Povidone-Iodine, 0.05% Chlorhexidine Gluconate, or Water for Periurethral Cleaning Before Indwelling Urinary Catheterization in a Pediatric Intensive Care: A Randomized Controlled Trial.
OBJECTIVE
The aim of this study was to evaluate the efficacy of periurethral cleaning with 10% povidone-iodine, 0.05% chlorhexidine gluconate, or sterile water in preventing catheter-associated urinary tract infections (CAUTIs) prior to indwelling urinary catheter insertion in a pediatric intensive care unit. A secondary aim was to identify pathogens resulting in CAUTIs in this group.


METHODS
Randomized controlled trial.


METHODS
One hundred twenty-two patients cared for in a pediatric intensive care unit of a university hospital between September 2012 and December 2013 participated in the study.


METHODS
Subjects were randomly allocated to 1 of 3 groups: periurethral cleansing with 0.05% chlorhexidine; 10% povidone-iodine; or sterile water. The patients in each group were cleansed 3 times using different sterile pads and assigned cleansing solutions for as long as the patients were observed or until the urinary catheter was removed. Daily monitoring forms, which included physiologic and physical parameters and catheter-related infections, were completed for all patients. We used Centers for Disease Control and Prevention/National Health and Safety Network criteria to determine the presence of a CAUTI.


RESULTS
CAUTIs occurred in 6 patients (15%) allocated to periurethral cleansing with povidone-iodine, 2 (4.8%) in the chlorhexidine gluconate group, and 3 (7.5%) in the sterile water group. Although more patients in the povidone-iodine group had CAUTI than in the other 2 groups, differences were not statistically significant (P > .05).


CONCLUSIONS
We found no statistically significant differences in CAUTI rates in the 3 groups. Further investigation with a larger study group is needed to more definitively identify any difference in CAUTI occurrences based on periurethral cleansing solution.
Duygu Sönmez Düzkaya, PhD, BSc, RN, Directorate of Nursing Services, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. Gülzade Uysal, PhD, BSc, RN, School of Health Sciences, Okan University, Istanbul, Turkey. Gülçin Bozkurt, PhD, BSc, RN, School of Health Sciences, Istanbul University, Istanbul, Turkey. Tülay Yakut, BSc, Pediatric Intensive Care Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. Agop Çitak, MD, Pediatric Intensive Care Unit, Acibadem University, Istanbul, Turkey.
Duygu Sönmez
DS
Düzkaya
Gülzade
G
Uysal
Gülçin
G
Bozkurt
Tülay
T
Yakut
Agop
A
Çitak
D000890:Anti-Infective Agents / Q000494:pharmacology* / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000517:prevention & control*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D002710:Chlorhexidine / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration / Q000706:statistics & numerical data; D008297:Male; D011206:Povidone-Iodine / Q000494:pharmacology / Q000627:therapeutic use; D016896:Treatment Outcome; D014421:Turkey; D014521:Urethra / Q000187:drug effects* / Q000382:microbiology / Q000503:physiopathology; D014546:Urinary Catheterization / Q000009:adverse effects / Q000379:methods / Q000451:nursing*; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000517:prevention & control; D014867:Water / Q000008:administration & dosage
D000890:Anti-Infective Agents; D014867:Water; D011206:Povidone-Iodine; C010882:chlorhexidine gluconate; D002710:Chlorhexidine