Reducing catheter-associated urinary tract infections in hospitals: study protocol for a multi-site randomised...

Area of Science:

• Infection Prevention and Control
• Clinical Microbiology
• Health Economics

Background:

• Catheter-associated urinary tract infections (CAUTIs) remain a significant clinical challenge despite advances in prevention.
• Meatal cleaning prior to urinary catheter insertion is a key preventive measure, but optimal antiseptic solutions are debated.
• Conflicting international guidelines highlight the need for robust evidence on meatal cleaning agents.

Purpose of the Study:

• To evaluate the effectiveness of 0.1% chlorhexidine solution for meatal cleaning in reducing CAUTI and catheter-associated asymptomatic bacteriuria.
• To assess the cost-effectiveness of using chlorhexidine for meatal cleaning in the hospital setting.
• To provide evidence-based recommendations for best practices in urinary catheter insertion.

Main Methods:

• A stepped wedge randomized controlled trial conducted across three Australian hospitals over 32 weeks.
• Intervention: 0.1% chlorhexidine solution for meatal cleaning before urinary catheter insertion.
• Primary outcomes: CAUTI and asymptomatic bacteriuria rates per 100 catheter days (Poisson regression); incremental cost-effectiveness ratio.

Main Results:

• Results are pending dissemination through peer-reviewed publications and conference presentations.
• The study protocol has been approved and registered.
• Data analysis will focus on comparing infection rates and healthcare costs between intervention and control periods.

Conclusions:

• The study will provide crucial data on the efficacy and economic viability of chlorhexidine for meatal cleaning.
• Findings are expected to inform clinical guidelines and improve patient outcomes by reducing CAUTI incidence.
• This research addresses a critical gap in evidence regarding antiseptic use in catheter care.