Observational studyBMJ open2026
Effect of transitioning from sterile to clean urinary catheterisation on catheter-associated urinary tract infections and sustainability: a pre-post study in a Dutch university hospital.
Observational study in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
11 authors.
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Abstract
introductionBladder catheterisation is one of the most commonly performed medical procedures worldwide in hospitals. Although traditionally performed as a sterile procedure to prevent infections, it incurs a considerable carbon footprint and substantial healthcare costs. This study aimed to assess whether adopting clean bladder catheterisation as standard hospital practice is non-inferior to sterile catheterisation regarding the occurrence of catheter-associated urinary tract infections (CAUTIs), and to evaluate the carbon footprint of catheterisation sets.
methodsThis retrospective observational non-inferiority study compared the proportion of patients with a suspected CAUTI during a 6-month sterile catheterisation phase and a 6-month clean catheterisation phase. The primary outcome was the proportion of CAUTIs, with secondary outcomes including positive urine cultures, cultured microorganisms and carbon footprint. Non-inferiority of clean catheterisation was assessed using multivariable logistic regression, reporting risk differences (RDs) and 95% CIs. Non-inferiority was concluded when the upper bound of the 95% CI did not exceed the non-inferiority margin of 0.5 percentage point. Interrupted time series (ITS) analysis assessed time trends, and the carbon footprint was evaluated using life-cycle assessment.
resultsAmong 3293 catheterised patients, 3.8% (62/1647) in the sterile phase and 3.3% (55/1646) in the clean phase met the criteria for a CAUTI (adjusted RD -0.44% (95% CI -1.4% to 0.5%)). ITS analysis showed no significant change in CAUTI trends following implementation. Positive urine cultures were found in 13.1% (216/1647) and 13.1% (215/1646) of patients in the sterile and clean catheterisation phases (adjusted RD 0.30% (95% CI -2.4% to 1.7%). The carbon footprint of the clean catheterisation set was 70.7%-82.3% lower compared with the sterile sets.
conclusionClean bladder catheterisation was non-inferior to sterile catheterisation in suspected CAUTI rates and significantly reduced the carbon footprint. Our findings suggest that clean catheterisation may be considered as a safe alternative default practice.
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