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A Pediatric Neurosurgery Shunt/Implant Checklist to Reduce Infection
Risk
Kelly B Mahaney, MD, MS Department of Neurosurgery Stanford University
Co-authors :Kevin Kumar, MD, PhD 1 ; Gerald A. Grant, MD 2
1. Stanford University Department of Neurosurgery
2. Duke University Department of Neurosurgery
INTRODUCTION: Shunt infection is a significant contributor to morbidity and
mortality for children with hydrocephalus. To standardize pediatric neurosurgi-
cal care and minimize risk of infections related to implanted shunts and neu-
rosurgical devices, we introduced a 23-point checklist for all pediatric neuro-
surgical implant procedures at Stanford University in March 2019. Our proto-
col minimizes operating room traffic and standardizes sterile technique, prep,
and antibiotic use.
METHODS: Prospective quality initiative data obtained from March 2019 to
March 2022 was compared with retrospective chart review data of cases from
March 2016 through February 2019. Checklist compliance was monitored by
data element. Infections of shunts or implanted devices within 6 months of the
surgical date were identified prospectively and by routine audits. Infection
rates in the “Pre-Checklist” era were compared to infection rates in the
“Checklist” era with Fisher’s Exact test.
RESULTS: Nine implant infections occurred in the 584 “Checklist” era surger-
ies (8 shunt infections, 1 baclofen pump infection), compared to 4 implant
infections that occurred in the 233 “Pre-Checklist” era surgeries (1.5% vs.
1.7%, p=0.7677). While we did not observe a reduction in our implant infec-
tion rate, we maintained a very low implant infection rate during a period of
significant volume growth. Shunt infections were the most common infections
observed. One baclofen pump infection was observed and no vagal nerve
stimulators, deep brain stimulators, generators, omaya reservoirs, or cranio-
plasties were infected in the study period. Our observed shunt infection rate
was 2.6% throughout the study period, with the majority of shunt infections
occurring in infants under 6 months of age.
CONCLUSIONS: Adherence to a strict implant protocol can ensure very low
rates of infections for pediatric shunts and neurosurgical implants. We ob-
served a lower shunt infection rate than the national pediatric benchmark –
the 5-6% infection rate consistently observed by the Hydrocephalus Clinical
Research Network.

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