Use of non-pharmacological interventions during urinary catheter insertion for reducing urinary tract infections in non-immunocompromised adults. A systematic review

Abstract

Introduction: Catheter-associated urinary tract infections (CAUTI) account for up to 30% of hospital-acquired infections. In this regard, several studies have reported the use of non-pharmacological interventions during urinary catheter insertion aimed at reducing the occurrence rate of CAUTI.Objective: To assess the safety and effectiveness of using non-pharmacological interventions during urinary catheter insertion aimed at reducing the risk of contracting infections in non-immunocompromised adults.Material and methods. A literature review was conducted in MEDLINE, Embase, and LILACS databases. Only randomized clinical trials comparing the use of non-pharmacological interventions with the use of placebos, the use of pharmacological interventions or the lack of any intervention at all during catheter insertion were included.Results: Eight studies were retrieved (8.718 participants). Based on the evidence found in the review (low-quality and very low-quality evidence according to the quality classification GRADE system), using non-pharmacological interventions reduces the frequency of asymptomatic bacteriuria episodes (RR: 0.67, 95%CI 0.48-0.94; 7 studies) or minor side effects (RR: 0.84, 95% CI 0.74-0.96; 4.157; 2 studies), but does not reduce the occurrence rate of symptomatic urinary tract infections (RR: 0.90, 95%CI 0.61-1.35; 4 studies) or improves quality-of-life scores (MD –0.01 EQ-5D scale; 95%CI (-0.03)-(0.01), 1 study).Conclusion: The use of non-pharmacological interventions during urinary catheter insertion does not imply any risk at all, instead it could help reduce the occurrence rate of infections associated with this procedure, such as asymptomatic bacteriuria and minor adverse events; however, there is very little evidence (in fact, low and very low quality evidence) to make conclusions on the effectiveness of these interventions.