Effect of chlorhexidine and urinary catheter infection prevention in a Brazilian coronary ICU

Abstract

Introduction Urinary catheter insertion is a common procedure in ICUs and can be an important cause of infection in the hospital environment [1,2]. We aimed to analyze the effect of chlorhexidine on long-term urinary catheter insertion and urinary tract infection (UTI) during a 5-year period in patients admitted to a coronary ICU. Methods Analysis of patients admitted to a coronary ICU of a mediumsized hospital in Brazil from January 2010 to May 2014. The institutional protocol of periprocedural antisepsis was changed from iodine-based antiseptic to chlorhexidine in 2012. The UTI diagnosis was based on urine culture (>105 colony-forming units per ml of urine) associated with at least one clinical/laboratory abnormality (fever >38degreeC, urination urgency, increased urinary frequency, dysuria, or suprapubic or lumbar pain). The UTI rate represents the urinary tract infections associated with long-term urinary catheter (patient with UTI associated with long-term urinary catheter divided by patients with long-term urinary catheter x 1,000). Results The urinary tract infection rates were 4.8 (year 2010: patients-day -1 (n: 2,511), long-term urinary catheter-day -1 (n: 1,455), device usage rate (958%)), 4.4 (year 2011: patients-day -1 (n: 2,529), longterm urinary catheter-day -1 (n: 1,140), device usage rate (45%)), 0.0 (year 2012: patients-day -1 (n: 2,660), long-term urinary catheter-day -1 (n: 783), device usage rate (29%)), 0.0 (year 2013: patients-day -1 (n: 2,573), longterm urinary catheter-day -1 (n: 960), device usage rate (37%)), and 0.0 (year 2014: patients-day -1 (n: 1,070), long-term urinary catheter-day -1 (n: 444), device usage rate (42%)). Conclusion The use of chlorhexidine in the periprocedural antisepsis of urinary catheterization contributed to the decrease of urinary tract infections associated with long-term urinary catheter in patients admitted to the coronary ICU.