Chapman, S. Evidently Cochrane Blog. Published online: 15 September 2016
By Sarah Chapman
What are the things that you do to reduce the risk of catheter-related infection in patients with central venous catheters (CVCs)? Take a moment to run through them. Now think about each one and why you do it. I’ll give you some prompts; mentally tick off all that apply:
- It’s Trust policy
- NICE (or other) guidance recommends it
- There’s evidence that it’s effective
- I’ve always done it [this way]
That last one always made me (inwardly) howl with frustration whenever I heard it, but I know you evidence-seekers won’t have ticked that one. It would be great to tick the first three, but can you? There might be more howling over those. I was rather shocked (ok, call me naïve) to discover that reliable evidence supporting the replacement of peripheral venous catheters only when clinically indicated, duly recommended by the UK’s epic3 National Evidence-Based Guidelines as being both safe and cost-saving, had not translated into practice in some hospitals. This came to light in a lively #WeNurses tweetchat on the evidence and you can catch up with it in this blog.
I’ve also blogged here about evidence from a number of Cochrane reviews on different aspects of infection prevention for people with CVCs but since then we’ve seen the publication of more reviews, including this one on skin antisepsis. Was that on your list? Here in the UK, NICE guidance (epic3 again) recommends cleansing with chlorhexidine gluconate in 70% alcohol, or povidone iodine in alcohol for patients sensitive to chlorhexidine (tick). Can we tick off evidence of effectiveness?
The review brought together data from 12 randomised studies with 3446 CVCs (number of patients unknown), comparing different skin antisepsis regimens with each other and with none. Whilst there is nothing here to overturn the guidance, the evidence is mostly low or very low quality and, beyond saying that chlorhexidine solution may be more effective than povidone iodine, any questions about which regimen is best or whether skin antisepsis benefits patients are left unanswered.
Read the full post here