To the Editor.
—In a recent article, Hoffmann et al1 found statistically significant increases in catheter-tip infection rates for transparent as opposed to gauze dressings. With hundreds of patients in the combined studies, they found no significant increase in phlebitis, infiltration or skin colonization for peripheral venous catheters, and none in bacteremia or sepsis for central venous catheters.Unfortunately, they conclude, "While it should not be assumed that transparent dressings would... increase... bacteremia, it is likely that higher rates of catheter-tip infection will result in an elevated rate of bacteremia." They say that the "literature [shows] that catheter-tip infection is an excellent harbinger of bacteremia and sepsis." They cite Maki,2 but his article says "positive cultures found using this technique have a 15 to 40 percent association with concomitant bacteremias." Also, Nahass and Weinstein3 estimate the positive predictive value to be 17%. "Excellent harbinger" is hardly appropriate.
Berry DA. Transparent Polyurethane Film as a Catheter Dressing. JAMA. 1992;268(18):2514–2515. doi:10.1001/jama.1992.03490180046016