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© SICS EBM Group 2004
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Do antiseptic coated central lines prevent catheter-related bloodstream infection?
Citation: Influence of triple-lumen central venous catheters coated with chlorhexidine and silver sulfadiazine on the incidence of catheter related bacteraemia. Arch Intern Med, 1998; 158: 81-87
Lead author's name: Heard SO
Three-part Clinical Question: Patients: surgical intensive care patients 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: Randomised, controlled trial, without intention-to treat analysis.
The Study Patients: 365 catheters were inserted in 251 patients, 57 drop-outs occurred because of protocol violation. Thus 308 catheters were studied.
Control group (standard CVC) n= 157 catheters
Experimental group (impregnated CVC) n=151 catheters
The Evidence:
EBM questions:
1) Do the methods allow accurate testing of the hypothesis? No, the study was supposed to examine the effect of antiseptic catheters on catheter-related infection. However it was not powerful enough to do so.
2) Do the statistical tests correctly test the results to allow differentiation of statistically significant results? No, the study was only powered to detect changes in catheter colonisation.
3) Are conclusions valid in light of the results? Yes
4) Did results get omitted, and why? Yes, some catheters were not studied because of removal out with the control of the investigators.
5) Did they suggest areas of further research? No
6) Did they make any recommendations based on the results and were they appropriate? That the use of antiseptic catheters does not provide clinical benefit – entirely appropriate
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. June 2005
Email: d.g.swann@ad.ac.uk
Edited by CC Kill by Date: 2010
©SICS EBMG 2002
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