| Study | Reason for exclusion |
|---|---|
| Almeida 2009 | Before‐and‐after study. Basis of exclusion: design |
| Apisarnthanarak 2010 | Quasi‐experimental before‐and‐after study. Basis of exclusion: design |
| Assadian 2004 | A commentary to Parienti 2004. Basis of exclusion: article type |
| Astle 2005 | An RCT that assessed ExSept versus chlorhexidine for patients with haemodialysis catheters. Basis of exclusion: population |
| Balamongkhon 2007 | Non‐randomised trial that assessed CVC site care using 2% chlorhexidine gluconate versus povidone‐iodine. Basis of exclusion: design |
| Bilir 2009 | This is a conference abstract of an study awaiting classification (BIlir 2013) |
| Borghesi 2011 | A review article on infection control strategies for the newborn. Basis of exclusion: article type and population |
| Bowling 2010 | A before‐and‐after study that assessed a multifaceted programme in decreasing blood culture contamination. Basis of exclusion: study design |
| Camins 2010 | Cross‐over study that assessed chlorhexidine‐impregnated foam dressing for prevention of catheter‐related BSI in patients undergoing haemodialysis. Basis of exclusion: design, population and intervention |
| Carrer 2005 | RCT that compared maximal sterile barrier (consisting of mask, cap, sterile gloves, gown, large drape) versus control precautions (mask, cap, sterile gloves, small drape) and transparent polyurethane film versus gauze dressing for reduction of CVC‐related infections. Basis of exclusion: intervention |
| Casey 2003 | A single‐centre RCT (UK) that compared the PosiFlow needleless connector against the standard luer cap attached to the CVCs for adult patients admitted for cardiac surgery. The authors used a factorial design which enabled the concurrent 3‐arm comparison of 3 different skin antiseptic solutions (0.5% chlorhexidine/alcohol, 70% isopropyl alcohol and 10% povidone–iodine) applied prior to the insertion of the catheters. However, the major outcome assessed was "stopcock entry port microbial contamination" rather than catheter colonisation, and this is not part of the prespecified outcomes in our review. Basis of exclusion: study design (design of the outcome) |
| Casey 2007 | RCT that compared a needless connector set (Clearlink Y‐type extension set) against standard 3‐way stopcocks with caps for reducing CVC related infections. Basis of exclusion: intervention |
| Cepkova 2006 | A review article on reducing catheter‐related infections in the ICU. Basis of exclusion: article type |
| Chaiyakunapruk 2003 | Cost‐effectiveness analysis on chlorhexidine gluconate versus povidone‐iodine for catheter site care. Basis of exclusion: article type |
| Crawford 2004 | Cost‐benefit analysis of chlorhexidine gluconate dressing in reducing catheter‐related infections. Basis of exclusion: article type |
| Daghistani 1996 | RCT that assessed antibiotic flush for CVCs in children with cancer. Basis of exclusion: intervention |
| Darouiche 2007 | A review article on strategies to prevent catheter‐related infections. Basis of exclusion: article type |
| Darouiche 2008 | A review article on strategies to prevent catheter‐related infections. Basis of exclusion: article type |
| Dean 2011 | A cross‐over study that compared the use of chlorhexidine solution against chlorhexidine‐impregnated cloth for CVC care. Basis of exclusion: study design |
| Dettenkofer 2002 | A quasi‐randomised trial in which patients were assigned on an alternate basis to either octenidine‐based skin antiseptic solution versus propanol‐based solution. Additionally, the results were presented in 25th centile, median and 75th centile of quantitative skin culture (in CFU/24 cm2) which does not allow extraction for meta‐analysis. Basis of exclusion: study design and data reporting |
| Eggimann 2010 | A prospective non‐randomised study that assessed catheter‐related infections following the introduction of various infection control strategies. Basis of exclusion: study design |
| Eyberg 2008 | RCT that assessed chlorhexidine gluconate gel dressing versus chlorhexidine gluconate disk in reducing CVC‐related infections. Basis of exclusion: intervention |
