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Chris Cairns
© SICS EBM Group 2004
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Do antiseptic coated central lines prevent catheter-related bloodstream infection?
Citation: Ciresi DL, et al. Failure of antiseptic bonding to prevent central venous catheter-related infection and sepsis. American Surgeon 1996; 62: 641-7 Lead author's name: Ciresi DL
Three-part Clinical Question: Patients: needed TPN Intervention: antiseptic impregnation with silver sulphadiazine and chlorhexidine or untreated central venous catheters Outcomes: catheter colonisation and catheter related bloodstream infection (CRBSI) Search Terms: intensive care, critical care, central venous catheters, infection, prevention, controlled trial The Study: Quasi-randomised, controlled trial, without intention-to treat analysis The Study Patients: Control group: (n=103; 99 analysed) Impregnated
CVCs.
The Evidence:
EBM questions:
1) Do the methods allow accurate testing of the hypothesis? No, power study indicated that 27 700 patients need to be recruited to detect difference in CRBSI rates
2) Do the statistical tests correctly test the results to allow differentiation of statistically significant results? No, type II error not excluded
3) Are conclusions valid in light of the results? Yes
4) Did results get omitted, and why? Yes, 11 patients dropped out because cultures were not done
5) Did they suggest areas of further research? No
6) Did they make any recommendations based on the results and were they appropriate? Yes, in that clinically significant differences in CRBSI are unlikely with the use of anti-septic coated catheters. Whether this is appropriate depends on the results of other trials
7) Is the study relevant to my clinical practice? Perhaps not, patients needing TPN may be different from intensive care patients
8) What level of evidence does this study represent? 1- mainly because the study sample was not from intensive care patients
9) What grade of recommendation can I make on this result alone? N/A
10) What grade of recommendation can I make when this study is considered along with other available evidence? A – see topic summary
11) Should I change my practice because of these results? Perhaps- it depends on your views about the validity and importance of pooled analysis of RCTs
12) Should I audit my current practice because of these results? No, but you should be auditing CRBSI rates anyway .
Appraised by Dr David Swann, Consultant, ICU, Royal Infirmary of Edinburgh.
Email: d.g.swann@ad.ac.uk
June 2005
Kill by Date: 2010
Edited by CC.
©SICS EBM 2005
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