title: A prospective interventional study to examine the effect of a silver alloy and hydrogel-coated catheter on the incidence of catheter-associated urinary tract infection.
abstract: BACKGROUND
  Catheter-associated urinary tract infection is a major hospital-acquired infection. This study aimed to analyse the effect of a silver alloy and hydrogel-coated catheter on the occurrence of catheter-associated urinary tract infection.
  
  
  METHODS
  This was a 1-year prospective study conducted at a single centre in Hong Kong. Adult patients with an indwelling urinary catheter for longer than 24 hours were recruited. The incidence of catheter-associated urinary tract infection in patients with a conventional latex Foley catheter without hydrogel was compared with that in patients with a silver alloy and hydrogel-coated catheter. The most recent definition of urinary tract infection was based on the latest surveillance definition of the National Healthcare Safety Network managed by Centers for Disease Control and Prevention.
  
  
  RESULTS
  A total of 306 patients were recruited with a similar ratio between males and females. The mean (standard deviation) age was 81.1 (10.5) years. The total numbers of catheter-days were 4352 and 7474 in the silver-coated and conventional groups, respectively. The incidences of catheter-associated urinary tract infection per 1000 catheter-days were 6.4 and 9.4, respectively (P=0.095). There was a 31% reduction in the incidence of catheter-associated urinary tract infection per 1000 catheter-days in the silver-coated group. Escherichia coli was the most commonly involved pathogen (36.7%) of all cases. Subgroup analysis revealed that the protective effect of silver-coated catheter was more pronounced in long-term users as well as female patients with a respective 48% (P=0.027) and 42% (P=0.108) reduction in incidence of catheter-associated urinary tract infection. The mean catheterisation time per person was the longest in patients using a silver-coated catheter (17.0 days) compared with those using a conventional (10.8 days) or both types of catheter (13.6 days) [P=0.01].
  
  
  CONCLUSIONS
  Silver alloy and hydrogel-coated catheters appear to be effective in preventing catheter-associated urinary tract infection based on the latest surveillance definition. The effect is perhaps more prominent in long-term users and female patients.
authors.affiliation: Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: P Hy
authors.initials: PH
authors.lastname: Chung
authors.affiliation: Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: C Wy
authors.initials: CW
authors.lastname: Wong
authors.affiliation: Department of Pathology, Queen Elizabeth Hospital, Jordan, Hong Kong.
authors.forename: C Kc
authors.initials: CK
authors.lastname: Lai
authors.affiliation: Chief Infection Control Officer's Office, Hospital Authority, Hong Kong.
authors.forename: H K
authors.initials: HK
authors.lastname: Siu
authors.affiliation: Department of Pathology, Queen Elizabeth Hospital, Jordan, Hong Kong.|Chief Infection Control Officer's Office, Hospital Authority, Hong Kong.
authors.forename: D Nc
authors.initials: DN
authors.lastname: Tsang
authors.affiliation: Infection Control Team, Central Nursing Department, Kowloon Hospital, Argyle Street, Hong Kong.
authors.forename: K Y
authors.initials: KY
authors.lastname: Yeung
authors.affiliation: School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: D Km
authors.initials: DK
authors.lastname: Ip
authors.affiliation: Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: P Kh
authors.initials: PK
authors.lastname: Tam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000497:Alloys; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D002408:Catheters, Indwelling; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D020100:Hydrogels; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D012737:Sex Factors; D012834:Silver / Q000737:chemistry; D013997:Time Factors; D014546:Urinary Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D000497:Alloys; D020100:Hydrogels; D012834:Silver
keywords: Catheter-related infections; Gold alloys/therapeutic use; Hydrogel/therapeutic use; Silver/therapeutic use; Urinary tract infections