Protocol paper: Reducing catheter associated urinary tract infections in hospital, a multi-site randomised controlled study

Prof. Brett Mitchell1, Dr Oyebola Fasugba Fasugba1,3, Professor Anne Gardner4, Dr Jane Koerner4, Professor Peter Collignon5,6, Professor Allen Cheng7,8, Professor Nicholas Graves9, Ms Victoria Gregory1

1Faculty of Arts, Nursing and Theology, Avondale College Of Higher Education, Wahroonga, Australia,

2School of Nursing and Midwifery, Griffith University, Gold Coast, Australia,

3Nursing Research Institute, St Vincent’s Health Australia (Sydney) and Australian Catholic University, Sydney, Australia,

4School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Dickson, Australia,

5Australian Capital Territory Pathology, Canberra Hospital and Health Services, Garran, Australia,

6Medical School, Australian National University, Canberra, Australia,

7Alfred Health, Melbourne, Australia,

8Monash University, Melbourne, Australia,

9Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia

Background: Evidence shows that reducing bacterial colonisation around the urethral area has the potential to reduce catheter associated urinary tract infection (CAUTI) risk. However, evidence about the best antiseptic solutions for cleaning is mixed. The objectives of this study are to evaluate the effectiveness and cost-effectiveness of using chlorhexidine in meatal cleaning prior to catheter insertion, in reducing catheter associated asymptomatic bacteriuria (CA-ASB) and CAUTI.

 Methods: A stepped wedge randomised controlled trial will be undertaken in three Australian hospitals over a 32-week period. The intervention in this study is the use of chlorhexidine (0.1%) solution for meatal cleaning prior to catheter insertion. The control is the use of normal saline (0.9%) for meatal cleaning. After eight weeks, one hospital will cross over to the intervention with the other two participating hospitals crossing over to the intervention at eight-week intervals respectively, based on randomisation

 Results: The primary outcomes are the cases of CA-ASB and CAUTI (effectiveness); and the cost effectiveness of the intervention. The cost effectiveness will be evaluated by monitoring changes in costs relative to health benefits (incremental cost-effectiveness ratio) from adoption of the intervention. This paper outlines the study protocol.

 Conclusion: The study commences in the second half of 2017.The findings of this study will determine the efficacy and cost-effectiveness of meatal cleaning, in turn informing clinical practice and policy in Australia and internationally.


Professor Brett Mitchell is a Professor of Nursing and Director of the Lifestyle Research Centre at Avondale College. He holds a honorary position at Griffith University and is the Editor-in-Chief of Infection, Disease and Health. Brett has over 100 peer reviewed journal and conference presentations. He is the Chair of an NHMRC committee revising the national infection control guidelines.

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