1. HOW TO REDUCED SHUNT INFECTION IN PHRAMONGKUTKLOA ARMY HOSPITAL Supakij Sanguandekul.

2. BACKGROUND THE SHUNT INFECTION IS THE MOST COMMON COMPLICATION OF SHUNT INSERTIONTHE SHUNT INFECTION IS THE MOST COMMON COMPLICATION OF SHUNT INSERTION MANY NEUROSURGEONS HAVE EXPERIENCE AND DEAL WITH THIS PROBLEMMANY NEUROSURGEONS HAVE EXPERIENCE AND DEAL WITH THIS PROBLEM THIS PROBLEM WAS INCREASED THE COST OF TREATMENT AND INCREASED MORBIDITY AND MORTALITYTHIS PROBLEM WAS INCREASED THE COST OF TREATMENT AND INCREASED MORBIDITY AND MORTALITY IN MANY CENTERS WERE DEVELOPED PROTOCAL AND SUCCESS TO REDUCE THIS PROBLEMIN MANY CENTERS WERE DEVELOPED PROTOCAL AND SUCCESS TO REDUCE THIS PROBLEM THE MAIN OBJECTIVE OF THIS RESEARCH IS TO FIND THE SIMPLY METHOD TO REDUCE SHUNT INFECTIONTHE MAIN OBJECTIVE OF THIS RESEARCH IS TO FIND THE SIMPLY METHOD TO REDUCE SHUNT INFECTION

3. MATERIAL&METHOD HISTORICAL COMPARATIVE STUDYHISTORICAL COMPARATIVE STUDY THE RISK FACTOR AND THE RATE OF PREVIOUS SHUNT INFECTION BETWEEN 1995-2000 WAS IDENTIFIED BY PREVIOUS RESEARCH STUDY,THE RATE OF INFECTION WAS 9%THE RISK FACTOR AND THE RATE OF PREVIOUS SHUNT INFECTION BETWEEN 1995-2000 WAS IDENTIFIED BY PREVIOUS RESEARCH STUDY,THE RATE OF INFECTION WAS 9% MANY RESEARCHS THAT MADE THE SUCCESS PROTOCOL WAS FOUND AND THE USEFUL METHOD WAS USE TO REDUCE SHUNT INFECTIONMANY RESEARCHS THAT MADE THE SUCCESS PROTOCOL WAS FOUND AND THE USEFUL METHOD WAS USE TO REDUCE SHUNT INFECTION THE DATA WERE COLLECTED FROM 198 HYDROCEPHALIC PATIENTS WHO OPERATED BY 206 VP SHUNT INSERTION AND 1 VA SHUNT INSERTION.THEN THE DATA WERE ANALYSED BY SPSS VERSION 10THE DATA WERE COLLECTED FROM 198 HYDROCEPHALIC PATIENTS WHO OPERATED BY 206 VP SHUNT INSERTION AND 1 VA SHUNT INSERTION.THEN THE DATA WERE ANALYSED BY SPSS VERSION 10

4. RESULT THE 305 HYDROCEPHALIC PATIENTS WERE ADMITTED IN PHRAMONGKUTKLOA HOSPITAL BETWEEN 2003-2006THE 305 HYDROCEPHALIC PATIENTS WERE ADMITTED IN PHRAMONGKUTKLOA HOSPITAL BETWEEN 2003-2006 198 HYDROCEPHALIC PATIENTS WERE OPERATED BY 206VP SHUNT INSERTION,1 VA SHUNT INSERTION198 HYDROCEPHALIC PATIENTS WERE OPERATED BY 206VP SHUNT INSERTION,1 VA SHUNT INSERTION THE AGE WAS BETWEEN NEWBORN 3 DAYS TO 86 YEARS.THE AVERAGE AGE WAS 4O YEARSTHE AGE WAS BETWEEN NEWBORN 3 DAYS TO 86 YEARS.THE AVERAGE AGE WAS 4O YEARS 134 MALES,64 FEMALES134 MALES,64 FEMALES THE OBSTRUCTIVE HYDROCEPHALUS WERE 168 CASES,NPH WERE 30 CASESTHE OBSTRUCTIVE HYDROCEPHALUS WERE 168 CASES,NPH WERE 30 CASES THE MOST COMMON CAUSED WAS CVA,POST TRAUMATICTHE MOST COMMON CAUSED WAS CVA,POST TRAUMATIC IN THE NPH THE MOST COMMON CAUSED WAS IDIOPATHICIN THE NPH THE MOST COMMON CAUSED WAS IDIOPATHIC

5. RESULT NO PATIENT WAS DEATH FROM SHUNT INFECTION.NO PATIENT WAS DEATH FROM SHUNT INFECTION. ONLY 7 OLD CVA PATIENTS WERE DEATH FROM ANOTHER CAUSED SUCH AS PNEUMONIA UTI,1 NEWBORN MYELOMENINGOCOLE PATIENT WAS UNSPECIFIED SUDDEN DEATH AFTER SHUNT REVISIONONLY 7 OLD CVA PATIENTS WERE DEATH FROM ANOTHER CAUSED SUCH AS PNEUMONIA UTI,1 NEWBORN MYELOMENINGOCOLE PATIENT WAS UNSPECIFIED SUDDEN DEATH AFTER SHUNT REVISION 5 PATIENTS WERE DIAGNOSED TO BE POST OPERATIVE SHUNT INFECTION (IN 2 MONTHS POST OPERATION)5 PATIENTS WERE DIAGNOSED TO BE POST OPERATIVE SHUNT INFECTION (IN 2 MONTHS POST OPERATION) THE RATE OF SHUNT INFECTION WAS 2.5%THE RATE OF SHUNT INFECTION WAS 2.5% SHUNT MALFUNCTION AND FEVER WERE THE MOST COMMON CLINICAL MANIFESTATIONSHUNT MALFUNCTION AND FEVER WERE THE MOST COMMON CLINICAL MANIFESTATION THE MOST COMMON ORGANISM WAS STAPH. epidermidisTHE MOST COMMON ORGANISM WAS STAPH. epidermidis

6. RISK FACTOR OF SHUNT INFECTION AGE<6 MONTHSAGE<6 MONTHS IMMUNOCOMPROMISEDIMMUNOCOMPROMISED SKIN CONDITIONSKIN CONDITION LENGTH OF OPERATIONLENGTH OF OPERATION EXPERIENCE OF NEUROSURGEONEXPERIENCE OF NEUROSURGEON

7. PATIENT SELECTION THE HYDROCEPHALIC PATIENT WHO NEED SHUNT IN SERTIONTHE HYDROCEPHALIC PATIENT WHO NEED SHUNT IN SERTION NO SYSTEMIC INFECTIONNO SYSTEMIC INFECTION SHUNT INFECTION THAT OCCUR IN 2 MONTHS POST OPERATION WAS DIAGNOSED TO BE POST OPERATIVE SHUNT INFECTIONSHUNT INFECTION THAT OCCUR IN 2 MONTHS POST OPERATION WAS DIAGNOSED TO BE POST OPERATIVE SHUNT INFECTION

8. DIAGNOSIS OF VP SHUNT INFECTION CLINICAL SIGNCLINICAL SIGN C/S FROM CSF,SHUNT HARDWAREC/S FROM CSF,SHUNT HARDWARE

9. NO TOUCH TECHNIC

10. TREATMENT OF VP SHUNT INFECTION REMOVE SHUNT HARDWARE AND EXTERNAL VENTRICULAR DRAINAGE,ANTIBIOTIC UNTIL CSF WAS CLEARED FROM INFECTION THEN RE OPERATED SHUNT INSERTION SUCCESS RATE 90%. IN PHRAMONGKUTKLOA HOSPITAL MOST PATIENTS WHO SUFFER SHUNT INFECTION WERE TREATED BY THIS METHODREMOVE SHUNT HARDWARE AND EXTERNAL VENTRICULAR DRAINAGE,ANTIBIOTIC UNTIL CSF WAS CLEARED FROM INFECTION THEN RE OPERATED SHUNT INSERTION SUCCESS RATE 90%. IN PHRAMONGKUTKLOA HOSPITAL MOST PATIENTS WHO SUFFER SHUNT INFECTION WERE TREATED BY THIS METHOD REMOVE OLD SHUNT AND REOPERATED WITH NEW SHUNT AT THE SAME TIME SUCCESS RATE 60 %REMOVE OLD SHUNT AND REOPERATED WITH NEW SHUNT AT THE SAME TIME SUCCESS RATE 60 % ANTIBIOTIC ALONE SUCCESS RATE 30% ONLY ONE CASE IN PHRAMONGKUTKLOA WAS TREARED BY THIS METHODANTIBIOTIC ALONE SUCCESS RATE 30% ONLY ONE CASE IN PHRAMONGKUTKLOA WAS TREARED BY THIS METHOD

11. SIMPLY WAY TO REDUCED SHUNT INFECTION STRICTED CRITERIA TO SELECT APPROPROATE HYDROCEPHALIC PATIENT WHO NEED SHUNT INSERTION AND LOW RISK OF SHUNT INFECTIONSTRICTED CRITERIA TO SELECT APPROPROATE HYDROCEPHALIC PATIENT WHO NEED SHUNT INSERTION AND LOW RISK OF SHUNT INFECTION REDUCED CONTAMINATION OF SHUNT HARDWARE FROM SKIN BY NO TOUCH TECHNIC OR DOUBLE GLOVE AND METICULOUS TECHNICREDUCED CONTAMINATION OF SHUNT HARDWARE FROM SKIN BY NO TOUCH TECHNIC OR DOUBLE GLOVE AND METICULOUS TECHNIC SHUNT OPERATION SHOULD BE OPERATED BY EXPERIENCED NEUROSURGEONSHUNT OPERATION SHOULD BE OPERATED BY EXPERIENCED NEUROSURGEON PROPHYLACTIC ANTIBIOTICPROPHYLACTIC ANTIBIOTIC

12. CONCLUSION ALTHOUGH SHUNT INFECTION IS THE MOST COMMON COMPLICATION,THE RATE OF INFECTION CAN BE REDUCED SATISFIED BY SIMPLY TECHNIC AS DESCRIBED BEFOREALTHOUGH SHUNT INFECTION IS THE MOST COMMON COMPLICATION,THE RATE OF INFECTION CAN BE REDUCED SATISFIED BY SIMPLY TECHNIC AS DESCRIBED BEFORE IN MANY CENTER THE RATE OF INFECTION WAS REDUCED FROM 3-10% TO BELOW 3% BY THE USE OF SIMPLY PROTOCOL IN THE SAME MANNERIN MANY CENTER THE RATE OF INFECTION WAS REDUCED FROM 3-10% TO BELOW 3% BY THE USE OF SIMPLY PROTOCOL IN THE SAME MANNER IN PHRAMONGKUTKLOA HOSPITAL THE RATE OF SHUNT INFECTION WAS REDUCED FROM 9 % TO 2.5 %IN PHRAMONGKUTKLOA HOSPITAL THE RATE OF SHUNT INFECTION WAS REDUCED FROM 9 % TO 2.5 % THE FUTURE RESEARCH OR METAANALYSIS SHOULD BE DONE TO FIND THE WAY TO REDUCED SHUNT INFECTION TO NEAR 0 % OR NO SHUNT INFECTIONTHE FUTURE RESEARCH OR METAANALYSIS SHOULD BE DONE TO FIND THE WAY TO REDUCED SHUNT INFECTION TO NEAR 0 % OR NO SHUNT INFECTION