A randomized crossover study of silver-coated urinary catheters in hospitalized patients

Background: Urinary tract infections (UTIs) account for 30% to 40% of nosoc omial infections resulting in morbidity, mortality, and increased length of hospital stay. Objective: To assess the efficacy of a silver-alloy, hydrogel-coated latex urinary catheter for the prevention of nosocomial catheter-associated UTIs. Methods: A 12-month randomized crossover trial compared rates of nosocomial catheter-associated UTI in patients with silver-coated and uncoated cathet ers. A cost analysis was conducted. Results: There were 343 infections among 27878 patients (1.23 infections pe r 100 patients) during 114368 patient-days (3.00 infections per 1000 patien t-days). The relative risk of infection per 1000 patient-days was 0.79 (95% confidence interval, 0.63-0.99; P=.04) for study wards randomized to silve r-coated catheters compared with those randomized to uncoated catheters. In fections occurred in 291 of 11032 catheters used on study units (2.64 infec tions per 100 catheters). The relative risk of infection per 100 silver-coa ted catheters used on study wards compared with uncoated catheters was 0.68 (95% confidence interval, 0.54-0.86; P=.001). Fourteen catheter-associated UTIs (4.1%) were complicated by secondary bloodstream infection. One death appeared related to the secondary infection. Estimated hospital cost savin gs with the use of the silver-coated catheters ranged from $14456 to $573 2 93. Conclusions: The risk of infection declined by 21% among study wards random ized to silver-coated catheters and by 32% among patients in whom silver-co ated catheters were used on the wards. Use of the more expensive silver-coa ted catheter appeared to offer cost savings by preventing excess hospital c osts from nosocomial UTI associated with catheter use.