Implementation of a Shunt Insertion Protocol and Its Effect on Institutional Shunt Infection Rates

Background Hydrocephalus treatment often involves cerebrospinal fluid diversion via a ventriculoperitoneal shunt (VPS) or endoscopic third ventriculostomy. However, VPS is associated with higher postoperative complication rates, particularly infection. The Hydrocephalus Clinical Research Network (HCRN) has developed protocols to reduce shunt infection rates, demonstrating significant success. This study aimed to evaluate the effectiveness of a locally adapted shunt protocol in reducing shunt infection rates. Methodology An 11-step Philippine General Hospital (PGH) Shunt Protocol, modeled after the HCRN protocol, was implemented from January to June 2023. Data from 69 patients who underwent shunt procedures were analyzed. Patient characteristics, operative factors, protocol compliance, and postoperative outcomes were reviewed. The primary outcome measure was shunt infection. A simple logistic regression analysis was performed to determine the association between patient characteristics, surgical factors, and individual protocol steps with shunt infection. Results The overall shunt infection rate was 11.6% (8 out of 69 cases). None of the patient characteristics and operative variables were significantly associated with shunt infection risk. Full compliance with the protocol was observed in only 36 out of 69 (52%) cases, but protocol adherence did not significantly reduce infection risk. No individual step in the shunt protocol was identified to be significantly associated with decreasing shunt infection risk. Conclusions Given the suboptimal compliance of 52% (36 out of 69 cases), we were unable to draw any significant conclusions regarding the efficacy of the PGH Shunt Protocol. No factors were identified among patient characteristics and operative variables to be associated with shunt infection risk.