{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T09:52:46Z","timestamp":1776851566833,"version":"3.51.2"},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,17]]},"abstract":"\n OBJECTIVE<\/jats:title>\n The Hydrocephalus Clinical Research Network\u2013Quality (HCRNq) was established to encourage adoption of evidence-based best practices for the care of children with hydrocephalus. A shunt infection prevention initiative is ongoing within the network, and an analysis of baseline data suggested important practice variation with respect to shunt infection prevention practices. In a first attempt to standardize care, the authors recommended adoption of an endorsed shunt infection prevention protocol within the network, and now present information related to protocol adoption, compliance, and its effect on shunt infection rates.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n A memorandum was circulated to HCRNq sites endorsing and recommending adoption of a 7-step shunt infection prevention protocol. Patient and procedural data relevant to shunt surgery and infection prevention were then prospectively collected from 31 network sites. The relationship between the infection outcome and patient and procedural variables, including protocol adoption, was modeled using uni- and multivariable statistics.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n An unadjusted infection rate of 3.6% was observed over nearly 3500 shunt procedures, similar to what was observed at baseline, but with a narrower range, suggesting that some outlying sites were brought closer to the network average. An increased infection risk was associated with shunt placement for preterm posthemorrhagic hydrocephalus, the occurrence of prior shunt surgery within 6 months of the index procedure, and the use of antibiotic ointment. A reduced infection risk with the use of antibiotic-impregnated catheters was suggested. Adoption of the recommended protocol was modest, and as a result, significant practice variation continued to be observed. In this analysis, no relationship was observed between infection risk and the use of an infection prevention protocol.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n This first attempt to encourage standardization of perioperative practices for shunt infection prevention, by endorsing an evidence-based shunt infection prevention protocol for use at network sites, resulted in incremental protocol adoption. Many shunt procedures continue to occur without the cover of a protocol. Although adherence to a protocol did not appear to influence infection risk in the present analysis, an opportunity to improve remains, with a potential beneficial effect on infection rates to follow. The authors continue to work toward further improvement in this regard.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.7.peds25208","type":"journal-article","created":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T02:08:22Z","timestamp":1760753302000},"page":"677-682","source":"Crossref","is-referenced-by-count":1,"title":["Effect of a recommended shunt infection prevention protocol on perioperative practices and infection rates in the Hydrocephalus Clinical Research Network\u2013Quality"],"prefix":"10.3171","volume":"36","author":[{"given":"Mandeep S.","family":"Tamber","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hailey","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ron","family":"Reeder","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Clawson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nichol","family":"Nunn","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John R. W.","family":"Kestle","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"N Engl J Med","first-page":"491","article-title":"A surgical safety checklist to reduce morbidity and mortality in a global population","volume":"360","author":"Haynes AB","year":"2009","unstructured":"Haynes AB, Weiser TG, Berry WR, A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360(5):491\u2013499."},{"issue":"1","key":"b2","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","volume":"8","author":"Kestle JRW","year":"2011","unstructured":"Kestle JRW, Riva-Cambrin J, Wellons JC III, A standardized protocol to reduce cerebrospinal fluid shunt infection: the Hydrocephalus Clinical Research Network Quality Improvement Initiative. J Neurosurg Pediatr. 2011;8(1):22\u201329."},{"issue":"4","key":"b3","series-title":"J Neurosurg Pediatr","first-page":"391","article-title":"A new Hydrocephalus Clinical Research Network protocol to reduce cerebrospinal fluid shunt infection","volume":"17","author":"Kestle JRW","year":"2016","unstructured":"Kestle JRW, Holubkov R, Douglas Cochrane D, A new Hydrocephalus Clinical Research Network protocol to reduce cerebrospinal fluid shunt infection. J Neurosurg Pediatr. 2016;17(4):391\u2013396."},{"issue":"6","key":"b4","series-title":"J Neurosurg Pediatr","first-page":"711","article-title":"The Hydrocephalus Clinical Research Network quality improvement initiative: the role of antibiotic-impregnated catheters and vancomycin wound irrigation","volume":"29","author":"Chu J","year":"2022","unstructured":"Chu J, Jensen H, Holubkov R, The Hydrocephalus Clinical Research Network quality improvement initiative: the role of antibiotic-impregnated catheters and vancomycin wound irrigation. J Neurosurg Pediatr. 2022;29(6):711\u2013718."},{"issue":"16","key":"b5","series-title":"JAMA","first-page":"1333","article-title":"It takes an average of 17 years for evidence to change practice\u2014the burgeoning field of implementation science seeks to speed things up","volume":"329","author":"Rubin R","year":"2023","unstructured":"Rubin R. 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