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UrduDetailed findings of this study are described in the article “A standardized infection prevention bundle for reduction of CSF shunt infections in adult ventriculoperitoneal shunt surgery performed without antibiotic-impregnated catheters,” by Sandeep Muram et al., published today in the Journal of Neurosurgery (https://thejns.org/doi/10.3171/2022.5.JNS22430).
VP shunt insertions are among the most common procedures performed by neurosurgeons, and unfortunately, shunt infections in adults often cause severe illness and usually require additional surgical procedures, prolonged intravenous antibiotic treatment, and extended hospital stays, with average direct hospital costs per infection of $50,000 to $100,000 USD.
The investigators at the University of Calgary undertook a single-surgeon quality improvement study in July 2013, at which time there was no standardized infection control protocol at their institution and the rate of shunt infection was 5.8%. When the CASIPP was implemented on July 1, 2013, the rate of shunt infection decreased to 4.0% in 621 consecutive shunt surgeries. Then, on July 1, 2015, the routine use of povidone-iodine as a preoperative skin antiseptic was replaced with 2% chlorhexidine gluconate in 70% isopropyl alcohol, which resulted in an infection rate of 0% in 379 consecutive procedures. The authors note that larger multicenter studies should be completed to verify the effectiveness of the protocol demonstrated in this preliminary study.
When asked about the study, Dr. Mark G. Hamilton said, “Infection associated with ventriculoperitoneal shunt surgery is a common clinically significant but modifiable operative complication. The Calgary Adult Shunt Infection Prevention Protocol (CASIPP) or bundle of preoperative and intraoperative strategies, which included using 2% chlorhexidine gluconate in 70% isopropyl alcohol for skin antisepsis without using antibiotic-impregnated catheters or intrathecal antibiotics, is a simple but highly effective and inexpensive strategy to reduce the risk of shunt infection.”
Article: Sandeep Muram, Albert M. Isaacs, Nicholas Sader, Richard Holubkov, Annie Fong, John Conly, Mark G. Hamilton. A standardized infection prevention bundle for reduction of CSF shunt infections in adult ventriculoperitoneal shunt surgery performed without antibiotic-impregnated catheters. Journal of Neurosurgery, published online, ahead of print, August 2, 2022; DOI: 10.3171/2022.5.JNS22430
Funding: Dr. Conly holds grants from the Canadian Institutes for Health Research on acute and primary care preparedness for COVID-19 in Alberta, Canada, and reports a nonfinancial relationship with Pfizer as the primary local investigator for a Staphylococcus aureus vaccine study funded by Pfizer for which all funding was provided only to the University of Calgary. Dr. Conly also received support from the CDC to attend an Infection Control Think Tank Meeting. He is a member of the CNISP Cerebrospinal Shunt Infection Working Group, affiliated with the Public Health Agency of Canada, and the Canadian Hospital Epidemiology Committee with AMMI Canada.
Dr. Hamilton is a member of the Medical Advisory Board for the Hydrocephalus Association, the Hydrocephalus Association Board of Directors, and the Hydrocephalus Canada Board of Directors, and a member of the Medical Advisory Board for Hydrocephalus Canada and the Hydrocephalus Society Board of Directors. Dr Hamilton also reports receiving honoraria from Integra Canada for delivering a CME-accredited lecture; and being a consultant for and receiving honoraria from CereVASC.
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Embargoed Article Access and Author/Expert Interviews: Contact JNSPG Director of Publications Gillian Shasby at [email protected] for advance access and to arrange interviews with the authors and external experts who can provide context for this research.
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The global leader for cutting-edge neurosurgery research for more than 75 years, the Journal of Neurosurgery (www.thejns.org) is the official journal of the American Association of Neurological Surgeons (AANS) representing over 12,000 members worldwide (www.AANS.org).
