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 (CAUTI) are one of the most frequent healthcare associated infections. Antiseptic cleaning of the meatal area before and during catheter use may have the potential to reduce CAUTI risk. Aim: To systematically review the literature and meta-analyse studies investigating the effectiveness of antiseptic cleaning before urinary catheter insertion and during catheter use for prevention of CAUTI. Methods: Electronic databases were searched to identify randomised controlled trials. Pooled odds ratios (ORs) and 95% confidence intervals (CI) 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: We identified 2665 potential papers, of which 14 studies were eligible for inclusion. There was no difference in CAUTI incidence when comparing an antiseptic and non-antiseptic agent (pooled OR=0.90, 95% CI=0.73-1.10; P=0.31) and for different agents compared: povidone-iodine versus routine care; povidone-iodine versus soap and water; chlorhexidine versus water; povidone-iodine versus saline; povidone-iodine versus water; and green soap and water versus routine care (P>0.05 for all). Comparison of an antibacterial 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 CAUTI incidence regarding country, setting, risk of bias, sex and frequency of administration. Conclusions: There were no differences in CAUTI rates although methodological issues hamper generalisability of this finding. Antibacterials might be significant in a well conducted study. Results provide good evidence to inform infection control guidelines in catheter management.