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Do silver impregnated central lines prevent catheter-related bloodstream infection?

 

Bottom Line: Antiseptic-impregnated catheters may not prevent CRBSIs in intensive care patients

 

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

 

Citation:  Evaluation of antiseptic-impregnated central venous catheters for prevention of catheter-related infection in intensive care unit patients. Diagnostic Microbiology and Infectious Disease, 2000; 38: 1-5

Lead author's name: Sheng W-H

 

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, blinded, controlled trial without intention-to treat analysis

 

The Study Patients: 235 catheters inserted into 235 patients
 

Control group (standard CVC) n= 122; all analysed
 

Experimental group (impregnated CVC) n=113; all analysed

 

The Evidence:

 

Outcome

Time to Outcome

CER

EER

RRR

ARR

NNT

CRBSI

At catheter removal

0.016

0.009

0.44

0.007

NS

95% Confidence Intervals:

NS

NS

NS

 

EBM questions:

 

1) Do the methods allow accurate testing of the hypothesis? No, the study was underpowered.

 

2) Do the statistical tests correctly test the results to allow differentiation of statistically significant results? No, the study was underpowered.

 

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

 

4) Did results get omitted, and why? Yes, some catheters were not cultured on removal

 

5) Did they suggest areas of further research? Yes, a larger study

 

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

No

 

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 

 

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