Does periurethral cleaning with water prior to indwelling urinary catheterization increase the risk of urinary tract infections? A systematic review and meta-analysis.

OBJECTIVE: To determine whether periurethral cleaning with water before indwelling urinary catheterization increases the risk of urinary tract infections (UTIs) compared with studies using anti-infective agents.

METHODS: A literature search via MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials through October 2017 and a manual search of references for additional relevant studies. Trials studying clean intermittent catheterization were excluded. Data were extracted independently by 2 reviewers. Disagreements were resolved through discussion. Results of randomized controlled trials were pooled using random effects models. Both individual and pooled risk estimates were reported using risk ratios (RRs) and 95% confidence intervals (CIs).

RESULTS: From 121 identified articles, 5 studies involving 824 patients were included in the review (822 patients included in meta-analysis). No statistical significance in the incidence of UTIs existed between the water group and antiseptics group (RR, 1.07; 95% CI, 0.77-1.49; P = .89; I2  = 0%). Available data comparing water with povidone-iodine or chlorhexidine gluconate demonstrated no significant difference between the incidence of UTIs (RR, 1.10; 95% CI, 0.66-1.83; P = .79; I2  = 0%; and RR, 1.05; 95% CI, 0.68-1.62; P = .72; I2  = 0%; respectively).

CONCLUSIONS: Based on current data, water is as safe as other topical antiseptics for periurethral cleansing before indwelling urinary catheter insertion.