HOW TO REDUCED SHUNT INFECTION IN PHRAMONGKUTKLOA ARMY HOSPITAL

1. HOW TO REDUCED SHUNT INFECTION IN PHRAMONGKUTKLOA ARMY HOSPITAL Supakij Sanguandekul.

2. BACKGROUND • THE SHUNT INFECTIONIS THE MOST COMMON COMPLICATION OF SHUNT INSERTION • MANY NEUROSURGEONS HAVE EXPERIENCE AND DEAL WITH THIS PROBLEM • THIS PROBLEM WAS INCREASED THE COST OF TREATMENT AND INCREASED MORBIDITY AND MORTALITY • IN MANY CENTERS WERE DEVELOPED PROTOCAL AND SUCCESS TO REDUCE THIS PROBLEM • THE MAIN OBJECTIVE OF THIS RESEARCH IS TO FIND THE SIMPLY METHOD TO REDUCE SHUNT INFECTION

3. MATERIAL&METHOD • HISTORICAL COMPARATIVE STUDY • THE RISK FACTOR AND THE RATE OF PREVIOUS SHUNT INFECTION BETWEEN 1995-2000 WAS IDENTIFIED BY PREVIOUS RESEARCH STUDY ,THE RATE OF INFECTION WAS 9% • MANY RESEARCHS THAT MADE THE SUCCESS PROTOCOL WAS FOUND AND THE USEFUL METHOD WAS USE TO REDUCE SHUNT INFECTION • THE DATA WERE COLLECTED FROM 198 HYDROCEPHALIC PATIENTS WHO OPERATED BY 206 VP SHUNT INSERTION AND 1 VA SHUNT INSERTION .THEN THE DATA WERE ANALYSED BY SPSS VERSION 10

4. RESULT • THE 305 HYDROCEPHALIC PATIENTS WERE ADMITTED INPHRAMONGKUTKLOA HOSPITAL BETWEEN 2003-2006 • 198 HYDROCEPHALIC PATIENTS WERE OPERATED BY 206VP SHUNT INSERTION ,1 VA SHUNT INSERTION • THE AGE WAS BETWEEN NEWBORN 3 DAYS TO 86 YEARS .THE AVERAGE AGE WAS 4O YEARS • 134 MALES,64 FEMALES • THE OBSTRUCTIVE HYDROCEPHALUS WERE 168 CASES,NPH WERE 30 CASES • THE MOST COMMON CAUSED WAS CVA,POST TRAUMATIC • IN THE NPH THE MOST COMMON CAUSED WAS IDIOPATHIC

5. RESULT • NO PATIENT WAS DEATH FROM SHUNT INFECTION. • ONLY 7 OLD CVA PATIENTS WERE DEATH FROM ANOTHER CAUSED SUCH AS PNEUMONIA UTI ,1 NEWBORN MYELOMENINGOCOLE PATIENT WAS UNSPECIFIED SUDDEN DEATH AFTER SHUNT REVISION • 5 PATIENTS WERE DIAGNOSED TO BE POST OPERATIVE SHUNT INFECTION (IN 2 MONTHS POST OPERATION) • THE RATE OF SHUNT INFECTION WAS 2.5% • SHUNT MALFUNCTION AND FEVER WERE THE MOST COMMON CLINICAL MANIFESTATION • THE MOST COMMON ORGANISM WAS STAPH. epidermidis

6. RISK FACTOR OF SHUNT INFECTION • AGE<6 MONTHS • IMMUNOCOMPROMISED • SKIN CONDITION • LENGTH OF OPERATION • EXPERIENCE OF NEUROSURGEON

7. PATIENT SELECTION • THE HYDROCEPHALIC PATIENT WHO NEED SHUNT IN SERTION • NO SYSTEMIC INFECTION • SHUNT INFECTION THAT OCCUR IN 2 MONTHS POST OPERATION WAS DIAGNOSED TO BE POST OPERATIVE SHUNT INFECTION

8. DIAGNOSIS OF VP SHUNT INFECTION • CLINICAL SIGN • C/S FROM CSF,SHUNT HARDWARE

9. NO TOUCH TECHNIC

10. TREATMENT OF VP SHUNT INFECTION • REMOVE SHUNT HARDWARE AND EXTERNAL VENTRICULAR DRAINAGE,ANTIBIOTIC UNTIL CSF WAS CLEARED FROM INFECTION THEN RE OPERATED SHUNT INSERTION SUCCESS RATE 90%. IN PHRAMONGKUTKLOA HOSPITAL MOST PATIENTS WHO SUFFER SHUNT INFECTION WERE TREATED BY THIS METHOD • REMOVE OLD SHUNT AND REOPERATED WITH NEW SHUNT AT THE SAME TIME SUCCESS RATE 60 % • ANTIBIOTIC ALONE SUCCESS RATE 30% ONLY ONE CASE IN PHRAMONGKUTKLOA WAS TREARED BY THIS METHOD

11. SIMPLY WAY TO REDUCED SHUNT INFECTION • STRICTED CRITERIA TO SELECT APPROPROATE HYDROCEPHALIC PATIENT WHO NEED SHUNT INSERTION AND LOW RISK OF SHUNT INFECTION • REDUCED CONTAMINATION OF SHUNT HARDWARE FROM SKIN BY NO TOUCH TECHNIC OR DOUBLE GLOVE AND METICULOUS TECHNIC • SHUNT OPERATION SHOULD BE OPERATED BY EXPERIENCED NEUROSURGEON • PROPHYLACTIC ANTIBIOTIC

12. CONCLUSION • ALTHOUGH SHUNT INFECTION IS THE MOST COMMON COMPLICATION,THE RATE OF INFECTION CAN BE REDUCED SATISFIED BY SIMPLY TECHNIC AS DESCRIBED BEFORE • IN MANY CENTER THE RATE OF INFECTION WAS REDUCED FROM 3-10% TO BELOW 3% BY THE USE OF SIMPLY PROTOCOL IN THE SAME MANNER • IN PHRAMONGKUTKLOA HOSPITAL THE RATE OF SHUNT INFECTION WAS REDUCED FROM 9 % TO 2.5 % • THE FUTURE RESEARCH OR METAANALYSIS SHOULD BE DONE TO FIND THE WAY TO REDUCED SHUNT INFECTION TO NEAR 0 % OR NO SHUNT INFECTION