Summary of findings 7. Chlorhexidine versus non‐antibacterial.
| Chlorhexidine versus non‐antibacterial | ||||||
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Patient or population: people with burns Intervention: chlorhexidine Comparison: non‐antibacterial treatments (dressings) Setting: hospitals and burn clinics | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with non‐antibacterial dressing | Risk with biguanides | |||||
| Wound healing: time to complete healing (time‐to‐event data): chlorhexidine versus polyurethane | 1000 per 1000 | 1000 per 1000 (1000 to 1000) | HR 0.71 (0.39 to 1.29) | 51 (1 RCT) | ⊕⊕⊝⊝ Low1 | There may be some difference in the 'chance' of healing for chlorhexidine compared with polyurethane but CIs span benefit and harm so a clear difference between treatments is not apparent |
| Risk Difference: 0 difference per 1000 for chlorhexidine compared with polyurethane (0 to 0) | ||||||
| Wound healing (mean time to healing): chlorhexidine versus non‐antibacterial | The mean time to wound healing ‐ chlorhexidine versus polyurethane was 10 days | The mean time to wound healing ‐ chlorhexidine versus polyurethane in the intervention group was 4.08 days longer (0.73 longer to 7.43 longer) | MD 4.08 (0.73 to 7.43) | 51
(1 RCT) 153 participants in 2 RCTs did not have evaluable data |
⊕⊕⊝⊝ Low2 | The mean time to wound healing may be slightly longer in burns treated with chlorhexidine compared with polyurethane; data from 2 additional RCTs comparing chlorhexidine with hydrocolloid lacked measures of variance |
| Infection: chlorhexidine versus no antimicrobial/no additional antimicrobial | 179 per 1000 | 184 per 1000 (86 to 396) | RR 1.11 (0.54 to 2.27) | 172 (2 RCT) | ⊕⊝⊝⊝ Very low3 | It is uncertain whether there is a difference in the incidence of infection between participants treated with chlorhexidine either alone or in addition to SSD and participants treated with no antimicrobial or SSD alone |
| Risk Difference: 15 more infections per 1000 with chlorhexidine compared with non‐antibacterial treatments (64 fewer to 178 more) | ||||||
| Adverse events: chlorhexidine versus hydrocolloid | 102 per 1000 | 20 per 1000 (2 to 168) | RR 0.20 (0.02 to 1.65) | 98 (1 RCT) | ⊕⊝⊝⊝ Very low4 | It is uncertain whether there is a difference in the number of participants with adverse effects between chlorhexidine and a hydrocolloid dressing |
| Risk Difference: 82 fewer participants with adverse events with chlorhexidine compared with hydrocolloid (100 fewer to 66 more) | ||||||
| *The risk in the intervention group (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). CI: confidence interval; HR: hazard ratio; MD: mean difference; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High: It is very likely that the effect will be close to what was found in the research. Moderate: It is likely that the effect will be close to what was found in the research, but there is a possibility that it will be substantially different. Low: It is likely that the effect will be substantially different from what was found in the research, but the research provides an indication of what might be expected. Very low: The anticipated effect is very uncertain and the research does not provide a reliable indication of what might be expected. | ||||||
1Downgraded twice for imprecision due to wide confidence intervals, which cross the line of no effect, and fragility due to small numbers of participants. 2Downgraded twice for imprecision due to wide confidence intervals, which cross the line of no effect, and fragility due to small numbers of participants. The study with unit of analysis issues did not contribute to the analysis. 3Downgraded once due to risk of detection bias and once due to attrition bias in a trial with 90% of the analysis weight and twice due to imprecision. 4Downgraded once due to risk of detection bias and once due to attrition bias in the single trial; downgraded once for imprecision as confidence intervals cross line of no effect.