title: Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter-associated urinary tract infections.
abstract: BACKGROUND
  Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections. Antiseptic cleaning of the meatal area before and during catheter use may reduce the risk of CAUTIs.
  
  
  OBJECTIVE
  To undertake a systematic review of the literature and meta-analysis of studies investigating the effectiveness of antiseptic cleaning before urinary catheter insertion and during catheter use for prevention of CAUTIs.
  
  
  METHODS
  Electronic databases were searched to identify randomized controlled trials. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and compared across intervention and control groups using DerSimonian-Laird random-effects model. Subgroup analyses were performed. Heterogeneity was estimated using the I2statistic.
  
  
  RESULTS
  In total, 2665 potential papers were identified; of these, 14 studies were eligible for inclusion. There was no difference in the incidence of CAUTIs when comparing antiseptic and non-antiseptic agents (pooled OR 0.90, 95% CI 0.73-1.10; P=0.31), or when comparing different agents: povidone-iodine vs routine care; povidone-iodine vs soap and water; chlorhexidine vs water; povidone-iodine vs saline; povidone-iodine vs water; and green soap and water vs routine care (P>0.05 for all). Comparison of an antibacterial agent with routine care indicated near significance (P=0.06). There was no evidence of heterogeneity (I2=0%; P>0.05). Subgroup analyses showed no difference in the incidence of CAUTIs in terms of country, setting, risk of bias, sex and frequency of administration.
  
  
  CONCLUSIONS
  There were no differences in CAUTI rates, although methodological issues hamper generalizability of this finding. Antibacterial agents may prove to be significant in a well-conducted study. The present results provide good evidence to inform infection control guidelines in catheter management.
authors.affiliation: Faculty of Health Sciences, Australian Catholic University, Canberra, Australian Capital Territory, Australia; Lifestyle Research Centre, Avondale College of Higher Education, Cooranbong, New South Wales, Australia. Electronic address: oyebola.fasugba@acu.edu.au.
authors.forename: O
authors.initials: O
authors.lastname: Fasugba
authors.affiliation: Faculty of Health Sciences, Australian Catholic University, Canberra, Australian Capital Territory, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Koerner
authors.affiliation: Faculty of Arts, Nursing and Theology, Avondale College, Wahroonga, New South Wales, Australia; School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.
authors.forename: B G
authors.initials: BG
authors.lastname: Mitchell
authors.affiliation: Faculty of Health Sciences, Australian Catholic University, Canberra, Australian Capital Territory, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Gardner
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D000985:Antisepsis / Q000379:methods*; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002404:Catheterization / Q000379:methods*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000517:prevention & control*
chemical_list: D000891:Anti-Infective Agents, Local
keywords: Antiseptic; Meatal cleaning; Meta-analysis; Systematic review; Urinary catheter; Urinary tract infection