{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:12:33Z","timestamp":1772827953867,"version":"3.50.1"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Implant infection is a significant contributor to morbidity and mortality for children with hydrocephalus and other neurosurgical conditions requiring shunts and other neurosurgical implants. To standardize pediatric neurosurgical care and minimize the risk of infections related to implanted shunts and neurosurgical devices, the authors introduced a 23-point checklist for all pediatric neurosurgical implant procedures at Stanford University in March 2019. This protocol minimizes operating room traffic and standardizes sterile technique, preparation, and antibiotic use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Prospective quality initiative data obtained for surgeries completed in the checklist era (March 2019\u2013May 2023, follow-up through November 2023) were compared with retrospective chart review data of the prechecklist era cases (March 2016\u2013February 2019). Checklist compliance was monitored by individual checklist elements. Infections of shunts or implanted devices within 6 months of the surgical date were identified prospectively and by routine audits. Infection rates in the prechecklist era were compared to infection rates in the checklist era using Fisher\u2019s exact test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>There were 4 infections in the 356 prechecklist era surgeries (1.1% infection rate, 95% CI 0.03%\u20132.21%) and 9 infections in the 630 postchecklist era surgeries (1.4% infection rate, 95% CI 0.50%\u20132.34%), resulting in an overall implant infection rate of 1.3% (95% CI 0.60%\u20132.02%). Infection rates did not significantly change during a period of significant case volume growth, with an absolute risk difference of 0.3% (95% CI \u22121.13% to 1.73%) and relative risk of 1.3 (95% CI 0.39\u20134.12, p &gt; 0.999). Shunt infections were the most common infections observed. One baclofen pump infection was observed and no vagus nerve stimulators, deep brain stimulators, generators, Ommaya reservoirs, neonatal reservoirs, or cranioplasties were infected in the study period. The majority of shunt infections occurred in infants younger than 6 months of age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Adherence to a strict implant protocol can ensure very low rates of infections for pediatric shunts and neurosurgical implants. This study found a lower shunt infection rate than the national pediatric benchmark\u2014the 5.1% infection rate observed within the Hydrocephalus Clinical Research Network (HCRN) and the 3.9% infection rate observed within the HCRN quality network, to which the authors\u2019 institution contributes data. Despite surgeon and staff turnover, high overall institutional checklist compliance and consistently low infection rates were observed over time.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.5.peds24335","type":"journal-article","created":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T01:50:07Z","timestamp":1754099407000},"page":"524-531","source":"Crossref","is-referenced-by-count":0,"title":["Comprehensive pediatric neurosurgical implant checklist to maintain low implant infection rates: lessons on compliance and institutional culture"],"prefix":"10.3171","volume":"36","author":[{"given":"Arokoruba O.","family":"Cheetham-West","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin K.","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenna F.","family":"Kruger","sequence":"additional","affiliation":[{"name":"Lucile Packard Children\u2019s Hospital, Stanford, California; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura M.","family":"Prolo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cormac O.","family":"Maher","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H. Westley","family":"Phillips","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David S.","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerald A.","family":"Grant","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University, Durham, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly B.","family":"Mahaney","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Pediatr Neurosurg","first-page":"66","article-title":"Repeat cerebrospinal fluid shunt infection in children","volume":"35","author":"Kulkarni AV","year":"2001","unstructured":"Kulkarni AV, Rabin D, Lamberti-Pasculli M, Drake JM. Repeat cerebrospinal fluid shunt infection in children. Pediatr Neurosurg. 2001;35(2):66\u201371."},{"issue":"6","key":"b2","series-title":"Pediatr Neurosurg","first-page":"285","article-title":"Reflections on shunt infection","volume":"39","author":"Kanev P","year":"2003","unstructured":"Kanev P, Sheehan JM. Reflections on shunt infection. Pediatr Neurosurg. 