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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: Maki D
Three-part Clinical Question: Patients: 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, with intention-to treat analysis
The Study Patients: 442 catheters were originally included, 39 drop-outs occurred because of protocol violation. Thus 403 catheters in 158 patients were studied.
Control group (standard CVC) n= 195 catheters;
all analysed Experimental group (impregnated CVC) nn=208 catheters, all analysed
The Evidence:
EBM questions:
1) Do the methods allow accurate testing of the hypothesis? Yes, a power study indicated that 664 catheter insertions needed to be studied to detect an ARR of 4%
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? Yes, some catheters were not studied because they were in less than 8h or were not cultured. The study design allowed for their exclusion from analysis.
5) Did they suggest areas of further research? Yes, RCTs with CRBSI as an outcome for any novel technology
6) Did they make any recommendations based on the results and were they appropriate? They did not see the antiseptic catheter as a final answer and advocated the consideration of other technologies.
7) Is the study relevant to my clinical practice? Yes, though catheter exchange over a guidewire is not standard practice in my unit
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.
Comments Catheters rather than patients were the experimental unit. Thus a patient may have received more than one catheter. Subsequent catheters were inserted over a guidewire placed in the old catheter. This increases the risk of colonisation and infection of subsequent catheters (8/11 CRBSIs originated in such CVCs).
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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