How Children’s Health achieved zero pediatric shunt infections
In 2021, the neurosurgery team at Children’s Health ℠ achieved the ultimate goal: zero shunt infections in the 160 shunt procedures they performed. Pediatric shunt infections are one of the most intractable challenges in neurosurgery. A recent study shows infection rates ranging from 4.1% to 20.5% at 41 pediatric hospitals across the United States. The team at Children's Health has spent 15 years on a mission to solve this in a way that can be replicated by children’s hospitals nationwide.
Bradley Weprin, M.D., Division Director of Pediatric Neurosurgery at Children’s Health and Professor at UT Southwestern, leads a multi-disciplinary shunt infection prevention team. He sees setting the goal at zero infections as the only sensible option because shunt infections can have profound consequences – from prolonged hospitalizations to increased seizure risk – on children with hydrocephalus and other complex conditions. But he cautions that there isn’t a magic bullet.
“Preventing shunt infections is an iterative process that demands the expertise and focus of an entire team, and creating space for everyone to provide ideas, voice opinions and participate in shared decision-making is critical,” Dr. Weprin says. “We’ve also embraced evidence-based practices like antibiotic impregnated catheters, which make a tremendous difference.”
Bundling prevention measures
The shunt infection prevention team includes neurosurgeons, anesthesiologists, infection control experts, surgical technicians and circulating and unit nurses. They meet regularly to discuss cases and opportunities to improve.
One process improvement strategy developed by the team are bundles that assign specific tasks and specify the materials and instruments necessary for each step in the infection prevention protocol. The bundles are assigned to the appropriate team member and completion of the bundle is tracked. Bundling helps the team reduce variability by clearly communicating who is responsible for each measure and by ensuring all infection prevention steps are completed for every case. The bundles and team approach also improve efficiency, reducing the time a child is in the operating room, which is where most infections occur.
“We are fortunate to have a dedicated team that performs all shunt surgeries. We reduce errors and increase efficiency when the same people are repetitively performing these procedures together using established protocols,” Dr. Weprin says.
Children’s Health patients also recover on a dedicated neurosurgery floor, where unit nurses are trained in shunt wound management.
Six practices that help reduce shunt infections
Dr. Weprin highlights six key practices that could help other surgical teams prevent shunt infections:
- Antibacterial body wash and shampoo that the patient uses twice at home prior to surgery
- Prophylactic antibiotics (one dose) given 30 minutes prior to incision
- Use of iodine and alcohol-based prep and 3M™ Ioban™ draping
- Double gloving by all members of the intraoperative team
- Antibiotic-impregnated catheters for all cases
- Shunt wound care training for unit nurses and caregivers
About the Children’s Health neurosurgery department
The progress in reducing shunt infections illustrates the neurosurgery team’s commitment to delivering innovative care and the best possible outcomes. Recognized with the Level I Children’s Surgery Verification by the American College of Surgeons, Children’s Health is a regional and national leader in pediatric surgery, backed by state-of-the-art facilities, technology, research and training.
“We’ve shown that achieving zero shunt infections is possible and, hopefully, have set an example that other hospitals can follow to improve outcomes for children nationwide,” Dr. Weprin says.
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