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Maximal Sterile Technique - Impact on CVC infections
Citation/s:
Raad I, et al.
Prevention of Central Venous Catheter-Related Infections by using Maximal
Sterile Barrier Precautions during insertion. Infect Control Hosp Epidemiol
1994;15:231-238
Three-part Clinical Question:
Does the use of Maximal Sterile Barrier (MSB) precautions during insertion of
CVC lines reduce the incidence of CVCr infections. Search Terms: CVC, complications, insertion
The Study: Single-blinded
randomised controlled trial with intention-to-treat. The Study Patients: Adult cancer, inpatients and outpatients requiring a non-tunnelled, non-cuffed CVC line. No significant differences in baseline characteristics between the two patient groups. 75% of the lines were subclavian, 25% were peripherally inserted central lines (ACF)
Definitions: Colonisaton: >14 cfu by role-plate culture or >100 cfu by sonication culture from either the tip or subcutaneous segment. Catheter-related septicaemia:
Signs of sepsis, isolation of same organism from a peripheral blood culture and
line tip/subcutaneous segment. Or ten fold increase in colony count of an
organism isolated in a blood culture taken from the line, compared with a
simultaneous peripheral blood culture. Control group (N = 167; 167
analysed): CVC inserted using 'standard care': sterile gloves and a small drape.
Experimental group (N = 176; 176 analysed): CVC inserted using MSB precautions: non-sterile cap and mask as well as sterile gown and gloves. The patient’s head and body was covered with a large drape
The Evidence:
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? Probably. The reduction in colonisation rates reaches statistical significance. The reduction in CVCrBSI is not statistically significant, however this may well be due to type II error – with an underpowered small study. 3. Are conclusions valid in light of the results? Yes 4. Did results get omitted, and why? No 5. Did they suggest areas of further research? Yes. Further similar studies. 6. Did they make any recommendations based on the results and were they appropriate? 7. Is the study relevant to my clinical practice? Yes. Although this study was restricted to cancer patients, only 1% were neutropenic when the line was inserted and the majority (75%) of infection occurred in patients with normal neutrophil counts. 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 12. Should I audit my current practice because of these results? Yes Appraised by: Dr Chris Cairns, Consultant, ICU, Stirling
Royal Infirmary, UK ; 27 September 2005 Citation: EBM Critical Appraisals. Scottish Intensive Care Society EBM Group. Cairns CJS. 2005. :Raad I, et al. Prevention of Central Venous Catheter-Related Infections by using Maximal Sterile Barrier Precautions during insertion. Infect Control Hosp Epidemiol 1994;15:231-238 .
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