| Freiberger 1992 | A quasi‐experimental study comparing 2 skin antisepsis regimens (chlorhexidine and povidone‐iodine) and 2 types of dressing (Tegaderm and standard gauze) in a 4‐arm comparison of different combinations. The authors only reported the results in F or X2 values along with the P values, without reporting the raw data, which precluded data extraction for meta‐analysis. Basis of exclusion: study design and data reporting |
| Fukunaga 2004 | A non‐randomised study with historical cohort that assessed povidone‐iodine ointment in addition to dressing in reducing CVC‐related infections. Basis of exclusion: study design |
| Garcia 2010 | A non‐randomised study that assessed the effect of chlorhexidine scrub of the CVC hub during each access in reducing CVC‐related infections. Basis of exclusion: study design |
| Garcia‐Teresa 2007 | A multicentre observational study that evaluated CVC‐related infections in children. Basis of exclusion: study design |
| Garcia‐Vazquez 2011 | A before‐and‐after study that evaluated the effect of a hand hygiene promotion programme in reducing infections in an ICU. Basis of exclusion: study design |
| Garland 1996 | An RCT that assessed the local reaction to a chlorhexidine gluconate‐impregnated antimicrobial dressing in very low birth weight infants. Basis of exclusion: population and intervention |
| Garland 2001 | An RCT that compared chlorhexidine gluconate‐impregnated dressing with povidone‐iodine skin scrub for prevention of CVC‐related infections in neonates. Basis of exclusion: population |
| Garland 2009a | An RCT that compared chlorhexidine gluconate with povidone‐iodine as skin antisepsis prior to CVC placement in neonates. Basis of exclusion: population |
| Garland 2009b | An RCT that assessed the safety of chlorhexidine gluconate in neonates with percutaneously inserted central venous catheters. Basis of exclusion: population |
| Gilad 2006 | A review article on prevention of catheter‐related BSI in the neonatal intensive care setting. Basis of exclusion: article type |
| Girard 2012 | A longitudinal cohort study that compared two CVC cleaning protocols (containing alcohol‐based povidone‐iodine solution (Betadine alcolique) and chlorhexidine‐based antiseptic (Biseptine), respectively) administered in different periods. Basis of exclusion: study design |
| Gnass 2004 | A prospective, non‐randomised study that evaluated the effect of multiple infection control strategies in reducing catheter‐related infections. Basis of exclusion: study design |
| Gunst 2011 | A non‐randomised trial that compared antiseptic‐impregnated CVC with peripherally‐inserted central line in reducing catheter‐related infections. Basis of exclusion: study design and intervention |
| Habibzadeh 2013 | A commentary on an included study (Yousefshahi 2013) |
| Hachem 2002 | A review article on prevention of catheter‐related infection in long‐term catheters. Basis of exclusion: article type |
| Halpin 1991 | An RCT that evaluated the effect of povidone‐iodine connection shield that is incorporated in the catheter hub in reducing CVC‐related infections. Basis of exclusion: intervention |
| Hanazaki 1999 | An RCT that assessed the effect of chlorhexidine dressing in reducing catheter colonisation. Basis of exclusion: intervention |
| Hill 1990 | An RCT that assessed the effect of mupirocin ointment on colonisation rate of internal jugular vein catheters. Basis of exclusion: intervention |
| Huang 2006 | A retrospective study that assessed the effect of multiple infection control measures on the rates of methicillin‐resistant Staphylococcus aureus infection in an adult ICU. Basis of exclusion: study design |
| Hutchinson 1990 | An RCT that assessed occlusive versus non‐occlusive right atrial catheter dressing change procedures in children with cancer. Basis of exclusion: intervention |
| Ishikawa 2010 | An RCT comparing maximal sterile barrier precaution versus standard sterile barrier precaution measures during CVC insertion in reducing CVC‐related infections. Basis of exclusion: intervention |
| Ishizuka 2009 | A non‐randomised trial that compared the use of chlorhexidine versus povidone‐iodine for CVC site skin disinfection in 2 separate cohorts of patients. Basis of exclusion: study design |
