The problem

One in 10 patients in an Australian hospital acquires an infection while in hospital. There are approximately 170,000 such infections acquired each year in Australian hospitals, often referred to as healthcare-associated infections (HAIs). One of the most common HAIs are urinary tract infections. These urinary tract infections are often associated with the use of indwelling urinary catheters and are referred to as catheter-associated urinary tract infection (CAUTIs). Indwelling urinary catheters are commonly used in healthcare facilities, with Australian research indicating that 21% of patients admitted to an Australian hospital receive an indwelling urinary catheter.

There are approximately 71,000 UTIs occurring in Australian hospitals each year, the majority being CAUTIs. CAUTIs have been associated with increased morbidity, mortality and higher hospital costs for patients and health systems through increased length of stay in hospital. CAUTIs are associated with higher risk of antimicrobial resistance, making the treatment of patients difficult and compounding the effects of resistance when treatment is provided.

Despite advances in infection prevention and control, CAUTIs remain problematic. Evidence shows that reducing bacterial colonisation around the urethral area prior to catheter insertion, has the potential to reduce CAUTI risk.

The lack of clarity has resulted in conflicting and non-committal recommendations for national practice guidelines in the United States and in Australia. Unsurprisingly, there is variation in practice within Australian hospitals with respect to catheter insertion, and specifically the agent used to clean the urethral area prior to insertion. Most clinicians use either saline 0.9% or chlorhexidine (0.1%) for meatal cleaning prior to urinary catheterisation. Given the importance of meatal colonisation in the pathogenesis of CAUTIs, emerging antimicrobial resistance, the frequency with which catheters are used and the burden of CAUTIs in Australia and in hospital settings worldwide, generation of evidence using a high-quality randomised trial is needed to determine the efficacy and cost-effectiveness of meatal cleaning, in turn informing clinical practice and policy in Australia and internationally.

The study

The aim of this study is to evaluate the efficacy and cost-effectiveness of cleaning the urethral meatal area with antiseptic prior to urinary catheter insertion for the prevention of catheter-associated urinary tract infections.

We are conducting a double-blind parallel randomised control trial will be undertaken in three Australian hospitals over a six to eight month period. We will compare chlorhexidine 0.1% solution against saline, with the primary outcome being CAUTIs.

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: ACTRN12625000278437