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Do antiseptic coated central lines prevent catheter-related bloodstream infection?

 

Bottom Line: Antiseptic CVCs reduced CRBSI in haematology patients.

 

Level of evidence: 1- (RCT with a high risk of bias)

 

Citation: Reduction of catheter-related infections in neutropenic patients: a prospective controlled randomized trial using a chlorhexidine and silver sulfadiazine-impregnated central venous catheter Ann Hematol., 2005;  84: 258–262

Lead author's name: Jaeger K

 

3-part Clinical Question

Patients: had haematological malignancy

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: Unblinded randomised controlled trial with intention-to treat analysis

 

The Study Patients:

 

Control group (standard CVC) n= 55; all analysed
 

Experimental group (impregnated CVC) n= 51; all analysed

 

The Evidence:

Outcome

Time to Outcome

CER

EER

RRR

ARR

NNT

CRBSI

At catheter removal

0.145

0.020

0.865

0.126

8

95% Confidence Intervals:

-0.041 to 0.983 

0.025 to 0.226

4 to 40

 

EBM questions:

 

1) Do the methods allow accurate testing of the hypothesis? Yes.

 

2) Do the statistical tests correctly test the results to allow differentiation of statistically significant results? Yes

 

3) Are conclusions valid in light of the results? Yes

 

4) Did results get omitted, and why? No

 

5) Did they suggest areas of further research? No

 

6) Did they make any recommendations based on the results and were they appropriate?

No

 

7) Is the study relevant to my clinical practice? Perhaps not, haematology patients have a much higher incidence of CRBSIs (~15 v. 5%), so the NNT is relatively low

 

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 – 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. June 2005 

 

Email: d.g.swann@ad.ac.uk

 

Edited by CC 

Kill by Date: 2010 

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