Transparent Polyurethane Film as an Intravenous Catheter Dressing: A Meta-analysis of the Infection Risks

Objective.—To obtain a quantitative estimate of the impact on infectious complications of using transparent dressings with intravenous catheters. Data Sources.—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. Study Selection.—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. Extraction.—Data for each study were abstracted independently by three investigators. At least three studies were used in the analysis of each outcome. Data Synthesis.—Applying a Mantel-Haenszel χ2 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). Conclusion.—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

In Reply

In Reply - When comparing the infection risks of transparent vs gauze dressings used on central venous catheters, the RRs were 1.78 for catheter-tip infection, 1.63 for bacteremia, and 1.69 for catheter sepsis. These RRs represent the best assessment of the overall risk associated with the use of transparent dressings. (For catheter-tip infection, P<.001; for catheter sepsis, P=.06.) In our discussion we used the word "trend" in discussing this level of significance. The choice of .05 as the level of "statistical significance" is arbitrary, and given the RRs demonstrated in the meta-analysis, further studies are warranted before accepting transparent dressings as safe

Plantation Forestry and Economic Development in the Tiwi Islands

The maritime borders of Australia include over 8,000 islands. The second largest of these – Melville Island 5,786 km² together with the fourth largest – Bathurst Island 1,693 km² (and a number of tiny outlier islands) comprise the Tiwi Island group within the Northern Territory. Since 1960 seven investment groups have attempted to develop forestry plantations on Melville Island. The Tiwi landowners and the investors have sought sustainable outcomes from plantation forestry. Fifty years experience has provided a range of data and understanding that informs the Tiwi Plantations corporate model developed by landowners. Three substantial independent financial appraisals of the Tiwi islands forestry project have been undertaken by Poyry Forest Industry Pty Ltd in 2010, 2012 and 2014. All analyses were for a single rotation of A. mangium, and they provide useful guidance about the economic merit, from a private investment viewpoint, of establishing, growing and harvesting this species over a series of ten year cycles of forest plantation on Melville Island. In this paper, a social benefit cost framework is used to appraise the potential contribution to Tiwi Islanders of plantation forestry on the Melville Island. Analysis of the priced benefits and costs of investment of a ten year cycle of A.mangium under most likely yields and prices indicates that the investment in Acacia plantation forestry has a 35 per cent probability of earning a 4 per cent p.a. or greater real return on capital. To double the odds to two chances in three of earning the annual required return on capital of 4 per cent real return on capital, an additional $100m of unpriced benefits need to be generated over the forty years life of the plantation rotation. This would require unpriced annual benefits of$5.1m or $2550 per Tiwi Islander. The Tiwi Islanders currently have 30,000 ha of mature Acacia to harvest. They have relatively small landowner debt to service, an established port and confirmed buyers. Re-investment of the cash returns from the current harvest into more plantation forestry to secure future community benefit is not a compelling attraction; re-investing these revenues to grow-out Acacia over further rotations is unlikely to benefit landowners as much as investing the proceeds in a sovereign wealth fund

Impaired Immunogenicity of Hepatitis B Vaccine in Obese Persons

To the Editor: The plasma-derived hepatitis B vaccine (Heptavax B, Merck Sharp & Dohme) is currently recommended for medical personnel at high risk of acquiring hepatitis B

Cost efficiency of anticoagulation with warfarin to prevent stroke in medicare beneficiaries with nonvalvular atrial fibrillation

10.1161/STROKEAHA.110.592907Stroke421112-118SJCC

Hypertension Improvement Project (HIP): Study protocol and implementation challenges

10.1186/1745-6215-10-13Trials101