The Role of Chlorhexidine in Reducing Catheter Associated Urinary Tract Infection: A Randomised Controlled Study

Introduction: The evidence on which solution to use for meatal cleaning, prior to urinary catheter insertion is mixed. There are conflicting recommendations in international guidelines and in clinical practice, which reflect this uncertainty. The aim of this study was to evaluate the effectiveness of using chlorhexidine in meatal cleaning prior to catheter insertion, in reducing catheter-associated asymptomatic bacteriuria (CA-ASB) and CAUTI. Methods: A stepped wedge randomised controlled clinical trial was undertaken in three Australian hospitals. The intervention was the use of chlorhexidine (0.1%) solution, compared to normal saline (0.9%) for meatal cleaning prior to catheter insertion. The number of CA-ASB and CAUTI were analysed using Poisson regression, with no intervention delay on the outcome. The stepped wedge design allows hospitals to act as their own control. Results: 1642 catheters were inserted over the study period (697 control, 945 intervention). The mean age of participants was 62 years, 57% were female. Following the introduction of the intervention, the incidence of CAUTI reduced by 94%, IRR 0.06 (95%CI 0.01-0.32). Similarly, there was a 72% reduction in CA-ASB (IRR 0.28, 95%CI 0.08-0.93). Conclusion: The use of chlorhexidine was associated with a decrease in both bacteriuria and CAUTI. This decrease was identified at all sites, with no CAUTI observed in the post-intervention period in two of the three study sites. The study findings will have implications for recommendation in national guidelines, hospital policy and clinical practice