OBJECTIVES: There are two types of intravenous (i.v.) fluid containers in use: a collapsible plastic container that requires no external venting for the bag to empty (a closed infusion container) and a non-collapsible container (glass bottle or semi-rigid plastic bottle) that must be vented externally to allow air to enter and the fluid to egress (an open infusion container). The objective of the review was to carry out meta-analytic statistical pooling of key clinical outcomes which define open vs. closed systems.

METHODS: MEDLINE including was systematically searched, pairing relevant keywords to identify English language articles describing outcomes in clinical studies. Direct meta-analysis technique was employed as-per appropriate algorithms (random effects/fixed effects model) with respect to clinical outcomes (dichotomous/continuous). RevMan 5 software was used for statistical analysis.

RESULTS: Meta-analysis showed that there is 3.26 times greater risk of central line blood-stream infections (CLABSI) in open compared to closed system and there is 3.43 times greater odds of CLABSI in open compared to closed system. CLABSI rate in open system ranges from 6.4 to 16.1 CLABSI /1000 CL days and CLABSI rate in closed system ranges from 2.2 to 3.5 CLABSI /1000 CL days. Meta Analysis of evidence pertaining to mortality showed that there is 1.23 times greater risk of death in open compared to closed system and there is 1.28 times greater odds of death in open compared to closed system. Mortality proportion in open system ranges from 2.8% to 23.40% while in closed system it ranges from 0.26% to 16.90%. Furthermore, mean (SD) LOS (ICU days) in open system ranges from 4.5 (7.16) to 17.41(0) whereas mean (SD) LOS (ICU days) in closed system ranges from 4.7(6.94) to 7.9 (8.57).

CONCLUSIONS: Meta-analytic findings indicate that use of open i.v. systems pose discernible threat to patients and significantly contributes to HAI burden.