Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter-associated urinary tract infections

O Fasugba; J Koerner; B G Mitchell; A Gardner

doi:10.1016/j.jhin.2016.10.025

Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter-associated urinary tract infections

J Hosp Infect. 2017 Mar;95(3):233-242. doi: 10.1016/j.jhin.2016.10.025. Epub 2016 Nov 4.

Authors

O Fasugba¹, J Koerner², B G Mitchell³, A Gardner²

Affiliations

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.

PMID: 27986361
DOI: 10.1016/j.jhin.2016.10.025

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.

Keywords: Antiseptic; Meatal cleaning; Meta-analysis; Systematic review; Urinary catheter; Urinary tract infection.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Anti-Infective Agents, Local / administration & dosage*
Antisepsis / methods*
Catheter-Related Infections / prevention & control*
Catheterization / methods*
Humans
Randomized Controlled Trials as Topic
Treatment Outcome
Urinary Tract Infections / prevention & control*

Substances

Anti-Infective Agents, Local