Prevention of catheter-associated infections : chlorhexidine vs unmedicated solutions

Abstract

Background: Urinary tract infections (UTIs) are amongst the most common type of nosocomial infections, of which, around 45-56% are directly related to a urethral catheter (Loveday et al., 2014). To avoid unnecessary UTIs caused by urethral catheterisations, meatal cleaning is recommended prior to insertion to prevent the introduction of bacteria within the urinary tract (NICE Guidelines, 2014). This dissertation attempts to identify the more effective cleansing agent in preventing UTIs, between Chlorhexidine and unmedicated solutions. Research Question and PICO Elements: ‘Does chlorhexidine wash of at least 0.05% concentration reduce the risk of infection in patients requiring a urinary catheter insertion, when compared to a normal saline wash or other unmedicated solutions?’ Patients were males and females requiring a urinary catheter (P). Chlorhexidine wash (I) was compared to normal saline or unmedicated solutions (C). The Outcome (O) was infection risks – UTI and catheter-associated asymptomatic bacteriuria. Method: Relevant literature, retrieved from 4 different databases, was identified through keywords, synonyms, Boolean operators, and limiters as needed. Eligibility criteria comprised of peer-reviewed literature in English, published in the last 12 years, having full text, including all PICO elements, and study design. The PRISMA checklist enabled the identification of relevant articles. The 5 key studies chosen, 3 meta-analyses and 2 randomised controlled trials, were critically appraised using the Critical Appraisal Skills Programme (CASP) tools as a guideline. This process is illustrated in the PRISMA flow diagram. Results and Conclusion: The studies chosen provided inconsistent results, due to several factors. One study presented statistical significance when using chlorhexidine to prevent infections, whilst the other 4 showed no statistical significance. Despite results suggesting that chlorhexidine does not significantly reduce infection rates, this conclusion is not definite. Implications and Recommendations: Ensuring competence of health care professionals in asepsis reduces infection rates. Developing adequate guidelines may help guide clinical staff.