Short-term Indwelling Urethral Catheters Research Articles

For adults with short-term indwelling urethral catheters, what are the effects of prophylactic alpha blockers?

For adults with short-term indwelling urethral catheters, what are the effects of prophylactic alpha blockers?

For adults with short-term indwelling urethral catheters, how does clamping compare with free drainage?

For adults with short-term indwelling urethral catheters, how does clamping compare with free drainage?

For adults with short-term indwelling urethral catheters, how does early removal compare with later removal?

For adults with short-term indwelling urethral catheters, how does early removal compare with later removal?

For adults with short-term indwelling urethral catheters, does time of day the catheter is removed affect outcomes?

For adults with short-term indwelling urethral catheters, does time of day the catheter is removed affect outcomes?

Strategies for the removal of short-term indwelling urethral catheters in adults.

Strategies for the removal of short-term indwelling urethral catheters in adults.

A systematic review of the management of short-term indwelling urethral catheters to prevent urinary tract infections.

Background Indwelling urinary catheterisation is a relatively common procedure in hospital settings, associated with potential risk of infection. Around 80% of urinary tract infections (UTIs) are associated with urinary catheters and the risk of infection increases in patients who are acutely ill. The objective of this review was to present the best available critically appraised evidence related to preventing infections associated with the use of short-term indwelling urethral catheters. This review is an update of a previous review published in 2004. Review methods The review considered randomised controlled trials that included adult patients with short-term indwelling urinary catheters. The main interventions related to catheterisation techniques, meatal care, catheter composition, bladder irrigation, drainage systems, care delivery practices and education programs. The primary outcome of interest was the difference in the rates of UTIs between the intervention group and control group. This review was limited to short-term urethral catheters, so studies that evaluated long-term or suprapubic catheters were excluded. Search strategy The search included both published and unpublished studies with an initial limited search of MEDLINE and CINAHL databases undertaken to identify key words contained in the title or abstract, and index terms used to describe relevant interventions. A second extensive search used all identified key words and index terms. The third step included a search of the reference lists and bibliographies of relevant articles. Methodological quality The methodological quality of the included papers was assessed using a checklist developed by the Joanna Briggs Institute. Two independent reviewers conducted critical appraisal and data extraction and any disagreements that arose were addressed through mutual discussion. Results The review found six new studies in relation to catheter composition and delivery care practices interventions. Studies from previous review have been reported on in the results, discussion and conclusion sections. No one type of catheter was found to be better than another in terms of reducing the risk of bacteriuria in hospitalised adults. The incidence of catheter associated bacteriuria and funguria (CABF) was lower in adult trauma patients when nitrofurazone-impregnated catheters were used. Nitrofurazone-coated and silver alloy-coated catheters reduced the development of asymptomatic bacteriuria during short-term (< 30 days) use when compared with latex or silicon control catheters. Studies that compared immediate versus delayed catheter removal following operations found that early removal of catheter after operation was safe and that there was a tendency for increased infection with longer duration of catheterisation. Stop (prewritten) orders for urinary catheters resulted in a significant reduction in duration of inappropriate catheterisation days. There was no significant difference in infection rate using either sterile surgical or non-sterile insertion technique. The use of water for cleansing prior to catheter insertion was recommended. There was no additional benefit from specific meatal care other than standard daily personal hygiene and removal of debris. Infection rates were similar for both latex and silicone catheters. Comparisons between silver and Teflon coating clearly favoured the silver alloy coating. The use of a complex closed drainage system in the intensive care environment did not confer any additional benefit. Studies comparing types of junction seals and use of junction seals either prior to or following catheterisation found no clear benefit from using either preconnected sealed systems or sealed systems with the addition of silver releasing devices. Neither the addition of chlorhexidine nor hydrogen peroxide to the drainage bag was found to be effective at reducing UTI rates. The findings indicated there was a higher incidence of bacteriuria associated with Foley catheters compared with intermittent catheterisation (P < 0.025). A single RCT examined the effect on UTI rates of routine bag changes against no routine TRUNCATED AT 600 WORDS

A systematic review of the management of short-term indwelling urethral catheters to prevent urinary tract infections

A systematic review of the management of short-term indwelling urethral catheters to prevent urinary tract infections

Removal of short-term indwelling urethral catheters

This information on best practice discusses the evidence for the removal of short-term indwelling urethral catheters. The article has been reproduced with the permission of the Joanna Briggs Institute (JBI). The article is derived from a systematic review of research published by the JBI,'Comparison of late night and early morning removal of short-term urethral catheters: a systematic review' (Fernandez et ol 2003), and another published in the Cochrane Library 'Policies for the removal of short-term indwelling urethral catheters' (Griffiths and Fernandez 2005). The primary references on which this information is based are available in the systematic review reports to members of the JBI via the website: www.joannabriggs.edu.au and the Cochrane Library.

Strategies to promote intermittent self-catheterisation in adults with neurogenic bladders: A systematic review.

Review Objective The purpose of this systematic review is to establish the best available evidence on strategies to promote intermittent urethral self-catheterisation in adults with neurogenic / neuropathic bladders. More specifically, the review questions are: What are the extrinsic and/or intrinsic factors that influence the suitability of individuals to perform self intermittent [urethral] catheterisation (SIMC)? What strategies promote long term compliance with SIMC? What are the advantages and disadvantages of using SIMC? Does SIMC improve the quality of life for people using this bladder management strategy? Criteria for considering studies for this review Types of Studies This review will incorporate the best available evidence for each of the sub-topics identified by the objectives and specific questions asked in this systematic review. Quantitative This component of the review will consider any randomised controlled trials (RCT) that examine the effectiveness of strategies to promote long term compliance with self-intermittent catheterisation. In the absence of RCT other quantitative research designs such as non-randomised experimental and quasi experimental, before and after studies, cohort studies and case series/case reports will be considered for inclusion in a narrative summary. For the remaining three sub-topics, i.e. quality of life, advantages and disadvantages of SIMC, and factors influencing suitability of individuals to perform SIMC, all quantitative research designs will be considered for inclusion. Qualitative This component of the review will consider any interpretive studies that draw on the experiences of intermittent self-catheterisation by adults for each of the sub-topics. This will include, but not be limited to, designs such as phenomenology, grounded theory and ethnography. Studies excluded from this review include: Those involving children and adolescents, i.e. > 18 years of age, Catheterisation performed by a carer or health professional, Catheterisation of a surgically created stoma, Indwelling catheters, Comparison of catheter types, Strategies to specifically reduce infection. Types of participants The review will include adults who are 18 years or older, who undertake urethral self-catheterisation for management of their neurogenic bladder dysfunction. Types of interventions/phenomena of interest The interventions, programs and strategies of primary interest are those TRUNCATED AT 350 WORDS

Strategies for the removal of short-term indwelling urethral catheters in adults

Approximately 15% to 25% of all hospitalised patients have indwelling urethral catheters, mainly to assist clinicians to accurately monitor urine output during acute illness or following surgery, to treat urinary retention, and for investigative purposes. The objective of this review was to determine the best strategies for the removal of catheters from patients with a short-term indwelling urethral catheter. The main outcome of interest was the number of patients who required recatheterisation following removal of indwelling urethral catheter. We searched the Cochrane Incontinence Group Specialised Register (searched 7 December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2006, Issue 2), MEDLINE (January 1966 to 12 July 2006), EMBASE (January 1980 to 12 July 2006), CINAHL (January 1982 to 12 July 2006), Nursing Collection (January 1995 to January 2002) and reference lists of relevant articles and conference proceedings were searched. We also contacted manufacturers and researchers in the field. No language or other restrictions were applied. All randomised and quasi-randomised controlled trials (RCTs) that compared the effects of alternative strategies for removal of short-term indwelling urethral catheters on patient outcomes were considered for inclusion in the review. Eligibility of the trials for inclusion in the review, details of eligible trials and the methodological quality of the trials were assessed independently by two reviewers. Relative risks (RR) for dichotomous data and a weighted mean difference (WMD) for continuous data were calculated with 95% confidence intervals (CI). Where synthesis was inappropriate, trials were considered separately. Twenty six trials involving a total of 2933 participants were included in the review. One trial included three treatment groups. In 11 RCTs amongst 1389 people, there was no significant difference in need for recatheterisation, although recatheterisation after removal at night was more likely to be during working hours. Pooled results demonstrated that, following urological surgery and procedures, patients whose indwelling urethral catheters were removed at midnight passed significantly larger volumes at their first void (Difference (fixed) 96 ml; 95% CI 62 to 130). Similar findings were reported for patients following TURP (Difference (fixed) 27; 95% CI 23 to 31). Removal at midnight was also associated with longer time to first void, and shorter lengths of hospitalisation (relative risk of not going home on day of removal = 0.71, 95% CI 0.64 to 0.79). Results in 13 trials amongst 1422 participants having early rather than delayed catheter removal were consistent with a higher risk of voiding problems and a lower risk of infection, with shorter hospitalisation. In three trials involving 234 participants the data were too few to assess differential effects of catheter clamping compared with free drainage prior to withdrawal. No eligible trials compared flexible with fixed duration of catheterisation, or assessed prophylactic alpha sympathetic blocker drugs prior to catheter removal. There is suggestive but inconclusive evidence of a benefit from midnight removal of the indwelling urethral catheter. There are resource implications but the magnitude of these is not clear from the trials. The evidence also suggests shorter hospital stay after early rather than delayed catheter removal but the effects on other outcomes are unclear. There is little evidence on which to judge other aspects of management, such as catheter clamping.

Epic2: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England

Executive SummaryNational evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were commissioned by the Department of Health (DH) and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were published in January 2001.1 These guidelines describe the precautions healthcare workers should take in three areas: standard principles for preventing HCAI, which include hospital environmental hygiene, hand hygiene, the use of personal protective equipment, and the safe use and disposal of sharps; preventing infections associated with the use of short-term indwelling urethral catheters; and preventing infections associated with central venous catheters.The evidence for these guidelines was identified by multiple systematic reviews of experimental and non-experimental research and expert opinion as reflected in systematically identified professional, national and international guidelines, which were formally assessed by a validated appraisal process. In 2003, we developed complementary national guidelines for preventing HCAI in primary and community care on behalf of the National Collaborating Centre for Nursing and Supportive Care (National Institute for Healthand Clinical Excellence).2A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective in preventing HCAI, incorporated into amended guidelines. Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority. Consequently, the DH commissioned a review of new evidence published following the last systematic reviews. We have now updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the original epic guidelines published in 2001 remain robust, relevant and appropriate but that adjustments need to be made to some guideline recommendations following a synopsis of the evidence underpinning the guidelines.These updated national guidelines (epic2) provide comprehensive recommendations for preventing HCAI in hospitals and other acute care settings based on the best currently available evidence. Because this is not always the best possible evidence, we have included a suggested agenda for further research in each section of the guidelines. National evidence-based guidelines are broad principles of best practice which need to be integrated into local practice guidelines. To monitor implementation, we have suggested key audit criteria for each section of recommendations.Clinically effective infection prevention and control practice is an essential feature of protecting patients. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and the risk of patients acquiring an infection during episodes of healthcare in NHS hospitals in England can be minimised.

Clamping Short-term Indwelling Catheters

The objective of this review is to determine the effects of clamping short-term indwelling urethral catheters before removal on the incidence of urinary tract infection, time to first void, voiding dysfunction, incidence of recatheterization, and the length of hospital stay. Published and unpublished randomized and quasi-randomized controlled trials, completed between January 1966 and July 2004, in English and other languages that compared the effects of clamping short-term indwelling urethral catheters, were systematically reviewed using multiple electronic databases. Determination of eligibility of trials for inclusion in the review, assessment of methodological quality, and data extraction were undertaken independently by 2 reviewers. Relative risks for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals. Where synthesis was inappropriate, a narrative overview has been undertaken. Three trials that investigated the effect of clamping the indwelling urethral catheter compared to free drainage before removal were eligible for inclusion. Two trials reported no significant difference in the incidence of urinary tract infection (UTI), number of patients who developed urinary retention or required recatheterization, and the length of hospital stay between the 2 groups. Another reported that the postvoid residual urine volume for patients who did not receive reconditioning of the bladder increased from 4.25 mL at baseline to 42.25 mL after removal of the indwelling urethral catheter, whereas the residual urine volume for patients who received reconditioning increased from 17.25 mL at baseline to 22 mL at follow-up. The evidence for clamping indwelling urethral catheters before removal remains equivocal. Given the current state of evidence, procedures relating to clamping of indwelling urinary catheters should not be initiated. Until stronger evidence becomes available, however, practices relating to clamping indwelling urethral catheters will continue to be dictated by local preferences and cost factors.

Removal of Short-term Indwelling Urethral Catheters

The objective of this systematic review was to determine the effect of the timing of removal of indwelling urethral catheters (IUCs) on the duration to and volume of first void, length of hospitalization, number of patients developing urinary retention and requiring recatheterization, patient satisfaction, and the percentage of IUCs removed according to the scheduled time for removal. Published and unpublished literature in English and other languages between January 1966 and June 2002, which compared the effects of the timing of removal of short-term indwelling urethral catheters on patient outcomes, was systematically reviewed using multiple electronic databases. To determine eligibility of the trials for inclusion in the review, assessment of methodologic quality and data extraction was undertaken independently by 2 reviewers and verified by a third reviewer. Odds ratio (OR) for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals (CI). Where synthesis was inappropriate, a narrative overview has been undertaken. Eight randomized controlled trials were eligible for this review. When IUCs were removed at midnight, the time to first void was significantly shorter (P = .012) after gynecologic surgery and significantly longer in patients after urologic surgery and procedures. Seven trials reported that the volume of the first void was greater in patients whose IUCs were removed late at night, and this was statistically significant in 4 trials. Patients who had their IUC removed at midnight were discharged from the hospital significantly (P < .00001) earlier than those who had their IUC removed in the morning, a finding that could result in potential cost savings for hospitals. Based on the limited available evidence, this article suggests benefits in terms of patient outcomes and reduction in the length of hospitalization after midnight removal of the IUCs. Further trials should be undertaken in wider settings and on specific groups of patients to enhance generalizability.

Management of short-term indwelling urethral catheters to prevent urinary tract infections

Background This systematic review updates a previous review published in 2000. The objective of this review was to present the best available evidence relating to the prevention of catheter-associated urinary tract infections (UTI). Selection criteria This review considered randomised controlled trials (RCTs) of adult patients with short-term urethral catheters. In the absence of RCTs, other research designs such as non-randomised controlled trials and before and after studies were considered for inclusion. Interventions of interest were those related to the prevention of catheter-related UTI and included: sterile versus non-sterile insertion technique, special coatings to catheters versus standard non-coated catheters, the use of flush solutions, the use of solutions added to urinary drainage bag, maintenance of a closed urinary drainage circuit, the use of antireflux valves, antibiotic creams applied to the external meatus–catheter interface, meatal care regimens, education programs, and changed care delivery practices. This review was limited to short-term urethral catheters, and so studies evaluating long-term or suprapubic catheters were excluded. The primary outcome of interest was the difference in the rates of UTI between experimental intervention and the control. Search strategy The search included both published and unpublished studies with an initial limited search of MEDLINE and CINAHL databases undertaken to identify key words contained in the title or abstract, and index terms used to describe relevant interventions. A second extensive search used all identified key words and index terms. The third step included a search of the reference lists and bibliographies of relevant articles. The databases searched included: CINAHL, MEDLINE, Current Contents, Cochrane Library, Expanded Academic Index, and Embase. The Dissertation Abstracts International database was searched for unpublished studies. Assessment of methodological quality Methodological quality was assessed using a standardised checklist. Critical appraisal and data extraction were conducted by two independent reviewers; discrepancies were addressed through discussion with a third reviewer as required. Results There was no significant difference in infection rate using either sterile surgical or non-sterile insertion technique. The use of water for cleansing prior to catheter insertion was recommended. There was no additional benefit from specific meatal care other than standard daily personal hygiene and removal of debris. Infection rates were similar for both latex and silicone catheters. Comparisons between silver and Teflon coating clearly favoured the silver alloy coating. The use of a complex closed drainage system in the intensive care environment did not confer any additional benefit. Studies comparing types of junction seals and use of junction seals either prior to or following catheterisation found no clear benefit from using either preconnected sealed systems or sealed systems with the addition of silver releasing devices. Neither the addition of chlorhexidine nor hydrogen peroxide to the drainage bag was found to be effective at reducing UTI rates. The findings indicated there was a higher incidence of bacteriuria associated with Foley catheters compared with intermittent catheterisation (P < 0.025). A single RCT examined the effect on UTI rates of routine bag changes against no routine bag change. Routine bag changes were not advantageous in reducing the risk of infection. Conclusions Current RCT evidence suggests the use of a surgical sterile catheterisation technique is not required, and that tap water is sufficient for cleaning genitalia. Following insertion, daily hygiene around the meatal area is as effective as catheter toilets; and catheters impregnated with silver may reduce the incidence of catheter associated bacteriuria. Sealed (e.g. taped, presealed) drainage systems should not be relied upon as the sole mechanism for prevention of bacteriuria. The addition of antibacterial solutions to drainage bags and the routine change of drainage bags had no effect on catheter associated infection. However, most of the recommendations arising from this review were based on single studies, often with limited numbers of participants. There is an urgent need to replicate these studies in other clinical settings.

Management of short-term indwelling urethral catheters to prevent urinary tract infections

Background This systematic review updates a previous review published in 2000. The objective of this review was to present the best available evidence relating to the prevention of catheter-associated urinary tract infections (UTI). Selection criteria This review considered randomised controlled trials (RCTs) of adult patients with short-term urethral catheters. In the absence of RCTs, other research designs such as non-randomised controlled trials and before and after studies were considered for inclusion. Interventions of interest were those related to the prevention of catheter-related UTI and included: sterile versus non-sterile insertion technique, special coatings to catheters versus standard non-coated catheters, the use of flush solutions, the use of solutions added to urinary drainage bag, maintenance of a closed urinary drainage circuit, the use of antireflux valves, antibiotic creams applied to the external meatus-catheter interface, meatal care regimens, education programs, and changed care delivery practices. This review was limited to short-term urethral catheters, and so studies evaluating long-term or suprapubic catheters were excluded. The primary outcome of interest was the difference in the rates of UTI between experimental intervention and the control. Search strategy The search included both published and unpublished studies with an initial limited search of MEDLINE and CINAHL databases undertaken to identify key words contained in the title or abstract, and index terms used to describe relevant interventions. A second extensive search used all identified key words and index terms. The third step included a search of the reference lists and bibliographies of relevant articles. The databases searched included: CINAHL, MEDLINE, Current Contents, Cochrane Library, Expanded Academic Index, and Embase. The Dissertation Abstracts International database was searched for unpublished studies. Assessment of methodological quality Methodological quality was assessed using a standardised checklist. Critical appraisal and data extraction were conducted by two independent reviewers; discrepancies were addressed through discussion with a third reviewer as required. Results There was no significant difference in infection rate using either sterile surgical or non-sterile insertion technique. The use of water for cleansing prior to catheter insertion was recommended. There was no additional benefit from specific meatal care other than standard daily personal hygiene and removal of debris. Infection rates were similar for both latex and silicone catheters. Comparisons between silver and Teflon coating clearly favoured the silver alloy coating. The use of a complex closed drainage system in the intensive care environment did not confer any additional benefit. Studies comparing types of junction seals and use of junction seals either prior to or following catheterisation found no clear benefit from using either preconnected sealed systems or sealed systems with the addition of silver releasing devices. Neither the addition of chlorhexidine nor hydrogen peroxide to the drainage bag was found to be effective at reducing UTI rates. The findings indicated there was a higher incidence of bacteriuria associated with Foley catheters compared with intermittent catheterisation (P < 0.025). A single RCT examined the effect on UTI rates of routine bag changes against no routine bag change. Routine bag changes were not advantageous in reducing the risk of infection. Conclusions Current RCT evidence suggests the use of a surgical sterile catheterisation technique is not required, and that tap water is sufficient for cleaning genitalia. Following insertion, daily hygiene around the meatal area is as effective as catheter toilets; and catheters impregnated with silver may reduce the incidence of catheter associated bacteriuria. Sealed (e.g. taped, presealed) drainage systems should not be relied upon as the sole mechanism for prevention of bacteriuria. The addition of antibacterial solutions to drainage bags and the routine change of drainage bags had no effect on catheter associated infection. However, most of the recommendations arising from this review were based on single studies, often with limited numbers of participants. There is an urgent need to replicate these studies in other clinical settings.

Management of short-term indwelling urethral catheters to prevent urinary tract infections.

This systematic review updates a previous review published in 2000. The objective of this review was to present the best available evidence relating to the prevention of catheter-associated urinary tract infections (UTI). This review considered randomised controlled trials (RCTs) of adult patients with short-term urethral catheters. In the absence of RCTs, other research designs such as non-randomised controlled trials and before and after studies were considered for inclusion. Interventions of interest were those related to the prevention of catheter-related UTI and included: sterile versus non-sterile insertion technique, special coatings to catheters versus standard non-coated catheters, the use of flush solutions, the use of solutions added to urinary drainage bag, maintenance of a closed urinary drainage circuit, the use of antireflux valves, antibiotic creams applied to the external meatus-catheter interface, meatal care regimens, education programs, and changed care delivery practices. This review was limited to short-term urethral catheters, and so studies evaluating long-term or suprapubic catheters were excluded. The primary outcome of interest was the difference in the rates of UTI between experimental intervention and the control. The search included both published and unpublished studies with an initial limited search of MEDLINE and CINAHL databases undertaken to identify key words contained in the title or abstract, and index terms used to describe relevant interventions. A second extensive search used all identified key words and index terms. The third step included a search of the reference lists and bibliographies of relevant articles. The databases searched included: CINAHL, MEDLINE, Current Contents, Cochrane Library, Expanded Academic Index, and Embase. The Dissertation Abstracts International database was searched for unpublished studies. Methodological quality was assessed using a standardised checklist. Critical appraisal and data extraction were conducted by two independent reviewers; discrepancies were addressed through discussion with a third reviewer as required. There was no significant difference in infection rate using either sterile surgical or non-sterile insertion technique. The use of water for cleansing prior to catheter insertion was recommended. There was no additional benefit from specific meatal care other than standard daily personal hygiene and removal of debris. Infection rates were similar for both latex and silicone catheters. Comparisons between silver and Teflon coating clearly favoured the silver alloy coating. The use of a complex closed drainage system in the intensive care environment did not confer any additional benefit. Studies comparing types of junction seals and use of junction seals either prior to or following catheterisation found no clear benefit from using either preconnected sealed systems or sealed systems with the addition of silver releasing devices. Neither the addition of chlorhexidine nor hydrogen peroxide to the drainage bag was found to be effective at reducing UTI rates. The findings indicated there was a higher incidence of bacteriuria associated with Foley catheters compared with intermittent catheterisation (P < 0.025). A single RCT examined the effect on UTI rates of routine bag changes against no routine bag change. Routine bag changes were not advantageous in reducing the risk of infection. Current RCT evidence suggests the use of a surgical sterile catheterisation technique is not required, and that tap water is sufficient for cleaning genitalia. Following insertion, daily hygiene around the meatal area is as effective as catheter toilets; and catheters impregnated with silver may reduce the incidence of catheter associated bacteriuria. Sealed (e.g. taped, presealed) drainage systems should not be relied upon as the sole mechanism for prevention of bacteriuria. The addition of antibacterial solutions to drainage bags and the routine change of drainage bags had no effect on catheter associated infection. However, most of the recommendations arising from this review were based on single studies, often with limited numbers of participants. There is an urgent need to replicate these studies in other clinical settings.

Incidence of urinary tract infections in patients with short-term indwelling urethral catheters: A comparison between a 3-day urinary drainage bag change and no change regimens

Background: The current practice of caring for hospitalized patients with indwelling urethral catheters in Siriraj Hospital is to change the drainage bag every 3 days. In an extensive medical literature search, no evidence was noted to support this practice. Objective: The purpose of this study was to compare the incidence of catheter-associated urinary tract infections (UTI) in hospitalized patients with indwelling catheters who receive a drainage bag change every 3 days with the incidence of UTI in patients who receive no bag change. Design: This study was a randomized controlled trial. Participants and study procedures: Of the patients at Siriraj Hospital, 153 with an indwelling urinary catheter for at least 3 days were randomized to a 3-day drainage bag change or a no change regimen. A urine sample was obtained from each patient for culture every 7 days, on the day the catheter was removed, or the day the patient was suspected of having a UTI. Results: Of the 153 study patients, 79 were randomized to the 3-day bag change regimen, and 74 patients were in the no-change group. Both groups were comparable for all baseline characteristics. The incidence of symptomatic UTI was 13.9% in the 3-day drainage bag change group and 10.8% in the no change group (P =.7). The incidence of asymptomatic UTI was 36.7% in the 3-day bag change group and 36.5% in the no change group (P =.9). Conclusion: There is no evidence for the necessity of a bag change every 3 days at Siriraj Hospital; the urine bag can be left longer than 3 days. However, the appropriate frequency of urinary drainage bag change needs additional study because the sample size in this study does not rule out a false-negative result. (Am J Infect Control 2003;31:9-12.)