Background In pediatrics, shunt infection is considered the most common complication of ventriculoperitoneal (VP) shunt insertion and the main cause of shunt failure. Careful surgical technique and hygienic skin preparations are highly important for prevention of shunt infections. Our objective was to assess the significance of using preoperative chlorhexidine/alcohol as a skin antiseptic in reducing the infection rate in pediatric VP shunts surgery.

Methods We conducted a retrospective, case control study of 80 pediatric patients with active hydrocephalus. The control group (a single step of preoperative skin antisepsis using povidone-iodine and isopropyl alcohol) comprised 40 patients who underwent a shunt surgery between January 2019 and June 2020 and the study group (two steps of preoperative skin antisepsis using 2% chlorhexidine gluconate in 70% isopropyl alcohol as a first step followed by povidone-iodine as a second step) comprised 40 patients who underwent a shunt surgery between July 2020 and January 2022.

Results Shunt infection was encountered in 11 (13.7%) patients. It was significantly higher in preterm babies (p = 0.010), patients with a previous shunt revision (p < 0.001), and those with a previous shunt infection (p < 0.001). The incidence of infection was 22.5% in the control group and 5% in study group, with a statistically significant difference (p = 0.023).

Conclusions Two steps of preoperative skin antisepsis, first using chlorhexidine/alcohol and then povidone-iodine scrub solution, may significantly reduce the infection rate in pediatric VP shunt surgeries.

The study was performed at the Department of Neurosurgery, Faculty of Medicine, Menoufia University Hospital, Shibin El Kom, Egypt.

All data and materials included in this work are available upon request.

Our local ethics committee approved our study.

This study was approved by the clinical research committee of the Menoufia University Hospital (IRB approval number: 4-2023.NEUS 4-2) and it followed the tenets of the Declaration of Helsinki.

All the authors made significant contributions to the work reported, whether that was in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas. All the authors took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; agreed on the journal to which the article has been submitted; and agreed to be accountable for all aspects of the work.

Received: 13 September 2023

Accepted: 06 February 2024

Accepted Manuscript online:
09 February 2024

Article published online:
15 April 2024

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