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HOW TO REDUCED SHUNT INFECTION IN PHRAMONGKUTKLOA ARMY HOSPITAL

HOW TO REDUCED SHUNT INFECTION IN PHRAMONGKUTKLOA ARMY HOSPITAL. Supakij Sanguandekul. BACKGROUND. THE SHUNT INFECTION IS THE MOST COMMON COMPLICATION OF SHUNT INSERTION MANY NEUROSURGEONS HAVE EXPERIENCE AND DEAL WITH THIS PROBLEM

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HOW TO REDUCED SHUNT INFECTION IN PHRAMONGKUTKLOA ARMY HOSPITAL

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  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

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