Risk of Bias Assessments of Individual Studies

Appendix - Updated Recommendations on the Use of Chlorhexidine-Impregnated Dressings for Prevention of Intravascular Catheter-Related Infections (2017)
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Appendix: 3.0 Risk of Bias Assessments of Individual Studies

 

Note: Overall risk of bias was calculated by dividing the total number of valuable trial characteristics by the total number of possible characteristics and applying these categories:

  • ≤ 25% = high risk of bias;
  • > 25% to ≤ 50% = moderate risk of bias;
  • > 50% = low risk of bias.
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Table 8
Evaluation of Risk of Bias in Studies Using C-I Dressings among Patients Aged ≥ 18 Years with Short-term, Non-tunneled Central Venous Catheters

n/a

Studies and risk of bias for patients 18 or over.
Author
Publication Year		 Arvaniti
20124		 Roberts
19985		 Ruschulte
20093		 Timsit
20092		 Timsit
20121
Described as randomized ✓ ✓ ✓ ✓ ✓
Randomization appropriately performed ✓ n/a ✓ ✓ ✓
Described as double–blind n/a n/a n/a n/a
Outcome assessor blinded ✓ ✓ n/a ✓ ✓
Study participant blinded n/a n/a n/a n/a
Investigator blinded n/a n/a n/a n/a n/a
Attrition described ✓ ✓ ✓ ✓ ✓
Attrition smaller than 10–15% of assigned patients ✓ n/a ✓ ✓ ✓
Attrition appropriately analyzed ✓ n/a ✓ ✓ ✓
Funding source(s) disclosed and no obvious conflict of interest n/a n/a n/a n/a n/a
Overall Risk of Bias Low Moderate Low Low Low
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Table 9
Evaluation of Risk of Bias in Studies Using C-I Dressings among Patients Aged < 18 Years with Short-term, Non-tunneled Central Venous Catheters

Studies and risk of bias for patients under 18.
Author
Publication Year		 Garland
20016		 Levy
20058		 Duzkaya
20167
Described as randomized ✓ ✓ ✓
Randomization appropriately performed ✓ ✓ ✓
Described as double–blind n/a n/a n/a
Outcome assessor blinded n/a n/a n/a
Study participant blinded n/a n/a n/a
Investigator blinded n/a n/a n/a
Attrition described ✓ ✓ ✓
Attrition smaller than 10–15% of assigned patients n/a n/a ✓
Attrition appropriately analyzed n/a n/a n/a
Funding source(s) disclosed and no obvious conflict of interest n/a n/a n/a
Overall Risk of Bias Moderate Moderate Moderate
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References
  1. Timsit JF, Mimoz O, Mourvillier B, et al. Randomized controlled trial of chlorhexidine dressing and highly adhesive dressing for preventing catheter-related infections in critically ill adults. Am J Respir Crit Care Med. 2012;186(12):1272-1278.
  2. Timsit JF, Schwebel C, Bouadma L, et al. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. 2009;301(12):1231-1241.
  3. Ruschulte H, Franke M, Gastmeier P, et al. Prevention of central venous catheter related infections with chlorhexidine gluconate impregnated wound dressings: a randomized controlled trial. Ann Hematol. 2009;88(3):267-272.
  4. Arvaniti K, Lathyris D, Clouva-Molyvdas P, et al. Comparison of Oligon catheters and chlorhexidine-impregnated sponges with standard multilumen central venous catheters for prevention of associated colonization and infections in intensive care unit patients: a multicenter, randomized, controlled study. Crit Care Med. 2012;40(2):420-429.
  5. Roberts B, Cheung D. Biopatch–a new concept in antimicrobial dressings for invasive devices. Aust Crit Care. 1998;11(1):16-19.
  6. Garland JS, Alex CP, Mueller CD, et al. A randomized trial comparing povidone-iodine to a chlorhexidine gluconate-impregnated dressing for prevention of central venous catheter infections in neonates. 2001;107(6):1431-1436.
  7. Duzkaya DS, Sahiner NC, Uysal G, Yakut T, Citak A. Chlorhexidine-Impregnated Dressings and Prevention of Catheter-Associated Bloodstream Infections in a Pediatric Intensive Care Unit. Crit Care Nurse. 2016;36(6):e1-e7.
  8. Levy I, Katz J, Solter E, et al. Chlorhexidine-impregnated dressing for prevention of colonization of central venous catheters in infants and children: a randomized controlled study. Pediatr Infect Dis J. 2005;24(8):676-679.
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Page last reviewed: December 14, 2017
Content source: Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP)