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Water or antiseptic for periurethral cleaning before urinary catheterization: A randomized controlled trial*

https://doi.org/10.1067/mic.2001.117447Get rights and content

Abstract

Background: Despite a lack of empiric data to support the practice, traditionally, antiseptic solutions have been used to clean the periurethral area before inserting an indwelling catheter. The purpose of this study was to compare urinary colonization rates of subjects whose periurethral area was cleaned with water versus chlorhexidine 0.1% before the insertion of an indwelling urinary catheter. Methods: Obstetric patients who required urinary catheterization as part of their routine care were randomly assigned to either the “water” or “chlorhexidine” group with a sealed envelope. A sterile specimen of urine was collected 24 hours after insertion of the catheter. Results: Of the 436 patients (86.2%) with complete data (water group, 219; antiseptic group, 217), 38 (8.7%) had urinary tract bacteriuria >106 cfu/L. Rates of urinary tract infection were similar in each group (water group, 8.2%; antiseptic group, 9.2%; odds ratio 1.13; 95% confidence interval 0.58-2.21). Conclusion: The practice of periurethral cleaning with an antiseptic did not decrease the rates of bacteriuria in this population and is probably not useful. (Am J Infect Control 2001:29:389-94.)

Section snippets

Use of antiseptics and aseptic techniques

Meatal care is usually included in discussions about urinary catheterization, presumably because of the well-established links between meatal colonization and subsequent UTI. However, it is now generally accepted that use of an antiseptic for catheter care does not decrease the risk of UTI.10, 11 Furthermore, no benefit has been demonstrated in the use of an antiseptic gel at the time of catheter insertion.12 It is also generally agreed that for intermittent catheter insertion, a clean rather

Subjects and methods

The sample was drawn from pregnant women admitted for delivery at the RWH between October 1999 and April 2000. The only criterion for enrollment was that an indwelling catheter be a required part of routine management. The Hospitals Executive Committee approved the study. Informed consent was not required, because hospital staff were using both water and chlorhexidine before inserting a urinary catheter (although the hospital policy nominates chlorhexidine for this purpose).

Women to be

Urine microbiology

Urine samples were processed immediately on receipt in the microbiology laboratory. Uncentrifuged samples were examined with phase contrast microscopy for the presence of leucocytes, erythrocytes, epithelial cells, casts, crystals, and bacteria. One μL of urine was cultured on both horse blood agar and MacConkey agar plates. Cultures were incubated aerobically at 35°C for 18 to 24 hours. Cultures showing a pure growth >108 organisms per liter were subject to full identification and

Organism identification and antimicrobial susceptibility tests

All gram-negative bacilli were identified with use of Vitek GNI panels (Biomerieux), and antimicrobial sensitivity tests were performed with Vitek GNS-424 panels. Isolates of staphylococci were identified with use of tube coagulase and novobiocin susceptibility to exclude Staphylococcus saprophyticus . Streptococci were identified with use of Strep API (bioMérieux, l'Etoile, France), and sensitivity testing was performed with NCCLS agar dilution. All yeast isolates were identified with use of

Sample size

The primary endpoint of the study was catheter-related bacteriuria. Rates of bacteriuria were unknown among RWH maternity patients; therefore, sample sizes were based on the UTI rate (8.1%) found in a sample of puerperal women in Sweden.19 Calculations indicated that a sample size of approximately 220 women in each group would be needed to provide a 90% power to show a 20% increase in the proportion of women diagnosed with a UTI, a clinically significant increase. To allow for a 15% loss, 33

Primary outcome measure

For the present study, a colony count equal to or greater than 106 cfu/L was used to define a UTI. This definition was used to fit in with standard reporting methods used by the campus laboratory.

Analysis

Analysis was by intention to treat. Null hypothesis and tests were 2-sided. Colonization counts were dichotomized into “high” (above 106 cfu/L) and “low” (below 106 cfu/L). Demographic and baseline data of interest included age, parity, history of UTI, number of vaginal examinations during labor, mode of delivery, and length of time the catheter remained in situ before the specimen was collected. These variables were used to compare the 2 groups with the X2 statistic or the Fisher exact test.

Results

Urine test results from 70 patients were unavailable. In all cases, results were unavailable because the catheter was inadvertently removed before a specimen was collected. Of the 436 patients (86.2%) with complete data (water group, 219; antiseptic group, 217), 38 (8.7%) had urinary tract bacteriuria >106cfu/L. Rates of bacteriuria were similar in each group (water group, 8.2%; antiseptic group, 9.2%; odds ratio, 1.13; 95% confidence interval, 0.58-2.21). The mean age of the sample population

Discussion

Results from the present study support findings from Carapeti et al,16 who assessed the rate of UTI after short-term perioperative urethral catheterization. In that study, 2 different techniques were used. The first technique involved a sterile procedure: a 4-minute scrub, use of sterile gloves and gown, and ue of a strict aseptic technique. Patients in this group were cleaned with an antiseptic, a sterile lubricant was used when inserting the catheter and the balloon was inflated with sterile

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  • Cited by (51)

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      2021, International Journal of Infectious Diseases
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      According to Hooton et al. (2010), evidence suggests that the most effective strategy for reducing CAB and CAUTI is to reduce the catheter use itself. The above studies were not randomized control trials (RCTs), and the study populations were restricted to specific groups, such as patients undergoing general surgery (Carapeti et al., 1996) or pregnant women at the time of delivery (Webster et al. 2001). The present study was conducted as an RCT in a generalized population group.

    • Chlorhexidine for meatal cleaning in reducing catheter-associated urinary tract infections: a multicentre stepped-wedge randomised controlled trial

      2019, The Lancet Infectious Diseases
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      Our findings contrast with previous RCTs that assessed the effect of chlorhexidine on catheter-associated asymptomatic bacteriuria and UTI. Although these single site RCTs19,20 found that the use of chlorhexidine did not decrease the incidence of bacteriuria or UTI, important limitations were noted. The study by Webster and colleagues19 comprised 436 young obstetric patients.

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    • 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 :

      Three trials27-29 including 306 patients compared water with povidone-iodine; no difference was observed in the rates of bacteriuria between groups (17.6% vs 15.9%, respectively; RR, 1.10; 95% CI, 0.66-1.83; P = .79; I2 = 0%) (Fig 3). In the 3 included trials25,26,29 comparing water with chlorhexidine gluconate, no difference was noted in the rates of bacteriuria (10.1% vs 10.4%, respectively; RR, 1.05; 95% CI, 0.68-1.62; P = .41; I2 = 0%) (Fig 3). We performed a systematic review and meta-analysis comparing the use of water and antiseptics for periurethral cleaning before indwelling urinary catheterization.

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    *

    Reprint requests: Joan Webster, BA, RN, RM, Teaching and Research Centre, 6th Floor, Ned Hanlon Building, Royal Women's Hospital, Butterfield Street, Herston 4029, Australia.

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