Prevention of nosocomial urinary tract infection in ICU patients - Comparison of effectiveness of two urinary drainage systems

Study objectives: To determine whether the rate of acquisition of bacteriur ia differs between the use of a complex closed drainage system (CCDS) with a preattached catheter, antireflux valve, drip chamber, and povidone-iodine releasing cartridge, and a two-chamber open drainage system (TCOS) in ICU patients. Design: Prospective, nonrandomized, controlled trial. Setting: Medical/surgical/trauma ICU in a university hospital. Patients: Two hundred twenty-four ICU patients requiring an indwelling urin ary catheter, Intervention: We compared the rate of acquisition of bacteriuria in two gro ups of consecutive patients (n = 113 and n = 111, respectively) who underwe nt bladder catheterization with a TCOS during the first 6 months and with a CCDS during the next 6 months. Urinary catheters were managed by a team of trained nurses following the same written protocol, No prophylactic antibi otics were administered, either during management of catheter placements or catheter withdrawal, but 75% of patients received one or more antimicrobia l medications for treatment of infected sites other than the urinary tract. Urine samples were obtained weekly for the duration of catheterization and within 24 h after catheter removal, and each time symptoms of urinary infe ction were suspected. Only patients who required an indwelling catheter for > 48 h were evaluated. Measurements and results: There was no statistical difference in the rate o f bacteriuria between the two groups. Bacteriuria occurred in 11.5% and 13. 5% of patients, and was diagnosed on day 14 +/- 8 and 13 +/- 9 of catheteri zation (mean +/- SD) for the TCOS and the CCDS, respectively. A CCDS cost $ 3 (US dollars) more than the TCOS, Conclusions: To our knowledge, this is the first study to compare the effec tiveness of a TCOS and a CCDS in ICU patients. No differences were noted be tween the two systems (alpha = 0.05). The higher cost of a CCDS is not just ified for ICU patients.