Ramsay, 1994

Web site designed and maintained by Chris Cairns © SICS EBM Group 2004

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

Bottom Line: Antiseptic coated central venous catheters may not reduce CRBSIs

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

Citation: Incidence of catheter colonization and catheter related infection with an antiseptic impregnated triple lumen catheter. Crit Care Med 1994; 22:A115

Lead author's name: Ramsay J

Three-part Clinical Question:

Patients: Hospital 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: Blinded randomised controlled trial

The Study Patients:

Control group (standard CVC) n= 189; unclear if all analysed

Experimental group (impregnated CVC) n= 199; unclear if all analysed

The Evidence:

Outcome	Time to Outcome	CER	EER	RRR	ARR	NNT
CRBSI	At catheter removal	0.021	0.005	0.76	0.016	NS
CRBSI	95% Confidence Intervals:			NS	NS	NS

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, though the study was not powered to detect differences in CRBSI

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

4) Did results get omitted, and why? Unstated in abstract

5) Did they suggest areas of further research? No

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

7) Is the study relevant to my clinical practice? Perhaps, though the sample was from a hospital-wide population, not intensive care patients

8) What level of evidence does this study represent? 1^-, mainly because the patients may not be similar to our own.

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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