Clean vs. sterile intermittent bladder catheterization – adapted from the Journal of the American Geriatric Society 1995;43:865-70 – Tips from Other Journals
Early clinical guidelines recommended strict sterile technique for intermittent catheterization to avoid the risk of infection from bacteria entering the bladder through the catheter. However, this recommendation limited the use of intermittent catheterization in nursing homes, since strict sterile techniques are considered expensive and cumbersome. Recent studies have suggested that clean intermittent catheterization of the urinary bladder does not increase the risk of urinary tract infection. Duffy and colleagues conducted a randomized clinical trial to compare the safety and efficacy of clean catheterization with that of sterile catheterization.
Eighty male veterans who were nursing home residents were included in the study The study subjects were randomized to receive either sterile catheterization (42 patients) or clean catheterization (38 patients). Standardized sterile procedures required a sterile field set up with drapes, use of only sterile equipment and cleaning of the urinary meatus with povidone and iodine before catheterization. The clean technique did not require a sterile field or cleaning of the meatus if daily hygiene was used. After the first use, the sterile catheters were washed with mild soap and running water, dried on a clean, lint-free towel and stored in a dry, clean container by the patient’s bedside. Each catheter was used for only one week. Laboratory analyses of blood and urine, as well as a cost comparison of nursing time and equipment usage, were performed during the study period.
Fifty-five percent of the men in the clean catheterization group and 62 percent of those in the sterile catheterization group were treated for symptomatic bacteriuria during the study The time to first infection, type of organism cultured and cost of antibiotic treatment were similar in the two groups. The nursing and supply costs were significantly higher for sterile procedures ($6.25 versus $4.00 per catheterization).
The authors conclude that clean intermittent catheterization is a safe and cost-effective procedure for this male nursing home population. An estimated $1,460 in annual savings per patient could be expected with clean catheterization if the patient were catheterized an average of four times per day.(Duffy L, et al. Clean intermittent catheterization: safe, cost-effective bladder management for male residents of VA nursing homes. J Am Geriatr Soc 1995;43:865-70.)
COPYRIGHT 1996 American Academy of Family Physicians
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