Abstract
BACKGROUND
The Philippine General Hospital, a public national referral center, sees 60–80 pediatric brain tumor cases per year. Historically, the rate of post-operative ventriculitis has been high, resulting in treatment delays and poor outcomes. Starting in July 2019, as a means to decrease infections, patients were provided standardized bathing and wound care kits and caregivers were trained to follow a bathing and wound care protocol.
METHODS
This quality improvement study included patients younger than 18 years who underwent craniotomy at PGH were enrolled. The type of surgery, length of surgery, existence of post-operative CNS infection, length of stay and total cost of care was collected. The outcome of these interventions are analyzed 6 months after implementation.
RESULTS
Thirty-two 32 patients were included, with mean age of 7 years (1–16). The surgeries performed were: tumor resection (n=20), ventriculo-peritoneal shunt insertion (VPS) (n=3), endoscopic third ventriculostomy (n=3), resection with tube ventriculostomy (n=3), Ommaya reservoir placement (n=2), and resection with shunt (n=1). Median surgery time was 4 hours (1–10). Three patients (9.4%) developed ventriculitis. No surgical site infections occurred. Compared to historical controls, a lower rate of infections was noted (9.4% vs. 15.5%, runchart analysis). Patients without post-operative infections had a shorter length of stay (median 14 vs 48 days, p<0.05) and a lower cost of care (median $1098 vs. $2425 USD, p<0.05).
CONCLUSION
Implementation of simple hygiene interventions effectively lowered post-operative CNS infections and hospital costs in a public hospital setting. Incorporation of these into standard clinical practices is urgently needed.