to 70months). One child developed an appendicitis with peritonitis (Streptococcus faecalis) after 6months. No SI was found. After peritonitis was cured, shunt reinsertion was uneventful. Conclusion: These preliminary results suggest that a uniform and drastic sterile surgical technique for shunt placement: (1) can be rigidly applied on a routine basis; (2) can lower the early SI rate below 1%; (3) might have a stronger impact to reduce SI than using antibiotic-impregnated catheters and optimizing the operative environment such as using laminar airflow and reducing the non-surgical staff. This last issue will be evaluated further in the present ongoing protocol. Springer-Verlag, 2007 Shunt infection rate nationallicence Ventriculoperitoneal shunt nationallicence Shunt placement nationallicence Shunt revision nationallicence Children nationallicence Sterile technique nationallicence Double gloving nationallicence Antibiotics prophylaxis nationallicence Pirotte Benoit Department of Neurosurgery, ERASME Hospital, Université Libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium aut Lubansu Alphonse Department of Neurosurgery, ERASME Hospital, Université Libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium aut Bruneau Michael Department of Neurosurgery, ERASME Hospital, Université Libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium aut Loqa Chakir Department of Neurosurgery, ERASME Hospital, Université Libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium aut Van Cutsem Nathalie Department of Anesthesiology, ERASME Hospital, Université Libre de Bruxelles, Brussels, Belgium aut Brotchi Jacques Department of Neurosurgery, ERASME Hospital, Université Libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium aut Child's Nervous System Springer-Verlag 23/11(2007-11-01), 1251-1261 0256-7040 23:11<1251 2007 23 381 https://doi.org/10.1007/s00381-007-0415-5 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00381-007-0415-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Pirotte Benoit Department of Neurosurgery, ERASME Hospital, Université Libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium aut NATIONALLICENCE 700 1- Lubansu Alphonse Department of Neurosurgery, ERASME Hospital, Université Libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium aut NATIONALLICENCE 700 1- Bruneau Michael Department of Neurosurgery, ERASME Hospital, Université Libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium aut NATIONALLICENCE 700 1- Loqa Chakir Department of Neurosurgery, ERASME Hospital, Université Libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium aut NATIONALLICENCE 700 1- Van Cutsem Nathalie Department of Anesthesiology, ERASME Hospital, Université Libre de Bruxelles, Brussels, Belgium aut NATIONALLICENCE 700 1- Brotchi Jacques Department of Neurosurgery, ERASME Hospital, Université Libre de Bruxelles, 808 route de Lennik, 1070, Brussels, Belgium aut NATIONALLICENCE 773 0- Child's Nervous System Springer-Verlag 23/11(2007-11-01), 1251-1261 0256-7040 23:11<1251 2007 23 381 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer