O Fasugba1, J Koerner2, B G Mitchell3, A Gardner2. 1. Faculty of Health Sciences, Australian Catholic University, Canberra, Australian Capital Territory, Australia; Lifestyle Research Centre, Avondale College of Higher Education, Cooranbong, New South Wales, Australia. Electronic address: oyebola.fasugba@acu.edu.au. 2. Faculty of Health Sciences, Australian Catholic University, Canberra, Australian Capital Territory, Australia. 3. Faculty of Arts, Nursing and Theology, Avondale College, Wahroonga, New South Wales, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.
Abstract
BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections. Antiseptic cleaning of the meatal area before and during catheter use may reduce the risk of CAUTIs. AIM: To undertake a systematic review of the literature and meta-analysis of studies investigating the effectiveness of antiseptic cleaning before urinary catheter insertion and during catheter use for prevention of CAUTIs. METHODS: Electronic databases were searched to identify randomized controlled trials. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and compared across intervention and control groups using DerSimonian-Laird random-effects model. Subgroup analyses were performed. Heterogeneity was estimated using the I2 statistic. FINDINGS: In total, 2665 potential papers were identified; of these, 14 studies were eligible for inclusion. There was no difference in the incidence of CAUTIs when comparing antiseptic and non-antiseptic agents (pooled OR 0.90, 95% CI 0.73-1.10; P=0.31), or when comparing different agents: povidone-iodine vs routine care; povidone-iodine vs soap and water; chlorhexidine vs water; povidone-iodine vs saline; povidone-iodine vs water; and green soap and water vs routine care (P>0.05 for all). Comparison of an antibacterial agent with routine care indicated near significance (P=0.06). There was no evidence of heterogeneity (I2=0%; P>0.05). Subgroup analyses showed no difference in the incidence of CAUTIs in terms of country, setting, risk of bias, sex and frequency of administration. CONCLUSIONS: There were no differences in CAUTI rates, although methodological issues hamper generalizability of this finding. Antibacterial agents may prove to be significant in a well-conducted study. The present results provide good evidence to inform infection control guidelines in catheter management.
BACKGROUND: Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections. Antiseptic cleaning of the meatal area before and during catheter use may reduce the risk of CAUTIs. AIM: To undertake a systematic review of the literature and meta-analysis of studies investigating the effectiveness of antiseptic cleaning before urinary catheter insertion and during catheter use for prevention of CAUTIs. METHODS: Electronic databases were searched to identify randomized controlled trials. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and compared across intervention and control groups using DerSimonian-Laird random-effects model. Subgroup analyses were performed. Heterogeneity was estimated using the I2 statistic. FINDINGS: In total, 2665 potential papers were identified; of these, 14 studies were eligible for inclusion. There was no difference in the incidence of CAUTIs when comparing antiseptic and non-antiseptic agents (pooled OR 0.90, 95% CI 0.73-1.10; P=0.31), or when comparing different agents: povidone-iodine vs routine care; povidone-iodine vs soap and water; chlorhexidine vs water; povidone-iodine vs saline; povidone-iodine vs water; and green soap and water vs routine care (P>0.05 for all). Comparison of an antibacterial agent with routine care indicated near significance (P=0.06). There was no evidence of heterogeneity (I2=0%; P>0.05). Subgroup analyses showed no difference in the incidence of CAUTIs in terms of country, setting, risk of bias, sex and frequency of administration. CONCLUSIONS: There were no differences in CAUTI rates, although methodological issues hamper generalizability of this finding. Antibacterial agents may prove to be significant in a well-conducted study. The present results provide good evidence to inform infection control guidelines in catheter management.
Authors: Felicia Skelton-Dudley; James Doan; Katie Suda; S Ann Holmes; Charlesnika Evans; Barbara Trautner Journal: Top Spinal Cord Inj Rehabil Date: 2019
Authors: Brett G Mitchell; Oyebola Fasugba; Anne Gardner; Jane Koerner; Peter Collignon; Allen C Cheng; Nicholas Graves; Peter Morey; Victoria Gregory Journal: BMJ Open Date: 2017-11-28 Impact factor: 2.692
Authors: Oyebola Fasugba; Allen C Cheng; Philip L Russo; Maria Northcote; Hannah Rosebrock; Brett G Mitchell Journal: BMJ Open Date: 2018-05-09 Impact factor: 2.692