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© SICS EBM Group 2004
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Do antiseptic coated central lines prevent catheter-related bloodstream infection?
Lead author's name: Collin GR.
Three-part Clinical Question: Patients: trauma intensive care patients. Intervention: antiseptic coating 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: Randomised, controlled trial, without intention-to treat analysis, in the first phase of this study. Only these results are evaluated in this appraisal.
The Study Patients: 242 catheters were placed in 123 patients, 237 catheters were evaluable in 119 patients. Patients randomised to the control group were more likely to have the catheter replaced. Replacement was always with the same type of catheter.
Control group: n= 139 (standard CVC)
The Evidence:
EBM questions:
1) Do the methods allow accurate testing of the hypothesis? No, the study was under-powered to detect a difference in CRBSI rates.
2) Do the statistical tests correctly test the results to allow differentiation of statistically significant results? No, there was no power calculation done. A beta error may explain the lack of statistical significance.
3) Are conclusions valid in light of the results? The author concluded that catheter colonisation rates were reduced in the experimental group. However he was not justified in the discussion to state that this “has resulted in the near disappearance of CRBSI.”
4) Did results get omitted, and why? There were drop-outs related to protocol violations – some cultures were not done
5) Did they suggest areas of further research? He recognised the need for a larger, powered study to examine the effect of antiseptic catheters on CRBSI rates.
6) Did they make any recommendations based on the results and were they appropriate? “The antiseptic impregnated catheter represents a clear advancement in the ability of the clinician to prevent catheter-related colonization” However the lack of effect on the clinically significant outcome of CRBSI does not receive due consideration.
7) Is the study relevant to my clinical practice? Yes
8) What level of evidence does this study represent? 1-
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
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 Edited by CC
June 2005
Kill by Date: 2010
©SICS EBM 2005
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