Chlorhexidine Use in Foley Catheter Care
Chlorhexidine should be used for meatal cleaning before Foley catheter insertion, but avoid alcohol-based chlorhexidine products and do not use chlorhexidine for routine daily meatal care or catheter irrigation after insertion. 1
Pre-Insertion Meatal Cleaning
Use chlorhexidine-based antiseptic (aqueous, not alcohol-based) for meatal and perineal cleaning immediately before catheter insertion. 1
The 2025 International Society for Infectious Diseases guidelines specifically state that "emerging literature suggests the use of chlorhexidine before catheter insertion" while recommending to "avoid alcohol-based products due to concerns about the alcohol causing drying of the mucosal tissues." 1
A 2021 meta-analysis of 18 studies demonstrated that antiseptics (chlorhexidine or povidone-iodine) reduced CAUTI incidence compared with saline, soap, or antimicrobial cloths (OR=0.65,95% CI 0.42-0.99; p=0.047). 2
Chlorhexidine 0.05-0.1% concentration is appropriate for periurethral cleaning, with evidence supporting its use in both adult and pediatric populations. 3, 4
What NOT to Do with Chlorhexidine
Do not use chlorhexidine for daily meatal cleaning after catheter insertion. 1
The 2009 IDSA guidelines (still referenced as current standard) explicitly state: "Daily meatal cleansing with povidone-iodine solution, silver sulfadiazine, polyantibiotic ointment or cream, or green soap and water is not recommended for routine use" (Grade A-I recommendation). 1
Large randomized trials showed that twice-daily application of povidone-iodine solution to the urethral meatus-catheter interface actually increased CA-bacteriuria rates compared with usual care (debris removal at daily baths). 1
Do not use chlorhexidine for catheter irrigation. 1, 5, 6
Catheter irrigation with antimicrobials or antiseptics should not be used routinely to reduce CA-bacteriuria (Grade A-I) or CA-UTI (Grade A-II). 1
In a randomized trial of 52 elderly catheterized patients, twice-daily bladder instillation of chlorhexidine had no effect compared with normal saline on CA-bacteriuria or CA-UTI. 1
The only exception is short-term surgical patients undergoing transurethral operations, where perioperative antiseptic irrigation may reduce postoperative bacteriuria (Grade C-I), but this does not apply to routine catheter care. 1, 5, 6
Evidence-Based Routine Catheter Care Instead
After catheter insertion, adhere to routine hygiene practices only—standard soap and water or debris removal during daily bathing. 1
One quality improvement study reported success with twice-daily chlorhexidine cleansing from umbilicus to knees (reducing CAUTI from 3.06 to 0.46 per 1000 catheter days), but this represents a single-center experience and conflicts with established guideline recommendations against routine antiseptic meatal care. 7
The bundle approach that effectively reduces CAUTI focuses on: appropriate indications, hand hygiene, aseptic insertion technique, proper catheter securing, maintaining closed drainage system, unobstructed flow, keeping bag below bladder level, regular emptying, and minimizing catheter duration. 1
Common Pitfalls to Avoid
Using alcohol-based chlorhexidine products on mucous membranes causes tissue drying and should be avoided. 1
Confusing pre-insertion antisepsis with post-insertion care—chlorhexidine has a role before insertion but not for daily maintenance. 1
Adding antiseptics to drainage bags—this does not reduce CA-bacteriuria or CA-UTI and is not recommended (Grade A-I). 1
Routine catheter changes as infection prevention—regularly changing catheters does not prevent infection and is not advisable. 1
Special Considerations
Medicated catheters (silver alloy, nitrofurazone, zinc oxide) do not provide significant advantage over standard catheters when proper insertion and maintenance techniques are followed. 8
The most important modifiable risk factor remains catheter duration—remove catheters as soon as clinically appropriate. 1
For patients requiring long-term catheterization, focus on maintaining closed drainage systems and proper technique rather than antiseptic interventions. 1