Urinary catheter-associated infection

Urinary catheter-associated infection

A urirary tract infection is an infection involving any part of the urinary system,including urethra,bladder,ureter,kidney.Urinary tract infection is one of the disease which can be acquired in the  hospital.catheter is the tube which is inserted into the bladder through urethra to drain urine.

Risk factors
• Presence of urinary catheter/convene.
• Duration of catheter.
• Advanced age/diabetes/immunosuppression.

Prevention
Before inserting a urinary catheter
• Is it really necessary? Review the indication for inserting a catheter in this particular patient at this particular time. Only use an indwelling urethral catheter after considering alternative options (penile sheath,incontinence pads). Suprapubic catheters, commonly used for acute retention, have a lower risk of infection.

 

 Infection control

• Choose the correct catheter type, catheter size, and drainage system. By selecting the optimum equipment, the risk of infection from recatheterization can be reduced. Use the smallest catheter possible which allows adequate drainage, and make sure the length is appropriate for male/female patients. In general, a catheter with a 10mL balloon capacity should be used, except for specific urology cases.

• Document the date of insertion, and the type and size of catheter.
Insertion of the catheter

• