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.
6 affiliations
- 1Center for Infection Prevention and Control, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
- 2Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 50 Hapseong-dong, Masanhoewon-gu, Changwon-si, 51353, Gyeongsangnam-do, Korea.
- 3Department of Research & Support, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
- 4Department of Occupational and Environmental Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
- 5Center for Infection Prevention and Control, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea. [email protected].
- 6Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 50 Hapseong-dong, Masanhoewon-gu, Changwon-si, 51353, Gyeongsangnam-do, Korea. [email protected].
Abstract
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.
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BibTeX
@article{jeon2026impact,
title = {{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.}},
author = {Cheon-Hoo Jeon and Si-Ho Kim and Mi Hyeon Jin and Ji Hong Park and Yu Jin Lee and Jeong Min Shin and Jung Seon Ryu and Seran Cheon and Nam Sun Hong and Chang-Ho Chae and Yu Mi Wi},
journal = {Antimicrobial resistance and infection control},
year = {2026},
month = aug,
doi = {10.1186/s13756-026-01800-0},
url = {https://europepmc.org/article/MED/42972462},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - 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.
AU - Cheon-Hoo Jeon
AU - Si-Ho Kim
AU - Mi Hyeon Jin
AU - Ji Hong Park
AU - Yu Jin Lee
AU - Jeong Min Shin
AU - Jung Seon Ryu
AU - Seran Cheon
AU - Nam Sun Hong
AU - Chang-Ho Chae
AU - Yu Mi Wi
PY - 2026
DA - 2026/08/01
JO - Antimicrobial resistance and infection control
DO - 10.1186/s13756-026-01800-0
UR - https://europepmc.org/article/MED/42972462
AB - 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.
SN - 2047-2994
ER -