Water versus antiseptic periurethral cleansing before catheterization among home care patients: A randomized controlled trial

doi:10.1016/j.ajic.2007.03.004

American Journal of Infection Control

Volume 36, Issue 5, June 2008, Pages 375-380

https://doi.org/10.1016/j.ajic.2007.03.004 Get rights and content

Background

There is a lack of research studies on periurethral cleansing before catheterization among home care patients. The purpose of this study was to compare the risk of acquiring symptomatic urinary tract infections through the conventional practice of using 0.05% chlorhexidine gluconate (CHG) versus sterile water for periurethral cleansing before insertion of an indwelling urinary catheter.

Methods

A randomized controlled trial was used, and subjects were randomly allocated to either the sterile water group or the 0.05% CHG group. Urine specimens for culture were collected 4 times for each subject within 2 weeks.

Results

Seventy-four urine samples were collected in 20 subjects (sterile water group, 8; 0.05% CHG group, 12). There was no significant difference in colonization count between the 2 groups. In addition, none of the subjects in the 2 groups developed symptomatic bacteriuria.

Conclusion

Using sterile water to clean the periurethral area before catheterization among home care patients will not increase the risk for urinary tract infections.

Section snippets

Subjects

This was a randomized controlled trial. Subjects were recruited from one community nursing service (CNS) center in Hong Kong. Nurses in the CNS provide services to patients who live at home or in a nursing home. The inclusion criteria for the study were (1) aged 18 years or older, (2) receiving community nursing services, (3) requiring long-term indwelling latex urinary catheter, and (4) already under community nursing service requiring long-term catheter care for at least 1 month. However,

Results

Twenty-six subjects were recruited. Four subjects refused to participate in the study on the day of the catheter change. Two subjects were excluded from data analysis because one had a UTI diagnosis and the other was on antibiotic treatment for fever. Therefore, 20 subjects (14 females and 6 males) and 74 observations were used for analysis. Eight subjects were in the sterile water group, and 12 subjects were in the 0.05% CHG group.

The average age of the subjects was 78.4 (SD, 11.8) years, and

Discussion

The results of the study suggest acceptance of the null hypothesis, ie, there is no difference in acquiring symptomatic UTIs between home care patients whose periurethral area is cleaned with sterile water or 0.05% CHG before the insertion of an indwelling urinary catheter. Also, the results of this study of home care patients support the findings of studies conducted with hospital patients.9, 12 The target populations were different in the studies of Carapeti et al¹² and Webster et al.⁹

References (20)

J. Webster et al.
Water or antiseptic for periurethral cleaning before urinary catheterization: a randomized controlled trial
Am J Infect Control
(2001)
R.A. Garibaldi
Residential care and the elderly: the burden of infection
J Hosp Infect
(1999)
B. Kozier et al.
Fundamentals of nursing: Concepts, process, and practice
(2000)
E. Bennett
Intermittent self-catheterization and the female patient
Nurs Stand
(2002)
V.L. Champion
Clean technique for intermittent self-catheterization
Nursing Res
(1976)
H. Duffin
Intermittent self-catheterization
J Community Nurs
(2000)
L.M. Duffy et al.
Clean intermittent catheterization: safe, cost-effective bladder management for male residents of VA nursing homes
J Am Geriatr Soc
(1995)
B.B. King et al.
Clean and sterile intermittent catheterization methods in hospitalized patients with spinal cord injury
Arch Phys Med Rehabil
(1992)
P.A. Potter et al.
Basic nursing: theory and practice
(1998)
T. Prieto-Fingerhut et al.
A study comparing sterile and nonsterile urethral catheterization in patients with spinal cord injury
Rehabil Nurs
(1997)

There are more references available in the full text version of this article.

Cited by (27)

