Effectiveness of meatal cleaning in the prevention of catheter-associated urinary tract infections and bacteriuria: an updated systematic review and meta-analysis

Brett Mitchell; Cassie Curryer; Elizabeth Holliday; Claire M Rickard; Oyebola Fasugba

doi:10.1136/bmjopen-2020-046817

Effectiveness of meatal cleaning in the prevention of catheter-associated urinary tract infections and bacteriuria: an updated systematic review and meta-analysis

BMJ Open. 2021 Jun 8;11(6):e046817. doi: 10.1136/bmjopen-2020-046817.

Authors

Brett Mitchell¹, Cassie Curryer², Elizabeth Holliday³, Claire M Rickard^{4

5

6}, Oyebola Fasugba⁷

Affiliations

¹ School of Nursing and Midwifery, The University of Newcastle-Central Coast Campus, Ourimbah, New South Wales, Australia brett.mitchell@newcastle.edu.au.
² School of Nursing and Midwifery, The University of Newcastle-Central Coast Campus, Ourimbah, New South Wales, Australia.
³ School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.
⁴ School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia.
⁵ Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia.
⁶ Herston Infectious Disease Institute, Metro North Hospitals and Health Service, Brisbane, Queensland, Australia.
⁷ Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Sydney, New South Wales, Australia.

Abstract

Objective: A systematic review on meatal cleaning prior to urinary catheterisation and post catheterisation and reduces the risk catheter-associated urinary tract infections (CAUTIs) and bacteriuria was published in 2017, with further studies undertaken since this time. The objective of this paper is to present an updated systematic review on the effectiveness of antiseptic cleaning of the meatal area for the prevention of CAUTIs and bacteriuria in patients who receive a urinary catheter.

Design: Systematic review.

Data sources: Electronic databases Cochrane Library, PubMed, Embase, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Academic Search Complete were searched from 1 January 2016 and 29 February 2020.

Eligibility criteria: Randomised controlled trials (RCTs) and quasi-experimental studies evaluating the use of antiseptic, antibacterial or non-medicated agents for cleaning the meatal, periurethral or perineal areas before indwelling catheter insertion or intermittent catheterisation or during routine meatal care.

Data extraction and synthesis: Data were extracted using the Cochrane Collaboration's data collection form for RCTs and non-RCTs. Data were extracted by one researcher and then checked for accuracy by a second researcher.

Results: A total of 18 studies were included. Some potential benefit of using antiseptics, compared with non-antiseptics for meatal cleaning to prevent bacteriuria and or CAUTI was identified (OR 0.84, 95% CI 0.69 to 1.02; p=0.071). Antiseptics (chlorhexidine or povidine-iodine) may be of value for meatal cleaning on the incidence of CAUTI, compared with comparator agents (saline, soap or antimicrobial cloths) (OR=0.65, 95% CI 0.42 to 0.99; p=0.047).

Conclusion: There is emerging evidence of the role of some specific antiseptics (chlorhexidine) prior to urinary catheterisation, in reducing CAUTIs, and some potential benefit to the role of antiseptics more generally in reducing bacteriuria.

Prospero registration number: CRD42015023741.

Keywords: infection control; preventive medicine; quality in health care; urinary tract infections.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Bacteriuria* / prevention & control
Chlorhexidine
Humans
Urinary Catheterization / adverse effects
Urinary Catheters
Urinary Tract Infections* / prevention & control

Substances

Chlorhexidine