| Johnson 2005 | An RCT that compared honey versus mupirocin applied at the catheter exit site for preventing catheter‐related infections in patients undergoing haemodialysis. Basis of exclusion: population and intervention |
| Khattak 2010 | An RCT that evaluated the absorption of silver in very low birthweight infants who received silver alginate‐impregnated central venous catheter. Basis of exclusion: population and intervention |
| Khouli 2009 | A conference abstract that reports the impact of simulation training on residents' performance in adhering to maximum sterile barrier precaution during CVC insertion. Basis of exclusion: research question and design |
| Krein 2007 | A national survey on measures to reduce catheter‐related BSI. Basis of exclusion: study design |
| Kruse 1999 | This is a commentary on an included study (Mimoz 1996). Basis of exclusion: article type |
| Kulkarni 2013 | An RCT that compared the use of 10% povidone‐iodine versus 2% chlorhexidine for skin disinfection prior to insertion of epidural or central venous catheters. The study combined both epidural and CVCs is the outcome reporting with no separate data for CVC, and more importantly, the outcome of skin colonisation was assessed based on a skin swab that was taken immediately after the application of the skin antiseptic agent, which did not fit in with our question of whether the application of skin antiseptic agent reduces catheter‐related infection during the period of catheter use. Excluded on th basis of research question and design |
| Lange 1997 | A non‐randomised trial that assessed a multifaceted strategy in CVC management in reducing catheter‐related infection in children with chronic illness. Basis of exclusion: study design |
| Le Corre 2003 | An RCT comparing transparent dressing versus a dry gauze applied at the exit site of the catheter on haemodialysis patients. Basis of exclusion: population and intervention |
| Legras 1997 | An RCT comparing alcohol‐chlorhexidine against povidone‐iodine for skin antisepsis for intravascular catheters. The study evaluated a mixture of venous, arterial and Swan Gantz catheters with no separate outcome reporting for venous catheters. There were no contact details provided in the paper to request for separate data for venous catheters. Basis of exclusion: insufficient information |
| Levy 2005 | An RCT that assessed the effectiveness of chlorhexidine gluconate‐impregnated dressing in reducing catheter‐related infections in children. Basis of exclusion: intervention |
| Madeo 1998 | An RCT comparing 2 different dressings for arterial and venous catheters in reducing catheter‐related infections. Basis of exclusion: intervention |
| Mahieu 2001 | A prospective cohort study that evaluated the effect of catheter manipulation on catheter‐related BSI in neonates. Basis of exclusion: study design, population and intervention |
| Maki 1981 | A commentary on disinfectant for vascular catheters. Basis of exclusion: article type |
| Maki 1992 | An RCT comparing different antibiotic ointments for preventing catheter‐related infection. Basis of exclusion: intervention |
| McCann 2016 | A pilot RCT involving in 3 Irish outpatient hemodialysis units compared 2% chlorhexidine gluconate (CHG) in 70% isopropyl alcohol with CHG solutions for central venous catheter exit site antisepsis. Basis of exclusion: population. |
| Montecalvo 2012 | A prospective cohort study that evaluated the rates of catheter‐related BSI over 3 study periods: pre‐intervention (phase 1), in which all patients were bathed with soap and water or non‐medicated washcloths; active intervention (phase 2), in which patients were bathed with 2% chlorhexidine gluconate cloths with the number of baths administered and skin tolerability assessed; and post‐intervention (phase 3), in which chlorhexidine bathing continued but without oversight by research personnel. Basis of exclusion: study design |
| Munoz‐Price 2009 | A non‐randomised study that evaluated a step‐wise infection control approach in reducing catheter‐related infection. Basis of exclusion: study design, intervention |
