Infection risk with impregnated urinary catheter in patients receiving short-term bladder drainage : a meta-analysis

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Infection risk with impregnated urinary catheter in patients receiving short-term bladder drainage : a meta-analysis


Author: Ngan, Wai-chow Adrian
Title: Infection risk with impregnated urinary catheter in patients receiving short-term bladder drainage : a meta-analysis
Degree: M.Sc.
Year: 2009
Subject: Hong Kong Polytechnic University -- Dissertations.
Urinary tract infections.
Urinary catheterization -- Complications.
Department: School of Nursing
Pages: x, 76 leaves : ill. ; 30 cm.
Language: English
Abstract: Background: Catheter-associated urinary tract infection is a problem within health care setting. Preventive measures are recommended in infection control guidelines. However, innovative intervention to prevent infection, such as use of impregnated catheters, is not included in the guidelines due to the time gap between the guideline formation and the development of the intervention. This study aims to examine the existing evidence of the use of impregnated urinary catheters, so as to provide scientific support for updating our practice and guidelines. Methods: This study was designed as a systematic review and a meta-analysis of previous studies. Both Chinese and English electronic databases were searched for relevant literature. The articles were selected according to pre-set inclusion and exclusion criteria. Data of included articles were extracted on an extraction form, which was derived from the CONSORT statement checklist. Two raters assessed the quality of trials selected according to Jadad's quality assessment scale. Trials scoring three or above were included in meta-analysis. Statistical software programmes, including Review Manager 5.0, SPSS 17.0 and G*Power 3.0, were used to calculate the pooled effect size, to assess heterogeneity among studies, and to perform power analysis. Results: Nine randomized control trials matched with the selection criteria. Five of the studies were rated with sufficient quality to proceed to meta-analysis. Heterogeneity testing showed that different types of impregnated catheters had different mean effect size. Silver oxide impregnated catheters and antibiotics impregnated catheters were analyzed separately. For silver oxide impregnated catheters, the effectiveness was not supported (RR 0.88, 95% CI 0.69 to 1.13). On the other hand, antibiotics impregnated catheters demonstrated considerable effectiveness (RR 0.36, 95% CI 0.22 to 0.59). The respective statistical powers were 8.4% and 83.6% at the 5% significance level. Conclusion: The type of impregnated catheter affected the effectiveness in decreasing incidence of urinary tract infection. Moreover, quality trials are needed for meta-analysis. Although the effectiveness of silver oxide impregnated catheters is not support by this study, further investigation with a large sample is encouraged. For antibiotics impregnated catheters, types of antibiotics may need to be differentiated. It is concluded that impregnated catheters may be included in guideline writing as an intervention, but catheter type and level of evidence should be clearly specified.

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