Dear Editor: Surgical site infections (SSI) can result in significant mor- bidity, occasionally mortality and increased length of hos- pital stay [7]. Most clinicians and microbiologists believe that the majority of SSI result from the skin flora entering the wound site during the incision [8]. Strict antisepsis around the wound site (pre-/intra- and post-operatively) should therefore be adhered to. A recent trial published in New England Journal of Medicine showed superiority in the use of chlorhexidine versus povidone [3]. In addition to skin antiseptics, the use of antimicrobial-impregnated incision drapes has been an- other advancement in the minimization of SSI risk. The use of iodine impregnated drapes (ioban) versus plain standard adhesive drapes or no adhesive drape still remains the choice and preference of the surgeon, scrub nurse or the local institution policy, with no trend towards standardizing practice. We looked at the current literature on the subject and found two retrospective studies [6, 10], four prospective studies [1, 2, 4, 11] and a Cochrane review [12] specifically addressing the issue of type of surgical drape. The results ranged from marginal significance to non significant in reducing the incidence of SSIs. At the same time, Parks [9] has calculated that in order to achieve statistical power a sample size of at least 10,000 patients would be needed, thus making the planning of such a study somewhat unfeasible. In another study, Eyberg et al. [5] studied the in vitro efficacy of standard versus iodine impregnated adhesive drapes by inoculating them with common pathogens and then calculated the reduction factor of the bacterial colony forming units. They concluded that the reduction factor ranged from 1 log to more than 6 log. The efficacy of the drape was primarily directed against staphylococci. We undertook a prospective study examining cultures from the steri-drapes of 75 consecutive ventriculoperitoneal shunt insertions performed in the same unit using a stereo- typical protocol (including preparative skin cleaning with aqueous iodine solution followed by alcoholic chlorhexi- dine; and antibiotic prophylaxis on induction and post- operatively for all cases) for shunt insertion. Ioban was under trial usage in the unit, and 20 VP shunts used Ioban drapes during that time, and the remaining 55 used non- impregnated drapes. At the end of the procedure, whilst the operative site remained sterile, a small drape area immediately adjacent to the wound edge was sent to microbiology for bacterio- logical culturing. There were two post-operative SSIs over a follow-up period ranging between 8 and 10 years. Intraoperative cerebrospinal fluid (CSF) cultures of these patients were all negative. The two patients who developed SSIs grew Staphylococcus aureus sensitive to Flucloxacillin. Coinciden- tally, these two patients were draped in a non-impregnated drape, and the cultures of these drapes grew S. aureus preceding the diagnosis of SSI. There were no other drape nor wound cultured infections in this series Although there is no statistical difference in the incidence of SSI in the 20 patients who were draped in Ioban N. Haliasos (*) : R. Bhatia : D. Thompson Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, Great Ormond St., London WC1N 3JH, UK e-mail: nhaliasos@gmail.com J. Hartley Department of Microbiology, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK LETTER TO THE EDITOR Ioban drapes against shunt infections? Nikolaos Haliasos & Robin Bhatia & John Hartley & Dominic Thompson Received: 5 February 2012 / Accepted: 8 February 2012 / Published online: 22 February 2012 # Springer-Verlag 2012 Childs Nerv Syst (2012) 28:509–510 DOI 10.1007/s00381-012-1724-x