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Background <p>Catheter-associated urinary tract infection (CAUTI) is the most common healthcare-associated infection. Chlorhexidine gluconate (CHG) has been widely adopted for reducing central line-associated bloodstream infections. We aimed to evaluate the impact of replacing normal saline with 0.5% CHG solution for periurethral cleansing at the time of foley catheter insertion on the incidence of CAUTI.</p> Methods <p>A single-center, before-and-after quasi-experimental study was conducted at a 750-bed tertiary care hospital from December 2024 to December 2025. The periurethral antiseptic was changed from normal saline to 0.5% CHG solution on June 11, 2025, with June 2025 serving as a washout period. The first catheter episode per patient was included in the analysis. The primary outcome was CAUTI incidence, assessed using interrupted time series (ITS) analysis with Poisson segmented regression. Kaplan-Meier survival analysis with the log-rank test was performed to compare CAUTI-free survival between groups.</p> Results <p>A total of 4153 patients were included (pre-intervention: 1905, post-intervention: 2248), among whom 55 CAUTI events were identified (pre-intervention: 41, post-intervention: 14). The incidence rate declined from 3.40 to 1.27 per 1,000 catheter-days (62.6% reduction). ITS analysis revealed a significant immediate level change at the intervention point (IRR 0.374, 95% CI 0.204–0.686, <i>P</i> = 0.001), corresponding to a 62.6% reduction in the CAUTI rate after adjusting for the pre-existing temporal trend. Kaplan-Meier analysis showed significantly higher CAUTI-free survival in the post-intervention group (log-rank <i>P</i> = 0.009). Among culture-positive isolates from prospective surveillance (pre <i>n</i> = 452, post <i>n</i> = 401), the proportion of gram-positive organisms decreased significantly from 51.1% to 31.7% (<i>P</i> &lt; 0.001), with a corresponding increase in gram-negative organisms from 48.9% to 68.3%.</p> Conclusions <p>Replacement of normal saline with 0.5% CHG for periurethral cleansing during foley catheter insertion was associated with a significant reduction in CAUTI incidence. These results support the integration of CHG-based periurethral antisepsis into catheter insertion care bundles. Ongoing microbiological surveillance is warranted given the observed shift from gram-positive to gram-negative organisms following CHG implementation.</p>

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Impact of chlorhexidine gluconate on periurethral cleansing on catheter-associated urinary tract infection: a before-and-after quasi-experimental study at a tertiary care hospital

  • 期刊论文

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  • 发表日期：

    2026年8月1日

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  • Cheon-Hoo Jeon,
  • Si-Ho Kim,
  • Mi Hyeon Jin,
  • Ji Hong Park,
  • Yu Jin Lee,
  • Jeong Min Shin,
  • Jung Seon Ryu,
  • Seran Cheon,
  • Nam Sun Hong,
  • Chang-Ho Chae,
  • Yu Mi Wi

摘要

Background

Catheter-associated urinary tract infection (CAUTI) is the most common healthcare-associated infection. Chlorhexidine gluconate (CHG) has been widely adopted for reducing central line-associated bloodstream infections. We aimed to evaluate the impact of replacing normal saline with 0.5% CHG solution for periurethral cleansing at the time of foley catheter insertion on the incidence of CAUTI.

Methods

A single-center, before-and-after quasi-experimental study was conducted at a 750-bed tertiary care hospital from December 2024 to December 2025. The periurethral antiseptic was changed from normal saline to 0.5% CHG solution on June 11, 2025, with June 2025 serving as a washout period. The first catheter episode per patient was included in the analysis. The primary outcome was CAUTI incidence, assessed using interrupted time series (ITS) analysis with Poisson segmented regression. Kaplan-Meier survival analysis with the log-rank test was performed to compare CAUTI-free survival between groups.

Results

A total of 4153 patients were included (pre-intervention: 1905, post-intervention: 2248), among whom 55 CAUTI events were identified (pre-intervention: 41, post-intervention: 14). The incidence rate declined from 3.40 to 1.27 per 1,000 catheter-days (62.6% reduction). ITS analysis revealed a significant immediate level change at the intervention point (IRR 0.374, 95% CI 0.204–0.686, P = 0.001), corresponding to a 62.6% reduction in the CAUTI rate after adjusting for the pre-existing temporal trend. Kaplan-Meier analysis showed significantly higher CAUTI-free survival in the post-intervention group (log-rank P = 0.009). Among culture-positive isolates from prospective surveillance (pre n = 452, post n = 401), the proportion of gram-positive organisms decreased significantly from 51.1% to 31.7% (P < 0.001), with a corresponding increase in gram-negative organisms from 48.9% to 68.3%.

Conclusions

Replacement of normal saline with 0.5% CHG for periurethral cleansing during foley catheter insertion was associated with a significant reduction in CAUTI incidence. These results support the integration of CHG-based periurethral antisepsis into catheter insertion care bundles. Ongoing microbiological surveillance is warranted given the observed shift from gram-positive to gram-negative organisms following CHG implementation.