Summary of findings for the main comparison. Chlorhexidine compared to povidone‐iodine in reducing catheter related infections.
| Chlorhexidine compared to povidone‐iodine for patients with a central venous catheter | |||||
| Patient or population: patients with a central venous catheter Settings: hospital inpatients Intervention: chlorhexidine Comparison: povidone‐iodine | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of Participants (studies) | Quality of the evidence (GRADE) | |
| Assumed risk | Corresponding risk | ||||
| Povidone‐iodine | Chlorhexidine | ||||
| Catheter‐related BSI ‐ overall comparison between chlorhexidine and povidone‐iodine (during in‐patient stay) |
Study population | RR 0.64 (0.41 to 0.99) | 1436 (4 RCTs) | ⊕⊝⊝⊝ Very lowb,c | |
| 64 per 1000 | 41 per 1000 (26 to 63) | ||||
| Moderatea | |||||
| 46 per 1000 | 29 per 1000 (19 to 45) | ||||
| Catheter‐related BSI ‐ subgroup: chlorhexidine in aqueous solution versus povidone‐iodine in aqueous solution | Study population | RR 0.64 (0.32 to 1.28) | 452 (2 RCTs) | ⊕⊝⊝⊝ Very lowc,d | |
| 86 per 1000 | 55 per 1000 (28 to 110) | ||||
| Moderate | |||||
| 84 per 1000 | 54 per 1000 (27 to 108) | ||||
| Catheter‐related BSI ‐ subgroup: chlorhexidine in alcohol versus povidone‐iodine in aqueous solution | Study population | RR 0.77 (0.39 to 1.53) | 503 (2 RCTs) | ⊕⊝⊝⊝ Very lowc,d | |
| 70 per 1000 | 54 per 1000 (27 to 108) | ||||
| Moderate | |||||
| 69 per 1000 | 53 per 1000 (27 to 106) | ||||
| Catheter‐related BSI ‐ subgroup: chlorhexidine in alcohol versus povidone‐iodine in alcohol | Study population | RR 0.4 (0.13 to 1.24) | 481 (1 RCT) | ⊕⊕⊕⊝ Moderatec | |
| 42 per 1000 | 17 per 1000 (5 to 52) | ||||
| Moderate | |||||
| 42 per 1000 | 17 per 1000 (5 to 52) | ||||
| Primary BSI or clinical sepsis | No studies under this comparison assessed this outcome. | ||||
| All‐cause mortality ‐ Chlorhexidine in aqueous solution versus povidone‐iodine in aqueous solution Clinical assessment | Study population | RR 1.15 (0.72 to 1.83) | 213 (1 RCT) | ⊕⊕⊝⊝ lowc,e | |
| 236 per 1000 | 271 per 1000 (170 to 432) | ||||
| Moderate | |||||
| 236 per 1000 | 271 per 1000 (170 to 432) | ||||
| All‐cause mortality ‐ Chlorhexidine in alcohol versus povidone‐iodine in aqueous solution Clinical assessment | Study population | RR 0.8 (0.48 to 1.34) | 222 (1 RCT) | ⊕⊕⊝⊝ lowc,e | |
| 236 per 1000 | 189 per 1000 (113 to 316) | ||||
| Moderate | |||||
| 236 per 1000 | 189 per 1000 (113 to 316) | ||||
| Mortality attributable the CVC‐related infections. | No studies under this comparison assessed this outcome. | ||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). BSI: bloodstream infection; CI: Confidence interval. | |||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | |||||
a'Moderate risk' was calculated from the median control event rate for each outcome. bThree of the four included studies had unclear risks of bias in allocation concealment, and all had high risks of bias in blinding of participants and personnel. cThe 95% CI was wide. dThere was an overall very serious concern on risk of bias that resulted in downgrading of two levels: both studies had unclear risk of bias under allocation concealment and high risk of bias under blinding of participants and personnel, and one study had serious unit of analysis issue as the outcome was reported using catheters as the unit, and the number of catheters analysed exceeded the number of participants by over 50%, reflecting that fact that some patients received multiple catheters during the study, which could have seriously affected the effect estimate. eThe single study had unclear risk in allocation concealment, high risk in blinding of patients and personnel which might give rise to performance bias, which in turn might affect the risk of mortality, as well as high risk of attrition bias.