BERKELEY, CA (UroToday.com) - Urinary tract infections (UTI) are some of the most common health care-associated infections and they occur primarily after bladder catheterization and are very common in hospital and home care contexts. Currently there are several recommendations for prevention, such as reducing the duration of catheterization (perhaps the most important measure), maintaining a closed drainage system, the use of a correct technique for sterile urine collection, and use of the recommended insertion technique. However, there continues to be a question about the best solution to use for preparing the urinary meatus prior to catheterization. The objective of this study were to determine the effectiveness of cleaning the urinary meatus with water or saline comparing to its sterilization by performing a systematic review with a meta-analysis which gathered and organized all the results of studies on cleaning the urinary meatus with water or saline or antiseptic solution, prior to bladder catheterization, for preventing UTI.
We followed the principles proposed by the Cochrane handbook. The critical analysis, extraction and synthesis of data were performed separately by two investigators, and statistical analysis was performed using STATA 11.1. The inclusion criteria were establish based on PI[C]OD method and were defined based on primary studies that included participants over 18-years of age, with no prior bladder catheterization, no signs of UTI, and without administration of antibiotics; interventions/comparisons between the use of water or saline with antiseptic to clean the urethral meatus prior to bladder catheterization; the primary outcome was the number of patients with UTI; and the design study was experimental, quasi-experimental studies and systematic reviews. The odds ratios and standard deviations were calculated according to the fixed effects model.
Five randomized controlled trials were included involving a total of 743 patients. The results of the meta-analysis indicated that the cleaning (with water or saline) when compared to disinfection (with chlorhexidine gluconate 0.05% or 0.1% or povidone-iodine) of the urinary canal prior to bladder catheterization was not statistically significant for infection rates (OR=1.07, CI 95%=0.68-1.68, p=0.779) and that there was some evidence that the use of water/saline reduced rates of UTI.
We concluded that the cleaning or disinfection of the urinary canal prior to bladder catheterization is not statistically significant and that there is some evidence that the use of water/saline, when compared to antiseptic disinfection, reduces rates of UTI, although these results did not reach statistical significance.
Implications for practice: The interventions considered in this systematic review are effective and can be useful in practice (Level of Evidence 1.a - Systematic review of RCT); health professionals can use these interventions in adults (Grade of Recommendation A). We suggest the realization and implementation of a new guideline, with the primary objective of greater management resources, making the technique related to the research question a general subject to all health professionals.
Implications for research: It is necessary to adequately perform RCTs designed to compare the economic evaluations, patient safety, cost-effectiveness of solutions in different patient groups (associated pathologies), different types of urinary catheters, and reasons for catheterization, according to the expected time (short or long term), and covering other outcomes, to establish causal relationships (beyond the number of patients with UTI). Later these studies should be integrated into future systematic reviews with meta-analysis that should explore these differences by subgroup analysis or by meta-regression, if possible.
Madalena Cunha, RN, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.