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

IntroductionDespite advances in infection prevention and control, catheter-associated urinary tract infections (CAUTIs) are common and remain problematic. A number of measures can be taken to reduce the risk of CAUTI in hospitals. Appropriate urinary catheter insertion procedures are one such method. Reducing bacterial colonisation around the meatal or urethral area has the potential to reduce CAUTI risk. However, evidence about the best antiseptic solutions for meatal cleaning is mixed, resulting in conflicting recommendations in guidelines internationally. This paper presents the protocol for a study to evaluate the effectiveness (objective 1) and cost-effectiveness (objective 2) of using chlorhexidine in meatal cleaning prior to catheter insertion, in reducing catheter-associated asymptomatic bacteriuria and CAUTI.Methods and analysisA stepped wedge randomised controlled trial will be undertaken in three large Australian hospitals over a 32-week period. The intervention in this study is the use of chlorhexidine (0.1%) solution for meatal cleaning prior to catheter insertion. During the first 8 weeks of the study, no hospital will receive the intervention. After 8 weeks, one hospital will cross over to the intervention with the other two participating hospitals crossing over to the intervention at 8-week intervals respectively based on randomisation. All sites complete the trial at the same time in 2018. The primary outcomes for objective 1 (effectiveness) are the number of cases of CAUTI and catheter-associated asymptomatic bacteriuria per 100 catheter days will be analysed separately using Poisson regression. The primary outcome for objective 2 (cost-effectiveness) is the changes in costs relative to health benefits (incremental cost-effectiveness ratio) from adoption of the intervention.DisseminationResults will be disseminated via peer-reviewed journals and presentations at relevant conferences.A dissemination plan it being developed. Results will be published in the peer review literature, presented at relevant conferences and communicated via professional networks.EthicsEthics approval has been obtained.Trial registration number12617000373370, approved 13/03/2017. Protocol version 1.1.

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Cost effectiveness of management strategies for urinary tract infections: results from randomised controlled trial

BMJ ◽

10.1136/bmj.c346 ◽

2010 ◽

Vol 340 (feb05 1) ◽

pp. c346-c346 ◽

Cited By ~ 19

Author(s):

D. Turner ◽

P. Little ◽

J. Raftery ◽

S. Turner ◽

H. Smith ◽

...

Keyword(s):

Urinary Tract ◽

Cost Effectiveness ◽

Randomised Controlled Trial ◽

Urinary Tract Infections ◽

Controlled Trial ◽

Management Strategies ◽

Randomised Controlled ◽

Tract Infections

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Lactobacillus rhamnosus PL1 and Lactobacillus plantarum PM1 versus placebo as a prophylaxis for recurrence urinary tract infections in children: a study protocol for a randomised controlled trial

BMC Urology ◽

10.1186/s12894-020-00723-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Maria Daniel ◽

Hanna Szymanik-Grzelak ◽

Agnieszka Turczyn ◽

Małgorzata Pańczyk-Tomaszewska

Keyword(s):