2003;39(6):285\u2013290."},{"issue":"4","key":"b3","series-title":"Pediatr Neurosurg","first-page":"205","article-title":"The treatment of cerebrospinal fluid shunt infections","volume":"35","author":"Whitehead WE","year":"2001","unstructured":"Whitehead WE, Kestle JRW. The treatment of cerebrospinal fluid shunt infections. Pediatr Neurosurg. 2001;35(4):205\u2013210."},{"issue":"1","key":"b4","series-title":"J Neurosurg Pediatr","first-page":"22","article-title":"A standardized protocol to reduce cerebrospinal fluid shunt infection: the Hydrocephalus Clinical Research Network Quality Improvement Initiative: clinical article","volume":"8","author":"Kestle JRW","year":"2011","unstructured":"Kestle JRW, Riva-Cambrin J, Wellons JC,  A standardized protocol to reduce cerebrospinal fluid shunt infection: the Hydrocephalus Clinical Research Network Quality Improvement Initiative: clinical article. 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J Neurosurg Pediatr. 2023;31(5):444\u2013452."},{"key":"b16","series-title":"World Neurosurg","first-page":"e87","article-title":"Care bundle approach to minimizing infection rates after neurosurgical implants for neuromodulation: a single-surgeon experience","volume":"128","author":"Arocho-Quinones EV","year":"2019","unstructured":"Arocho-Quinones EV, Huang CC, Ward BD, Pahapill PA. Care bundle approach to minimizing infection rates after neurosurgical implants for neuromodulation: a single-surgeon experience. World Neurosurg. 2019;128:e87\u2013e97."},{"key":"b17","series-title":"J Clin Neurosci","first-page":"188","article-title":"Analysis of hospital infection register indicates that the implementation of WHO surgical safety checklist has an impact on early postoperative neurosurgical infections","volume":"53","author":"Westman M","year":"2018","unstructured":"Westman M, Marttila H, Rahi M, Rintala E, L\u00f6yttyniemi E, Ikonen T. 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J Neurosurg. 2015;123(1):145\u2013152."},{"issue":"2","key":"b19","series-title":"J Neurosurg","first-page":"494","article-title":"A standardized infection prevention bundle for reduction of CSF shunt infections in adult ventriculoperitoneal shunt surgery performed without antibiotic-impregnated catheters","volume":"138","author":"Muram S","year":"2023","unstructured":"Muram S, Isaacs AM, Sader N,  A standardized infection prevention bundle for reduction of CSF shunt infections in adult ventriculoperitoneal shunt surgery performed without antibiotic-impregnated catheters. J Neurosurg. 2023;138(2):494\u2013502."},{"issue":"4","key":"b20","series-title":"BMJ Qual Saf","first-page":"299","article-title":"Surgical checklists: a systematic review of impacts and implementation","volume":"23","author":"Treadwell JR","year":"2014","unstructured":"Treadwell JR, Lucas S, Tsou AY. Surgical checklists: a systematic review of impacts and implementation. 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BMJ Open Qual. 2021;10(4):e001593."},{"key":"b22","series-title":"Ann Med Surg (Lond)","first-page":"19","article-title":"Quality improvement strategy to enhance compliance with the World Health Organization Surgical Safety Checklist in a large hospital: quality improvement study","volume":"55","author":"R\u00f6hsig V","year":"2020","unstructured":"R\u00f6hsig V, Maestri RN, Mutlaq MFP,  Quality improvement strategy to enhance compliance with the World Health Organization Surgical Safety Checklist in a large hospital: quality improvement study. Ann Med Surg (Lond). 2020;55:19\u201323."},{"issue":"2","key":"b1","series-title":"Pediatr Neurosurg","first-page":"66","article-title":"Repeat cerebrospinal fluid shunt infection in children","volume":"35","author":"Kulkarni AV","year":"2001","unstructured":"Kulkarni AV, Rabin D, Lamberti-Pasculli M, Drake JM. Repeat cerebrospinal fluid shunt infection in children. 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J Neurosurg. 2004;100(5 Suppl Pediatrics):442\u2013446."},{"issue":"1","key":"b7","series-title":"J Neurosurg","first-page":"31","article-title":"Risk factors for repeated cerebrospinal shunt failures in pediatric patients with hydrocephalus","volume":"92","author":"Tuli S","year":"2000","unstructured":"Tuli S, Drake J, Lawless J, Wigg M, Lamberti-Pasculli M. Risk factors for repeated cerebrospinal shunt failures in pediatric patients with hydrocephalus. J Neurosurg. 2000;92(1):31\u201338."},{"issue":"2","key":"b8","series-title":"J Neurosurg","first-page":"195","article-title":"Cerebrospinal fluid shunt infection: a prospective study of risk factors","volume":"94","author":"Kulkarni AV","year":"2001","unstructured":"Kulkarni AV, Drake JM, Lamberti-Pasculli M. Cerebrospinal fluid shunt infection: a prospective study of risk factors. 