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

 

Bottom Line: Antiseptic-bonded catheters may not prevent CRBSIs in patients receiving TPN

 

Level of evidence: 1- (RCT with a high risk of bias, not ICU patients)

 

Citation: No difference in catheter sepsis between standard and antiseptic central venous catheters. A prospective randomized trial. Archives of Surgery 1996; 131: 986-9

Lead author's name: Pemberton LB

 

Three-part Clinical Question:

Patients: surgical patients having 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: Randomised, controlled trial, without intention-to treat analysis

 

The Study Patients: 88 catheters, 72 were evaluable

 

Control group (standard CVC) n=40
 

Experimental group (impregnated CVC) n=32

 

The Evidence:

 

Outcome

Time to Outcome

CER

EER

RRR

ARR

NNT

CRBSI

On removal

0.075

0.063

0.16

0.012

NS

95% Confidence Intervals:

NS

NS

NS

 

EBM questions:

 

1) Do the methods allow accurate testing of the hypothesis? No, because of a potential type II error

 

2) Do the statistical tests correctly test the results to allow differentiation of statistically significant results? No, because of a potential type II error. No power calculation was made

 

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

 

4) Did results get omitted, and why? Yes, 16 patients were excluded from analysis because their catheters were not cultured.

 

5) Did they suggest areas of further research? Yes – the need for larger RCTs

 

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, the patients were not intensive care patients, but surgical patients on TPN.

 

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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