A comparison of the efficacy of normal saline and Savlon solutions in periurethral cleaning to reduce catheter-associated bacteriuria: A randomized control trial
2021, International Journal of Infectious Diseases
Catheter-associated urinary tract infection (CAUTI) is a common nosocomial infection. However, there has been no randomized control trial (RCT) comparing the efficacy of periurethral cleaning solutions for reducing CAUTI. This study aimed to compare the efficacy of normal saline solution (NSS) and Savlon solution.
A non-inferiority cross-over RCT was conducted to compare the 2 solutions by the incidence of significant bacteriuria (SB) on day 5 after Foley catheterization. Patients admitted to a tertiary referral hospital from June 2018 to August 2019 participated in the study. The acceptable prespecified non-inferiority margin was 10%.
There were 265 and 275 patients in the NSS and Savlon groups, respectively. The incidence of CAUTI was 2.65/1000 catheter-days, and the median duration of catheterization was 5 days (IQR 4, 7). There was no significant difference between the incidence of SB in the NSS and Savlon groups, as indicated by the adjusted difference of 0.6 (95% CI: -3.1-4.2).
This study was the first RCT in patients from multiple hospital units to compare the efficacy of the 2 solutions in the periurethral cleaning process. The study demonstrated non-inferiority of NSS to Savlon solution.
TCTR20180518001.
Does periurethral cleaning with water prior to indwelling urinary catheterization increase the risk of urinary tract infections? A systematic review and meta-analysis
2018, American Journal of Infection Control
Citation Excerpt :
The 5 trials included 824 patients: 60 (7.3%) underwent gynecologic surgery, 186 (22.6%) were in the emergency department of a pediatric hospital, 436 (52.9%) were in obstetrics, 20 (2.4%) were in a community nursing service center, and 122 (14.8%) were in a pediatric intensive care unit. All studies described the method of randomization, and that method was appropriate in 4 studies.25-27,29 Concealment allocation was adequate in only 3 studies.25,27,29
To determine whether periurethral cleaning with water before indwelling urinary catheterization increases the risk of urinary tract infections (UTIs) compared with studies using anti-infective agents.
A literature search via MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials through October 2017 and a manual search of references for additional relevant studies. Trials studying clean intermittent catheterization were excluded. Data were extracted independently by 2 reviewers. Disagreements were resolved through discussion. Results of randomized controlled trials were pooled using random effects models. Both individual and pooled risk estimates were reported using risk ratios (RRs) and 95% confidence intervals (CIs).
From 121 identified articles, 5 studies involving 824 patients were included in the review (822 patients included in meta-analysis). No statistical significance in the incidence of UTIs existed between the water group and antiseptics group (RR, 1.07; 95% CI, 0.77-1.49; P = .89; I² = 0%). Available data comparing water with povidone-iodine or chlorhexidine gluconate demonstrated no significant difference between the incidence of UTIs (RR, 1.10; 95% CI, 0.66-1.83; P = .79; I² = 0%; and RR, 1.05; 95% CI, 0.68-1.62; P = .72; I² = 0%; respectively).
Based on current data, water is as safe as other topical antiseptics for periurethral cleansing before indwelling urinary catheter insertion.
Intermittent urethral catheterization-descriptive study at a Brazilian service
2014, Applied Nursing Research
Citation Excerpt :
As illustrated by Table 2, intermittent urethral catheterization is an effective method, which has been progressively used at the place of study to treat patients for about 30 years, suggesting that patients increasingly search treatment, and not necessarily that the number of new cases of neurogenic bladder is rising. At home, the clean technique should be adopted (Cheung et al., 2008; Mazzo et al., 2012; Webster et al., 2001). Nevertheless, although almost all patients under analysis were diagnosed with neurogenic bladder, started treatment and trained the procedure while hospitalized at the teaching hospital, many practice the sterile technique, using antiseptic solutions and even 70% alcohol for perineum antisepsis (Table 4).
The rehabilitation process of patients with neurogenic bladder involves psychosocial, cultural, political and economic human factors, representing a challenge for patients/caregivers as well as health professionals. This study was aimed at characterizing patients with neurogenic bladder who use intermittent urethral catheterization and were going through rehabilitation at a teaching hospital.
This descriptive study was undertaken in the interior of São Paulo State–Brazil. All ethical guidelines were complied with. To collect the data, interviews were held during nursing consultations with patients more than 18 years of age suffering from neurogenic bladder who used intermittent urethral catheterization.
Most patients had spinal cord trauma, are single, male and gain a low income. They have been using catheterization for several years, at irregular frequencies, using polyethylene catheters.
No standardization exists in the accomplishment of the practices used and strategies are needed to remodel the service.
Bladder catheterization in Greek nursing education: An audit of the skills taught
2011, Nurse Education Today
Citation Excerpt :
Appropriate aseptic techniques: only one aseptic procedure was followed by all staff with little discussion concerning other techniques which would be equally sterile but were not included in the textbook. ( Cheung et al., 2008). Catheter withdrawal: evidence dictates that catheters should be left in for the shortest possible time necessary.
The auditing of nurse teaching is in its infancy in Greece. One area urgently in need of audit is the teaching of male catheterization.
To assess the current educational model regarding male bladder catheterization at a sole tertiary education nursing establishment in a major Greek city and to improve nurse undergraduate training by implementing appropriate recommendations for change to the current educational module and support these changes in the long term.
A systematic search of international databases for guidelines or best practice regarding bladder catheterization was conducted. Audit measures included direct observation of the teaching process and compilation of a checklist.
The shortcomings are discussed under the following headings: patient pre-preparation, choice and quality of materials used, appropriate aseptic techniques, catheter withdrawal, connecting and handling the drainage bag, diminishing risk of Catheter Associated Urinary Track Infections (CAUTIs), no problem solving trouble-shooting training, textbook and educational resources, lack of national guidelines, setting of the educational experience.
The main problem with the teaching process exposed by the audit is entrenched use of an outmoded textbook with little effort to enrich teaching with current evidence base practices.
Effect of different disinfectants on preventing asymptomatic bacteriuria and catheter-related urinary tract infection: a network meta-analysis
2023, Frontiers in Urology
Pharmaceutical Incompatibility of Lubricating Gel Formulation Reduces Antibacterial Activity of Chlorhexidine Gluconate: In Vitro Study in Northern Thailand
2022, International Journal of Environmental Research and Public Health

View all citing articles on Scopus

: Supported by The Hong Kong Polytechnic University and Kwong Wah Hospital.

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Major articleWater versus antiseptic periurethral cleansing before catheterization among home care patients: A randomized controlled trial

Background

Methods

Results

Conclusion

Section snippets

Subjects

Results

Discussion

Am J Infect Control

J Hosp Infect

Fundamentals of nursing: Concepts, process, and practice

Intermittent self-catheterization and the female patient

Nurs Stand

Clean technique for intermittent self-catheterization

Nursing Res

Intermittent self-catheterization

J Community Nurs

Clean intermittent catheterization: safe, cost-effective bladder management for male residents of VA nursing homes

J Am Geriatr Soc

Clean and sterile intermittent catheterization methods in hospitalized patients with spinal cord injury

Arch Phys Med Rehabil

Basic nursing: theory and practice

A study comparing sterile and nonsterile urethral catheterization in patients with spinal cord injury

Rehabil Nurs

Major article
Water versus antiseptic periurethral cleansing before catheterization among home care patients: A randomized controlled trial