Betadine Bladder Irrigations vs. Standard of Care Prior to Indwelling Catheter Removal
Betadine Bladder Irrigations vs. Standard of Care Prior to Indwelling Catheter Removal
Over the last decade, there has been great emphasis on reducing the incidence of
 hospital-acquired infections, including catheter-associated UTI (CAUTI). This study will
 evaluate the effectiveness of Betadine irrigation solution (2% povidone-iodine) instilled
 into the bladder immediately prior to indwelling catheter removal to decrease the risk of
 subsequent bacteriuria, leading to decreased rates of NHSN defined CAUTI.
Indwelling urinary catheters are routinely used in the care of hospitalized patients for a
 variety of reasons, including monitoring of urine output in critically ill patients, relief
 of urinary obstruction, and prevention of contamination of decubitus ulcers. Bacteriuria
 increases by 3-10% each day a catheter is left in place, meaning that by 30 days, generally
 100% of patients with indwelling catheters will have bacteria in their urine. The majority of
 these people do not have urinary tract infections (UTIs), they are merely colonized and do
 not require treatment.

 To define a standard (and ultimately to compare hospitals against each other), a surveillance
 definition for CAUTI has been developed by the National Healthcare Safety Network (NHSN).
 While useful for surveillance, the definition does not correlate with clinical UTIs, leading
 to over diagnosis and over-reporting of UTIs (in other words, those with merely bladder
 colonization being diagnosed as having a UTI). Despite continuing progress in standard
 methods of reducing infection rates (including decreasing the number of catheters inserted,
 ensuring proper catheter maintenance, and removing catheters when no long necessary) there
 continue to be unacceptably high rates of CAUTIs.

 A single dose of povidone-iodine prior to catheter removal seems a novel and promising
 practice for several reasons. First, we suspect it will be helpful in reducing rates of NHSN
 defined CAUTI, as these are still diagnosed for 2 days after the catheter is removed. Second,
 using multiple doses of povidone-iodine would be inadvisable, since we suspect bacteria over
 time would become resistant even to this antiseptic. Third, we suspect use of an antiseptic
 is preferable to an antibacterial for preventing further antimicrobial resistance
 development. Finally, use of this method, as opposed to the suggested use of systemic
 antibiotics at time of removal, is potentially preferable from the downstream standpoint of
 less antimicrobial resistance and reduced risk of Clostridium difficile infection.
Inclusion Criteria:

 1. Provide written informed consent and the willingness and ability to comply with all
 aspects of study requirements

 2. Male

 3. Inpatients ≥ 18 years of age with an indwelling catheter in place for at least 5 days
 with a plan for removal

 Exclusion Criteria:

 1. Patients planned for discharge with an indwelling catheter in place

 2. Patients unable to report urinary symptoms accurately

 3. Patients with hyper-sensitivity or allergic reaction to Betadine, iodine, shellfish or
 other related compounds

 4. Clinical signs or symptoms of urinary tract infection at the time of consent

 5. Patients currently being treated for UTI

 6. Patients currently taking any antibiotic medication, other than vancomycin, linezolid,
 daptomycin, clindamycin, or metronidazole.

 7. Patients already taking medications known to potentially irritate the bladder, such
 as, but not limited to, cyclophosphamide, ifosfamide, and other chemotherapeutic
 agents

 8. Patients with history of bladder cancer, pelvic radiation or interstitial cystitis

 9. Patients unable to comply with study requirements

 10. Any other condition which, per investigators' judgment, may increase patient risk
 and/or impede the reliability of study data