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J Neurosurg Pediatr. 2022;29(6):711\u2013718."},{"issue":"5","key":"b11","series-title":"J Neurosurg Pediatr","first-page":"559","article-title":"Calgary Shunt Protocol, an adaptation of the Hydrocephalus Clinical Research Network shunt protocol, reduces shunt infections in children","volume":"23","author":"Yang MMH","year":"2019","unstructured":"Yang MMH, Hader W, Bullivant K, Brindle M, Riva-Cambrin J. Calgary Shunt Protocol, an adaptation of the Hydrocephalus Clinical Research Network shunt protocol, reduces shunt infections in children. J Neurosurg Pediatr. 2019;23(5):559\u2013567."},{"issue":"3","key":"b12","series-title":"Neurosurgery","first-page":"508","article-title":"The impact of a pediatric shunt surgery checklist on infection rate at a single institution","volume":"83","author":"Lee RP","year":"2018","unstructured":"Lee RP, Venable GT, Vaughn BN, Lillard JC, Oravec CS, Klimo P. The impact of a pediatric shunt surgery checklist on infection rate at a single institution. Neurosurgery. 2018;83(3):508\u2013520."},{"issue":"2","key":"b13","series-title":"J Neurosurg Pediatr","first-page":"157","article-title":"Shunt infection prevention practices in Hydrocephalus Clinical Research Network\u2013Quality: a new quality improvement network for hydrocephalus management","volume":"33","author":"Tamber MS","year":"2024","unstructured":"Tamber MS, Jensen H, Clawson J,  Shunt infection prevention practices in Hydrocephalus Clinical Research Network\u2013Quality: a new quality improvement network for hydrocephalus management. J Neurosurg Pediatr. 2024;33(2):157\u2013164."},{"issue":"6","key":"b14","series-title":"Childs Nerv Syst","first-page":"1839","article-title":"Implementation of an adapted perioperative ventriculoperitoneal shunting protocol in a tertiary center located in a low-to-middle-income country","volume":"40","author":"Shahbandi A","year":"2024","unstructured":"Shahbandi A, Jahangiri P, Meybodi KT, Nejat F, Habibi Z. 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J Neurosurg Pediatr. 2023;31(5):444\u2013452."},{"key":"b16","series-title":"World Neurosurg","first-page":"e87","article-title":"Care bundle approach to minimizing infection rates after neurosurgical implants for neuromodulation: a single-surgeon experience","volume":"128","author":"Arocho-Quinones EV","year":"2019","unstructured":"Arocho-Quinones EV, Huang CC, Ward BD, Pahapill PA. Care bundle approach to minimizing infection rates after neurosurgical implants for neuromodulation: a single-surgeon experience. World Neurosurg. 2019;128:e87\u2013e97."},{"key":"b17","series-title":"J Clin Neurosci","first-page":"188","article-title":"Analysis of hospital infection register indicates that the implementation of WHO surgical safety checklist has an impact on early postoperative neurosurgical infections","volume":"53","author":"Westman M","year":"2018","unstructured":"Westman M, Marttila H, Rahi M, Rintala E, L\u00f6yttyniemi E, Ikonen T. Analysis of hospital infection register indicates that the implementation of WHO surgical safety checklist has an impact on early postoperative neurosurgical infections. J Clin Neurosci. 2018;53:188\u2013192."},{"issue":"1","key":"b18","series-title":"J Neurosurg","first-page":"145","article-title":"Analysis of neurosurgical reoperations: use of a surgical checklist and reduction of infection-related and preventable complication-related reoperations","volume":"123","author":"Lep\u00e4nluoma M","year":"2015","unstructured":"Lep\u00e4nluoma M, Rahi M, Takala R, L\u00f6yttyniemi E, Ikonen TS. Analysis of neurosurgical reoperations: use of a surgical checklist and reduction of infection-related and preventable complication-related reoperations. J Neurosurg. 2015;123(1):145\u2013152."},{"issue":"2","key":"b19","series-title":"J Neurosurg","first-page":"494","article-title":"A standardized infection prevention bundle for reduction of CSF shunt infections in adult ventriculoperitoneal shunt surgery performed without antibiotic-impregnated catheters","volume":"138","author":"Muram S","year":"2023","unstructured":"Muram S, Isaacs AM, Sader N,  A standardized infection prevention bundle for reduction of CSF shunt infections in adult ventriculoperitoneal shunt surgery performed without antibiotic-impregnated catheters. J Neurosurg. 2023;138(2):494\u2013502."},{"issue":"4","key":"b20","series-title":"BMJ Qual Saf","first-page":"299","article-title":"Surgical checklists: a systematic review of impacts and implementation","volume":"23","author":"Treadwell JR","year":"2014","unstructured":"Treadwell JR, Lucas S, Tsou AY. Surgical checklists: a systematic review of impacts and implementation. 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