Prof. Brett Mitchell1, Professor Allen Cheng2, Dr Oyebola Fasugba1,3, Professor Anne Gardner4, Dr Jane Koerner5, Professor Peter Collignon6, Professor Nicholas Graves7, Mrs Victoria Gregory1
1Avondale College of Higher Education, Wahroonga, Australia
2Monash University, Melbourne, Australia
3Australian Catholic University & St Vincent’s Health Australia , Sydney, Australia
4Queensland University of Technology, Brisbane, Australia
5Australian Catholic University, Watson, Australia
6Australian National University and ACT Pathology, Canberra, Australia
7Queensland University of Technology, Brisbane, Australia
Introduction: The evidence on which solution to use for meatal cleaning, prior to urinary catheter insertion is mixed. There are conflicting recommendations in international guidelines and in clinical practice, which reflect this uncertainty. The aim of this study was to evaluate the 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 clinical trial was undertaken in three Australian hospitals. The intervention was the use of chlorhexidine (0.1%) solution, compared to normal saline (0.9%) for meatal cleaning prior to catheter insertion. The number of CA-ASB and CAUTI were analysed using Poisson regression, with no intervention delay on the outcome. The stepped wedge design allows hospitals to act as their own control.
Results: 1642 catheters were inserted over the study period (697 control, 945 intervention). The mean age of participants was 62 years, 57% were female. Following the introduction of the intervention, the incidence of CAUTI reduced by 94%, IRR 0.06 (95%CI 0.01-0.32). Similarly, there was a 72% reduction in CA-ASB (IRR 0.28, 95%CI 0.08-0.93).
Conclusion: The use of chlorhexidine was associated with a decrease in both bacteriuria and CAUTI. This decrease was identified at all sites, with no CAUTI observed in the post-intervention period in two of the three study sites. The study findings will have implications for recommendation in national guidelines, hospital policy and clinical practice.
Trial Registry. Australian and New Zealand Clinical Trial Registry, 12617000373370.
Professor Brett Mitchell is a Professor of Nursing and Director of the Lifestyle Research Centre at Avondale College in New South Wales, Australia. He holds an honorary position at Griffith University and is the Editor-in-Chief of Infection, Disease and Health, a peer reviewed journal published by the Australasian College for Infection Prevention and Control. Brett has over 100 peer reviewed journal and conference presentations. He has many interests in infection control, including environmental cleaning, surveillance and urinary tract infections.