The problem

Tens of thousands of people in the community undertake intermittent self-catheterisation to empty their bladders due to a chronic condition or disability such as a spinal cord injury, and they often do so for the rest of their lives. The use of a catheter several times a day can cause complications, such as a urinary tract infections (UTIs). Although a UTI may seem trivial to anyone who has not experienced one, people with UTIs do not report the experience as trivial. In Australia, approximately 2% of all GP consultations relate to UTIs, indicating the significant burden and cost this has for health services. Community based strategies for preventing catheter-associated UTIs present an opportunity for significant impact.

One theory associated with infection prevention is that cleaning the urethral area with an antiseptic wipe can prevent opportunistic bacteria from entering the urinary tract during catheter insertion. A study by Mitchell and colleagues, that found that using the antiseptic chlorhexidine (0.1%) to clean the urethral area prior to insertion of indwelling catheters was associated with a 74% relative reduction in the incidence of catheter-associated UTI in hospitalised patients with indwelling urinary catheters. It was also shown to be cost-saving for health services.

There have been limited studies exploring the effect of an antiseptic on reducing UTIs in people who undertake intermittent catheterisation.

The study

Preventing catheter-associated urinary tract infections: A randomised double-blind crossover study

We are undertaking a double-blind randomised crossover trial to investigate the effectiveness and cost-effectiveness of a chlorhexidine 0.1% solution in reducing the incidence of UTI in people undertaking intermittent catheterisation, compared with normal practice (saline). The trial will last 12 months overall for each participant.

The trial objectives are:

1. To evaluate the efficacy in reducing the incidence of UTI of a 0.1% chlorhexidine solution, compared with normal practice for meatal cleaning before urinary catheter insertion.
2. To estimate the cost-effectiveness of using antiseptics for meatal cleaning.
3. To explore the personal experience of participants who undertake intermittent catheterisation, either themselves (self-catheterisation) or by a caregiver or healthcare worker.
4. To explore the effect of UTIs on the quality of life of participants who undertake intermittent catheterisation, either themselves (self-catheterisation) or by a caregiver or healthcare worker.

Publications

We will post publications and findings from our study here in due course.

Additional detail

Further detail about the trial can be found on the Australian and New Zealand Clinical Trial Registry. Trial registration number: ACTRN12623000917639