Types of urethral catheters for management of short-term voiding problems in hospitalised adults: a systematic review

Abstract

This thesis describes the process of completing a systematic review for the Cochrane Collaboration and reports on the findings of this review that aimed to determine the effect of different types of indwelling urethral catheters on the risk of urinary tract infection in hospitalised adults who undergo short-term catheterisation. Urinary tract infection is the most common infection acquired by patients in hospital. The major associated cause is the presence of indwelling urinary catheters. A variety of specialised urethral catheters have been specifically designed to reduce the risk of infection. These include antiseptic impregnated catheters and antibiotic impregnated catheters. Catheter choice or selection is primarily a nursing decision and nurses also take a leading role in leading decision-making in the choice of catheters purchased for hospitals. Following a systematic search 18 studies met the inclusion criteria established for the review: antiseptic impregnated catheters versus standard catheters, which included silver oxide (n=3 trials) and silver alloy (n=8 trials), antibiotic impregnated catheters versus standard catheters (n=1 trial) and comparisons of different types of standard catheters (n=6 trials). Silver alloy catheters were found to significantly reduce the incidence of asymptomatic bacteriuria (RR 0.36, 95% CI 0.25 to 0.52) in hospitalised adults catheterised for less than one week. Cost benefit analyses indicate that compensation for the increased cost of silver alloy catheters would come from the reduction in the cost of catheter acquired urinary tract infection. The publication of this review in the Cochrane Library will provide not only nurses and nurse managers, but also other health professionals with evidence of effectiveness to influence catheter choice. Many gaps in the evidence have also been identified which should be used as a guide for future urinary catheter research.