Safety and efficacy of silicone tape for indwelling urinary catheter fixation in intensive care patients-A randomized clinical trial.

BACKGROUND: Critically ill patients are more vulnerable to medical adhesive-related skin injuries (MARSI), whose prevention is a constant challenge and one of the main quality indicators of nursing care. MARSI associated with indwelling urinary catheter (IUC) fixation is a relevant adverse event, mainly because of the constant involuntary traction and high skin vulnerability of the fixation site. Silicone adhesive tape has appreciable qualities for fragile skin among the range of adhesives, leading to the inference that it reduces the risk of MARSI. AIM: To compare silicone adhesive tape for IUC fixation with acrylate tape regarding its safety and efficacy. STUDY DESIGN: This was a randomized controlled trial blinded to the patients and evaluator. Data were collected from an intensive care unit (ICU) of a tertiary university hospital in Brazil. Patients with IUC and no MARSI at the fixation site were considered eligible. The omega (Ω) fixation technique was used for IUC fixation. A total of 132 participants were enrolled and divided into two research groups: 66 patients in the intervention group (silicone tape) and 66 in the control group (acrylate tape). Outcomes were the incidence of MARSI, patient outcome in the ICU and hospital and partial, total and overall spontaneous detachment of the tapes. RESULTS: The overall incidence of MARSI was 28%, with 21% in the silicone group and 35% in the acrylate group, with no statistically significant difference (p = .121), including the severity of the lesions (p = .902). However, partial (p = .003) and overall (p < .001) detachment of the tapes were more frequent in the silicone group. CONCLUSIONS: Silicone tape is no safer than acrylate tape for IUC fixation and is less adhesively effective. RELEVANCE TO CLINICAL PRACTICE: There is no evidence to support the extensive use of silicone tape in this context.

Impact of sterile gloves on blood-culture contamination rates: A randomized clinical trial.

BACKGROUND: Reducing the blood-culture contamination rate is a constant challenge for health services. This study aimed to analyze whether blood-culture (BC) collection using sterile gloves reduces the contamination rate when compared to the non-sterile gloves, and to compare baseline and intervention periods. METHODS: A randomized clinical trial, performed in an intensive care unit in Brazil and paired in two groups: sterile (BCs obtained with modified sterile technique: only sterile gloves; no fenestrated drape or dedicated sterile collection kit) and clean (clean technique: usual care with non-sterile gloves). Two paired blood samples were obtained from each patient by trained and calibrated nurses. BCs were processed by conventional microbiological methods and the results were issued by blinded microbiologists. RESULTS: There was no difference (P = 1.00) in the contamination rate of BC between the sterile (1%) and clean (1%) groups. However, there was a significant difference (P = 0.05; relative risk: 0.17; 95% confidence interval: 0.04-0.70) in the contamination rate between baseline (6.1%; 20/330) and intervention (1%; 2/200). CONCLUSIONS: This study suggests that the aseptic care provided in obtaining samples is more important than the sterile technique itself, and highlights the value of standardizing the practices, qualification and calibration of phlebotomists.