Hoffmann K K, Weber D J, Samsa G P, Rutala W A
Department of Medicine, University of North Carolina, Chapel Hill 27599-7030.
JAMA. 1992 Apr 15;267(15):2072-6.
To obtain a quantitative estimate of the impact on infectious complications of using transparent dressings with intravenous catheters.
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.
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.
Data for each study were abstracted independently by three investigators. At least three studies were used in the analysis of each outcome.
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).
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.
定量评估使用透明敷料固定静脉导管对感染性并发症的影响。
对英文文献中发表的所有研究进行荟萃分析，包括摘要、信函和报告，这些研究探讨了与透明敷料相比，纱布敷料用于中心静脉导管和外周静脉导管时的感染风险这一主要研究问题。通过使用MEDLINE数据库，利用“封闭敷料”“透明敷料”和“感染”等索引词，并查阅参考文献目录来识别研究。
15项关于中心静脉导管的研究中有7项（47%），12项关于外周导管的研究中有7项（58%）符合我们的纳入分析标准。所有研究均采用前瞻性队列设计，纳入住院患者，并报告了我们定义的至少一项结局。
由三名研究人员独立提取每项研究的数据。每项结局的分析至少使用三项研究。
应用Mantel-Haenszel卡方分析，在中心静脉导管上使用透明敷料与导管尖端感染的相对风险（RR）显著升高相关（RR = 1.78；95%置信区间[CI]，1.38至2.30）。导管相关败血症（RR = 1.69；95%CI，0.97至2.95）和菌血症（RR = 1.63；95%CI，0.76至3.47）的RR也均升高。在外周导管上使用透明敷料与导管尖端感染的RR升高相关（RR = 1.53；95%CI，1.18至1.99），但与静脉炎（RR = 1.02；95%CI，0.86至1.20）、渗血（RR = 1.12；95%CI，0.92至1.37）或皮肤定植（RR = 0.99；95%CI，0.90至1.09）无关。
结果表明，与纱布敷料相比，透明敷料用于中心静脉导管或外周静脉导管时，导管尖端感染的风险显著增加。提示与纱布敷料相比，透明敷料用于中心静脉导管时，菌血症和导管败血症的风险增加。
