Oyebola Fasugba 1, Jane Koerner 1, Brett Mitchell 2, Anne Gardner 1
1 Australian Catholic University, Watson, Canberra, ACT, Australia
2 Avondale College, Wahroonga, NSW, Australia
Introduction: Catheter associated urinary tract infections (CAUTI) are one of the most frequent health care associated infections. Reviews to date have been inconclusive about benefits of antiseptic cleaning of the meatal area before and during catheter use to prevent CAUTIs. This study aimed to systematically review the literature and meta-analyse studies investigating effectiveness of antiseptic cleaning before and during catheter insertion for prevention of CAUTI.
Methods: Electronic databases were searched from inception to December 2015 to identify randomised control trials (RCT). Pooled odds ratios of CAUTIs in the intervention and control groups were calculated using DerSimonian-Laird random-effects models. Subgroup analyses were also performed. Heterogeneity was estimated using the I2 statistic.
Results: We identified 2665 potentially relevant papers, of which 14 RCTs were eligible for inclusion. Given the variability in the interventions used, meta-analysis was stratified by meatal cleaning agent. Results showed no significant differences in CAUTI incidence for the agents compared: povidone-iodine versus routine care; povidone-iodine versus soap and water/saline/water; chlorhexidine versus water; and green soap and water versus routine care. Antibacterial versus routine care indicated near significance (P=0.055). There was no evidence of heterogeneity (I2<1%; P>0.05). Subgroup analyses showed no difference in CAUTI incidence regarding country, setting, risk of bias, sex and frequency of administration.
Conclusion: Antiseptic meatal cleaning was not shown to be preventive for CAUTI although methodological issues hamper the generalisability of this finding. Meatal cleaning using antibacterials might be shown to be significant in a well conducted study.