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.

Data Sources.

—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 termsocclusive dressings, transparent dressings, andinfectionand by review of referenced bibliographies.

Study Selection.

—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.

Extraction.

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

Data Synthesis.

—Applying a Mantel-Haenszel χ²analysis, 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).

Conclusion.

—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. (JAMA. 1992;267:2072-2076)