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Chlorhexidine vs Iodine: A Meta-Analysis

 

Chlorhexidine is superior to iodine in preventing  CVCrBSI (NNT 94)

 

Level of Evidence: 1+ (Meta-analysis with a low risk of bias)

 

Citation/s: Chaiyakunapruk N, et al. Chlorhexidine Campared with Povidone-Iodine Solution for Vascular Catheter-Site Care: A Meta-Analysis. Ann Intern Med. 2002;136:792-801


Lead author's name and fax: DL Veenstra: veenstra@u.washington.edu

 

Three-part Clinical Question: In  hospital patients, which is superior in preventing VCrBSI or line colonization; chlorhexidine or iodine
 

Search Terms: see summary

 

The Review:
Data Sources: : Cochrane Library, Medline, Embase, Citation Index, pharmaceutical companies, CINAHL, Dissertation Abstracts, Lexis-Nexus, Web of science


Study Selection: Search: chlorhexidine & catheterization, expl. for chlorhexidine & catheter. Clinical trials, Randomized, any type of chlorhexidine or iodine, report of infection rates.
 

Data Extraction: Size of study, type of patient, type of catheter, type of antiseptic, site, exchange catheter, infection.

The studies were multiple independent reviews of individual reports. They were tested for heterogeneity.

 

The Evidence:

 

Outcome

Time to Outcome

Typical CER

Typical OR

RRR

NNT

p Value

Catheter Colonization

variable

0.135

0.49

47%

16

unclear

95% Confidence Intervals:

0.31 to 0.71

 

11 to 28

Heterogenious

CVCrBSI

variable

0.021

0.49

50%

94

unclear

95% Confidence Intervals:

0.28 to 0.88

 

67 to 404

Homogenious

 

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. Although there was a significant reduction in colonization rates associated with the use of chlorhexidine the authors correctly stated that the study populations were too heterogeneous to allow their results to be collated. When applied to CVCrBSI the study populations were homogenious enough to allow collation.
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? Yes. One should consider Chlorhexidine as a replacement for iodine solutions, especially in high risk patients. Valid conclusion.
7) Is the study relevant to my clinical practice? Yes. Although care must be taken when applying these results from a wide patient base, using many different types of venous and arterial catheters to an ICU population.
8) What level of evidence does this study represent? 1+
9) What grade of recommendation can I make on this result alone? B

10) What grade of recommendation can I make when this study is considered along with other available evidence? B
11) Should I change my practice because of these results? Yes. Change to chlorhexidine represents an inexpensive effective intervention.
12) Should I audit my current practice because of these results? Yes.

 

Appraised by: Dr A Longmate & Dr C Cairns. Consultants. Stirling Royal Infirmary. UK. ; 01 June 2005
Email: Andrew.Longmate@fvah.scot.nhs.uk & Chris .Cairns@fvah.scot.nhs.uk

 

Citation: EBM Critical Appraisals. Scottish Intensive Care Society EBM Group. Longmate A, Cairns CJS. 2005. Chaiyakunapruk N, et al. Chlorhexidine Campared with Povidone-Iodine Solution for Vascular Catheter-Site Care: A Meta-Analysis. Ann Intern Med. 2002;136:792-801.


Kill or Update By: June 2010

 

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