The impact of a pediatric shunt surgery checklist on infection rate at a single institution

Ryan P. Lee, Garrett T. Venable, Brandy N. Vaughn, Jock C. Lillard, Chesney S. Oravec, Paul Klimo

Research output: Contribution to journalArticle

1 Citation (Scopus)

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 infectionwas 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, thatwere 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.

Original languageEnglish (US)
Pages (from-to)508-520
Number of pages13
JournalClinical neurosurgery
Volume83
Issue number3
DOIs
StatePublished - Jan 1 2018

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Checklist
Pediatrics
Infection
Surgical Wound Infection
Numbers Needed To Treat
Neurosurgery
Risk Reduction Behavior
Centers for Disease Control and Prevention (U.S.)
Compliance
Databases
Safety

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

The impact of a pediatric shunt surgery checklist on infection rate at a single institution. / Lee, Ryan P.; Venable, Garrett T.; Vaughn, Brandy N.; Lillard, Jock C.; Oravec, Chesney S.; Klimo, Paul.

In: Clinical neurosurgery, Vol. 83, No. 3, 01.01.2018, p. 508-520.

Research output: Contribution to journalArticle

Lee, Ryan P. ; Venable, Garrett T. ; Vaughn, Brandy N. ; Lillard, Jock C. ; Oravec, Chesney S. ; Klimo, Paul. / The impact of a pediatric shunt surgery checklist on infection rate at a single institution. In: Clinical neurosurgery. 2018 ; Vol. 83, No. 3. pp. 508-520.
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