| Munoz‐Price 2012 | A non‐randomised study that evaluated the use of daily chlorhexidine bath in reducing catheter‐related infection. Basis of exclusion: study design |
| Nikoletti 1999 | An RCT comparing transparent polyurethane and hydrocolloid dressings for CVC in reducing catheter‐related infection. Basis of exclusion: intervention |
| Noto 2014 | A cluster‐RCT that assessed the effects of daily chlorhexidine bathing on the rates of healthcare associated infection in general for all ICU patients, not specific to patients with CVC in place. Basis of exclusion: population |
| Parienti 2004 | A cluster‐randomised cross‐over study that assessed the effectiveness of alcoholic povidone‐iodine in preventing catheter‐related infection. Basis of exclusion: study design |
| Peterson 2011 | An evidence‐based summary on the effectiveness of chlorhexidine versus 70% alcohol for CVC injection cap disinfection. Basis of exclusion: article type |
| Raad 1994 | An RCT that assessed the effectiveness of maximal sterile precaution during CVC insertion in reducing catheter‐related infection. Basis of exclusion: intervention |
| Render 2006 | A cluster‐randomised trial that assessed the effectiveness of 2 multifaceted infection control projects in reducing central line infections. Basis of exclusion: study design |
| Rezaei 2009 | An RCT that assessed the effectiveness of mupirocin ointment in reducing catheter‐related infection. Basis of exclusion: intervention |
| Richardson 2006 | A commentary on Parienti 2004. Basis of exclusion: article type |
| Rickard 2004 | An RCT that assessed the effectiveness of changing intravenous administration set for reducing catheter‐related infection. Basis of exclusion: intervention |
| Rijnders 2003 | An RCT that assessed the use of full sterile barrier precaution in reducing catheter‐related infection. Basis of exclusion: intervention |
| Rubinson 2004 | A review article on measures to reduce catheter‐related infection during insertion of CVC. Basis of exclusion: article type |
| Rupp 2008 | A non‐randomised, comparative, cross‐over trial that evaluated the effectiveness of alcohol‐based hand gel in reducing hospital‐acquired infections. Basis of exclusion: research question, study design |
| Ruschulte 2009 | An RCT that assessed the effectiveness of chlorhexidine‐impregnated wound dressing in reducing CVC‐related infection in patients undergoing chemotherapy. Basis of exclusion: intervention |
| Schwebel 2012 | An economic analysis on chlorhexidine‐impregnated sponges for reducing catheter‐related infection. Basis of exclusion: article type |
| Sheehan 1993 | An article identified through a related review paper in the form of a conference abstract. The text of the conference abstract could not be traced after contacting the author of the review article. We were unable to locate the contact details of the authors of this conference paper to request for further information. The conference abstract did not appear to be published subsequently in full. Basis of exclusion: insufficient information |
| Spiegler 2010 | A review article comparing central venous line and arterial line infections. Basis of exclusion: article type |
| Swan 2014 | A cluster‐RCT that compared chlorhexidine bathing versus soap and water bathing in decreasing the rates of healthcare associated infection for all patients in ICUs, and not only patients with a CVC in place. Basis of exclusion: population |
| Tietz 2005 | A prospective observational study that assessed the effectiveness of octenidine hydrochloride for CVC site care in patients receiving bone marrow transplant. Basis of exclusion: study design |
| Van Esch 2002 | An evidence‐based summary that examined the role of chlorhexidine versus povidone‐iodine antisepsis for reducing catheter‐related infection in neonates. Basis of exclusion: article type |
| Zingg 2008 | An overview on catheter‐related BSI. Basis of exclusion: article type |
| Zingg 2009 | A before‐and‐after study that assessed the effectiveness of an educational programme on promoting hand hygiene measures in reducing catheter‐related BSI. Basis of exclusion: study design |
BSI: bloodstream infection; CFU: colony‐forming units; CVC: central venous catheter; RCT: randomised controlled trial.