Abstract
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.
Highlights
Several studies have reported the use of non-pharmacological interventions during urinary catheter insertion aimed at reducing the occurrence rate of Catheter-associated urinary tract infections (CAUTI)
Based on the evidence found in the review, using non-pharmacological interventions reduces the frequency of asymptomatic bacteriuria episodes (RR 0.67, 95%confidence intervals (CI) 0.48-0.94; 7 studies) or mild adverse events (RR 0.84, 95%CI 0.74-0.96; 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)
A total of 8 studies met the inclusion criteria;[19,20,21,22,23,24,25,26 12] papers were excluded because they were not randomized controlled trials (RCTs), 6 trials implemented a different intervention and 4 studies recruited a different kind of population
Summary
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. Based on the evidence found in the review (low-quality and very low-quality evidence according to the 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 mild adverse events (RR 0.84, 95%CI 0.74-0.96; 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 pose any risk at all Instead, it could help reduce the occurrence rate of infections associated with this procedure, such as asymptomatic bacteriuria and mild adverse events. In Bogotá, a prevalence of 16.1% was reported for the 2012-2013 period, with an incidence rate of 3.9 cases per 1 000 days of exposure.[6]
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