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Preventing peripheral intravenous catheter-associated bloodstream infection: the randomised controlled trial versus the real world

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To the Editor: Debate regarding the prevention of peripheral intravenous catheter (PIVC)-associated bloodstream infection has been enriched by research and letters published in the Journal.13 Stuart and colleagues and Collignon and colleagues highlighted an association of long dwell times with PIVC-associated bloodstream infection.1,2 Rickard and colleagues refer to contrasting high-level evidence in a Cochrane review.3,4 We would suggest that important lessons can be learnt from both perspectives.

The Hawthorne effect and strict inclusion and exclusion criteria mean that, while largely free of bias, the outcomes of clinical trials are not generalisable. The retrospective data on PIVC-associated bloodstream infections reported by Stuart et al and Collignon et al, while methodologically limited, demonstrate the real-world experience of hundreds of patients.1,2

We believe that clinicians should consider all forms of evidence when designing processes to ensure safe stewardship of PIVCs. In health services with independent “line teams” and…