Transparent polyurethane film as an intravenous catheter dressing. A meta-analysis of the infection risks.
OBJECTIVE
To obtain a quantitative estimate of the impact on infectious complications of using transparent dressings with intravenous catheters.


METHODS
Meta-analysis of all studies published in the English literature, including abstracts, letters, and reports that examined the primary research question of infection risks associated with transparent compared with gauze dressings for use on central and peripheral venous catheters. Studies were identified by use of the MEDLINE database using the indexing terms occlusive dressings, transparent dressings, and infection and by review of referenced bibliographies.


METHODS
Seven of the 15 studies (47%) of central venous catheters and seven of 12 studies (58%) of peripheral catheters met our inclusion criteria for analysis. All studies used a prospective cohort design, utilized hospitalized patients, and reported at least one of our defined outcomes.


METHODS
Data for each study were abstracted independently by three investigators. At least three studies were used in the analysis of each outcome.


RESULTS
Applying a Mantel-Haenszel chi 2 analysis, use of transparent dressings on central venous catheters was significantly associated with an elevated relative risk (RR) of catheter tip infection (RR = 1.78; 95% confidence interval [CI], 1.38 to 2.30). Catheter-related sepsis (RR = 1.69; 95% CI, 0.97 to 2.95) and bacteremia (RR = 1.63; 95% CI, 0.76 to 3.47) were both associated with an elevated RR. Use of transparent dressings on peripheral catheters was associated with an elevated RR of catheter-tip infection (RR = 1.53; 95% CI, 1.18 to 1.99) but not phlebitis (RR = 1.02; 95% CI, 0.86 to 1.20), infiltration (RR = 1.12; 95% CI, 0.92 to 1.37), or skin colonization (RR = 0.99; 95% CI, 0.90 to 1.09).


CONCLUSIONS
The results demonstrated a significantly increased risk of catheter-tip infection with the use of transparent compared with gauze dressings when used with either central or peripheral catheters. An increased risk of bacteremia and catheter sepsis associated with the use of transparent compared with gauze dressings for use on central venous catheters was suggested.
Hoffmann
K K
KK
Department of Medicine, University of North Carolina, Chapel Hill 27599-7030.
Weber
D J
DJ
Samsa
G P
GP
Rutala
W A
WA
D016470:Bacteremia / Q000209:etiology; D001424:Bacterial Infections / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data*; D002406:Catheterization, Peripheral / Q000706:statistics & numerical data*; D006801:Humans; D015201:Meta-Analysis as Topic; D009779:Occlusive Dressings / Q000706:statistics & numerical data*; D011140:Polyurethanes; D012307:Risk Factors
D011140:Polyurethanes