Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter-associated urinary tract infections

O. Fasugba; J. Koerner; B. G. Mitchell; A. Gardner

doi:10.1016/j.jhin.2016.10.025

Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter-associated urinary tract infections

O. Fasugba, J. Koerner, B. G. Mitchell, A. Gardner

Research output: Contribution to journal › Article › peer-review

27 Citations (Scopus)

Abstract

Background Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections. Antiseptic cleaning of the meatal area before and during catheter use may reduce the risk of CAUTIs. Aim To undertake a systematic review of the literature and meta-analysis of studies investigating the effectiveness of antiseptic cleaning before urinary catheter insertion and during catheter use for prevention of CAUTIs. Methods Electronic databases were searched to identify randomized controlled trials. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and compared across intervention and control groups using DerSimonian–Laird random-effects model. Subgroup analyses were performed. Heterogeneity was estimated using the I² statistic. Findings In total, 2665 potential papers were identified; of these, 14 studies were eligible for inclusion. There was no difference in the incidence of CAUTIs when comparing antiseptic and non-antiseptic agents (pooled OR 0.90, 95% CI 0.73–1.10; P=0.31), or when comparing different agents: povidone-iodine vs routine care; povidone-iodine vs soap and water; chlorhexidine vs water; povidone-iodine vs saline; povidone-iodine vs water; and green soap and water vs routine care (P>0.05 for all). Comparison of an antibacterial agent with routine care indicated near significance (P=0.06). There was no evidence of heterogeneity (I²=0%; P>0.05). Subgroup analyses showed no difference in the incidence of CAUTIs in terms of country, setting, risk of bias, sex and frequency of administration. Conclusions There were no differences in CAUTI rates, although methodological issues hamper generalizability of this finding. Antibacterial agents may prove to be significant in a well-conducted study. The present results provide good evidence to inform infection control guidelines in catheter management.

Original language	English
Pages (from-to)	233-242
Number of pages	10
Journal	Journal of Hospital Infection
Volume	95
Issue number	3
DOIs	https://doi.org/10.1016/j.jhin.2016.10.025
Publication status	Published - 1 Mar 2017
Externally published	Yes

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10.1016/j.jhin.2016.10.025

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@article{6b930ddf91ac4e6c9e8c417f8f5981f9,

title = "Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter-associated urinary tract infections",

abstract = "Background Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections. Antiseptic cleaning of the meatal area before and during catheter use may reduce the risk of CAUTIs. Aim To undertake a systematic review of the literature and meta-analysis of studies investigating the effectiveness of antiseptic cleaning before urinary catheter insertion and during catheter use for prevention of CAUTIs. Methods Electronic databases were searched to identify randomized controlled trials. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and compared across intervention and control groups using DerSimonian–Laird random-effects model. Subgroup analyses were performed. Heterogeneity was estimated using the I2 statistic. Findings In total, 2665 potential papers were identified; of these, 14 studies were eligible for inclusion. There was no difference in the incidence of CAUTIs when comparing antiseptic and non-antiseptic agents (pooled OR 0.90, 95% CI 0.73–1.10; P=0.31), or when comparing different agents: povidone-iodine vs routine care; povidone-iodine vs soap and water; chlorhexidine vs water; povidone-iodine vs saline; povidone-iodine vs water; and green soap and water vs routine care (P>0.05 for all). Comparison of an antibacterial agent with routine care indicated near significance (P=0.06). There was no evidence of heterogeneity (I2=0%; P>0.05). Subgroup analyses showed no difference in the incidence of CAUTIs in terms of country, setting, risk of bias, sex and frequency of administration. Conclusions There were no differences in CAUTI rates, although methodological issues hamper generalizability of this finding. Antibacterial agents may prove to be significant in a well-conducted study. The present results provide good evidence to inform infection control guidelines in catheter management.",

keywords = "Antiseptic, Meatal cleaning, Meta-analysis, Systematic review, Urinary catheter, Urinary tract infection, Humans, Treatment Outcome, Antisepsis/methods, Randomized Controlled Trials as Topic, Urinary Tract Infections/prevention & control, Anti-Infective Agents, Local/administration & dosage, Catheterization/methods, Catheter-Related Infections/prevention & control",

author = "O. Fasugba and J. Koerner and Mitchell, {B. G.} and A. Gardner",

year = "2017",

month = mar,

day = "1",

doi = "10.1016/j.jhin.2016.10.025",

language = "English",

volume = "95",

pages = "233--242",

journal = "Journal of Hospital Infection",

issn = "0195-6701",

publisher = "W.B. Saunders Ltd",

number = "3",

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TY - JOUR

T1 - Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter-associated urinary tract infections

AU - Fasugba, O.

AU - Koerner, J.

AU - Mitchell, B. G.

AU - Gardner, A.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Background Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections. Antiseptic cleaning of the meatal area before and during catheter use may reduce the risk of CAUTIs. Aim To undertake a systematic review of the literature and meta-analysis of studies investigating the effectiveness of antiseptic cleaning before urinary catheter insertion and during catheter use for prevention of CAUTIs. Methods Electronic databases were searched to identify randomized controlled trials. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and compared across intervention and control groups using DerSimonian–Laird random-effects model. Subgroup analyses were performed. Heterogeneity was estimated using the I2 statistic. Findings In total, 2665 potential papers were identified; of these, 14 studies were eligible for inclusion. There was no difference in the incidence of CAUTIs when comparing antiseptic and non-antiseptic agents (pooled OR 0.90, 95% CI 0.73–1.10; P=0.31), or when comparing different agents: povidone-iodine vs routine care; povidone-iodine vs soap and water; chlorhexidine vs water; povidone-iodine vs saline; povidone-iodine vs water; and green soap and water vs routine care (P>0.05 for all). Comparison of an antibacterial agent with routine care indicated near significance (P=0.06). There was no evidence of heterogeneity (I2=0%; P>0.05). Subgroup analyses showed no difference in the incidence of CAUTIs in terms of country, setting, risk of bias, sex and frequency of administration. Conclusions There were no differences in CAUTI rates, although methodological issues hamper generalizability of this finding. Antibacterial agents may prove to be significant in a well-conducted study. The present results provide good evidence to inform infection control guidelines in catheter management.

AB - Background Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections. Antiseptic cleaning of the meatal area before and during catheter use may reduce the risk of CAUTIs. Aim To undertake a systematic review of the literature and meta-analysis of studies investigating the effectiveness of antiseptic cleaning before urinary catheter insertion and during catheter use for prevention of CAUTIs. Methods Electronic databases were searched to identify randomized controlled trials. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and compared across intervention and control groups using DerSimonian–Laird random-effects model. Subgroup analyses were performed. Heterogeneity was estimated using the I2 statistic. Findings In total, 2665 potential papers were identified; of these, 14 studies were eligible for inclusion. There was no difference in the incidence of CAUTIs when comparing antiseptic and non-antiseptic agents (pooled OR 0.90, 95% CI 0.73–1.10; P=0.31), or when comparing different agents: povidone-iodine vs routine care; povidone-iodine vs soap and water; chlorhexidine vs water; povidone-iodine vs saline; povidone-iodine vs water; and green soap and water vs routine care (P>0.05 for all). Comparison of an antibacterial agent with routine care indicated near significance (P=0.06). There was no evidence of heterogeneity (I2=0%; P>0.05). Subgroup analyses showed no difference in the incidence of CAUTIs in terms of country, setting, risk of bias, sex and frequency of administration. Conclusions There were no differences in CAUTI rates, although methodological issues hamper generalizability of this finding. Antibacterial agents may prove to be significant in a well-conducted study. The present results provide good evidence to inform infection control guidelines in catheter management.

KW - Antiseptic

KW - Meatal cleaning

KW - Meta-analysis

KW - Systematic review

KW - Urinary catheter

KW - Urinary tract infection

KW - Humans

KW - Treatment Outcome

KW - Antisepsis/methods

KW - Randomized Controlled Trials as Topic

KW - Urinary Tract Infections/prevention & control

KW - Anti-Infective Agents, Local/administration & dosage

KW - Catheterization/methods

KW - Catheter-Related Infections/prevention & control

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U2 - 10.1016/j.jhin.2016.10.025

DO - 10.1016/j.jhin.2016.10.025

M3 - Article

C2 - 27986361

AN - SCOPUS:85008217218

SN - 0195-6701

VL - 95

SP - 233

EP - 242

JO - Journal of Hospital Infection

JF - Journal of Hospital Infection

IS - 3

ER -

Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter-associated urinary tract infections

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