Urinary Tract ◽

Randomised Controlled Trial ◽

Lactobacillus Plantarum ◽

Urinary Tract Infections ◽

Acute Pyelonephritis ◽

Controlled Trial ◽

Lactobacillus Rhamnosus ◽

Recurrent Utis ◽

Randomised Controlled ◽

Tract Infections

Abstract Background Urinary tract infections (UTIs) are one of the most common bacterial infections in children. In children < 7 years of age, the prevalence of one episode of symptomatic UTI has been estimated at 3–7% in girls and 1–2% in boys, whereas 8–30% of them will have one or more episodes of UTI. The use of some probiotics appears to reduce the risk of recurrence of UTIs. Since the effects of probiotics are strain-specific, the efficacy and safety of each strain has to be assessed. The main aim of this study is to determine whether probiotics (containing Lactobacillus rhamnosus PL1 and Lactobacillus plantarum PM1) therapy are effective in preventing UTI in children compared to placebo. Method A superiority, double-blind, randomised, controlled trial is being conducted. One hundred and six patients aged 3 to 18 years with recurrent UTIs in last year (defined as: ≥ 2 episodes of UTI with acute pyelonephritis/upper UTI; or 1 episode of UTI with acute pyelonephritis and ≥ 1 episodes of UTI with cystitis/lower UTI; or ≥ 3 episodes of UTI with cystitis/lower UTI) or children with ≥ 1 infection in the upper urinary tract and ≥ 1 of recurrent UTIs risk factors (congenital anomalies of the kidney and urinary tract, constipation, bladder dysfunction, myelomeningocele, sexual activity in girls) will be randomly assigned to receive a 90-day prophylaxis arm (probiotic containing L. rhamnosus PL1 and L. plantarum PM1) or a 90-day placebo arm. The primary outcome measure will be the frequency of recurrence of UTI during the intervention and in the period 9 months after the intervention. Discussion The findings of this randomised controlled trial (RCT), whether positive or negative, will contribute to the formulation of further recommendations on prevention of recurrent UTIs in children. Trial registration number NCT03462160, date of trial registration 12th March 2018.

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Cluster randomised controlled trial of tailored interventions to improve the management of urinary tract infections in women and sore throat

BMJ ◽

10.1136/bmj.325.7360.367 ◽

2002 ◽

Vol 325 (7360) ◽

pp. 367-367 ◽

Cited By ~ 96

Author(s):

S. Flottorp

Keyword(s):

Urinary Tract ◽

Randomised Controlled Trial ◽

Sore Throat ◽

Urinary Tract Infections ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Tailored Interventions ◽

Cluster Randomised ◽

Randomised Controlled ◽

Tract Infections

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Use of non-pharmacological interventions during urinary catheter insertion for reducing urinary tract infections in non-immunocompromised adults. A systematic review

Revista de la Facultad de Medicina ◽

10.15446/revfacmed.v68n1.74383 ◽

2020 ◽

Vol 68 (1) ◽

Author(s):

Ximena Saenz-Montoya ◽

Carlos Fernando Grillo-Ardila ◽

Jairo Amaya-Guio ◽

Jessica Muñoz-Vesga

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Randomized Clinical Trials ◽

Urinary Catheter ◽

Asymptomatic Bacteriuria ◽

Catheter Insertion ◽

Occurrence Rate ◽

Pharmacological Interventions ◽

Tract Infections ◽

Quality Evidence

Introduction: Catheter-associated urinary tract infections (CAUTI) account for up to 30% of hospital-acquired infections. In this regard, several studies have reported the use of non-pharmacological interventions during urinary catheter insertion aimed at reducing the occurrence rate of CAUTI.Objective: To assess the safety and effectiveness of using non-pharmacological interventions during urinary catheter insertion aimed at reducing the risk of contracting infections in non-immunocompromised adults.Material and methods. A literature review was conducted in MEDLINE, Embase, and LILACS databases. Only randomized clinical trials comparing the use of non-pharmacological interventions with the use of placebos, the use of pharmacological interventions or the lack of any intervention at all during catheter insertion were included.Results: Eight studies were retrieved (8.718 participants). Based on the evidence found in the review (low-quality and very low-quality evidence according to the quality classification GRADE system), using non-pharmacological interventions reduces the frequency of asymptomatic bacteriuria episodes (RR: 0.67, 95%CI 0.48-0.94; 7 studies) or minor side effects (RR: 0.84, 95% CI 0.74-0.96; 4.157; 2 studies), but does not reduce the occurrence rate of symptomatic urinary tract infections (RR: 0.90, 95%CI 0.61-1.35; 4 studies) or improves quality-of-life scores (MD –0.01 EQ-5D scale; 95%CI (-0.03)-(0.01), 1 study).Conclusion: The use of non-pharmacological interventions during urinary catheter insertion does not imply any risk at all, instead it could help reduce the occurrence rate of infections associated with this procedure, such as asymptomatic bacteriuria and minor adverse events; however, there is very little evidence (in fact, low and very low quality evidence) to make conclusions on the effectiveness of these interventions.

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