Bottom line: Best available evidence suggests that tap water can be used to effectively clean genitalia; daily cleaning of the meatal area and early removal of catheters are associated with reduction in CAUTIs. Some evidence suggests silver-impregnated catheters associated with decreased incidence of bacteriuria. Evidence does not support use of sealed drainage systems (as a single strategy), adding antibacterial solutions to drainage bags, or routinely changing drainage bags (as opposed to changing only when clinically necessary.)
Moola S, Konno R. A systematic review of the management of shot-term indwelling urethral catheters to prevent urinary tract infections. JBI Library of Systematic Reviews. 2010;8(17): 695-729.
Review of studies retrieved from Medline and CINAHL and that included adult patients using urinary catheters 1 to 14 days. Methodologies included first RCTs. If no RCTs available, then non-randomized studies and before and after studies were included. Results section describes findings for various types of intervention strategies.
Reviewed by John Nemeth 4/14
“Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery.” Spine (Philadelphia, Pa. 1976) 30.15 (2005):1689.
Lid scrub may reduce endophthalmitis rate when used with topical Betadine… including commentary by Trattler WB. Ocular Surgery News 2009 vol:27 iss:19 pg:16
Swenson BR ; Hedrick TL ; Metzger R ; Bonatti H ; Pruett TL ; Sawyer RG. Effects of preoperative skin preparation on postoperative wound infection rates: a prospective study of 3 skin preparation protocols. Infection Control & Hospital Epidemiology, 2009 Oct; 30 (10): 964-71.
Giordano, Salvatore, et al. “Povidone-iodine combined with antibiotic topical irrigation to reduce capsular contracture in cosmetic breast augmentation: a comparative study.” Aesthetic surgery journal 33.5 (2013):675-680.
Haas, David Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections. Cochrane Database of Systematic Reviews. 2014 Dec 21;(12):CD007892. doi: 10.1002/14651858.CD007892.pub5.
Spinal Surgery: Prevention and Management of Infection. [Recommended Practices] 2013
Searched CINAHL, PubMed & Joanna Briggs. Keywords: Betadine or Povidone-iodine, postoperative
Reviewed by John Nemeth 4/14
Updated links for last two items, 10/16/2017 ldt
A search of Joanna Briggs for the term piggyback identified several evidence summaries and recommendations. Each of them cited the 2002 CDC guidelines as evidence in discussing piggyback systems.
MMWR Recomm Rep. 2002 Aug 9;51(RR-10):1-29.
O’Grady NP, et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention.
On p. 11, the guidelines state that “modified piggyback systems have the potential to prevent contamination…” and cite this single study:
JPEN J Parenter Enteral Nutr. 1992 Nov-Dec;16(6):581-5.
Inoue Y, et al. Prevention of catheter-related sepsis during parenteral nutrition: effect of a new connection device.
A search of PubMed was conducted using the following terms:
(piggyback OR secondary iv OR (secondary AND infusion)) AND infections AND prevention AND central venous catheters
The results include the Inoue study. No other studies focus on prevention of catheter-associated bloodstream infections, but may report data on infection rates, which may also be useful. However, the populations for most of the other studies were neonates.
jkn 3/14
Kressel, Amy B, et al. “Hospitals learn their collective power: an isolation gown success story.” American journal of infection control 39.1 (2011):76-78.
Srinivasan A ; Song X ; Ross T ; Merz W ; Brower R ; Perl TM A prospective study to determine whether cover gowns in addition to gloves decrease nosocomial transmission of vancomycin-resistant enterococci in an intensive care unit. Infection Control & Hospital Epidemiology, 2002 Aug; 23 (8): 424-8.
Community-acquired MRSA boosts need for awareness: hand hygiene, knowledge block cross-contamination. Same-Day Surgery, 2008 Feb; 32 (2): 17-9.
Kressel AB ; McVey JL ; Miller JM ; Fish LL Hospitals learn their collective power: an isolation gown success story. Department of Medicine, Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN
Lovitt SA ; Nichols RL ; Smith JW ; Muzik AC ; Pearce PF Isolation gowns: a false sense of security? Dept Surg, Tulane Univ School Med, 1430 Tulane Ave, New Orleans, LA 70112-2669 American Journal of Infection Control, 1992 Aug; 20 (4): 185-91.
McLane C Commentary on Isolation gowns: a false sense of security? AACN Nursing Scan In Critical Care, 1993 Jul-Aug; 3 (4): 23.
Databases searched: PubMed & CINAHL. Keywords: isolation (gown or gowns) and infection
Smith J. It’s Contagious! CLABSI Prevention is Spreading. American Journal Of Infection Control [serial online]. June 2012;40(5):e128-9. Available from: CINAHL, Ipswich, MA. Accessed June 5, 2013.
National Estimates of Central Line–Associated Bloodstream Infections in Critical Care Patients.” Infection control and hospital epidemiology 34.6 (2013):547.
Saffer M. Preventing Central Line Infections In Outpatients. Pediatric Nursing. November 2012;38(6):336. Available from: CINAHL, Ipswich, MA. Accessed June 5, 2013.
Prevention of catheter-related infection: toward zero risk?.” Current opinion in infectious diseases 24.4 (2011):377.
Evidence Matters 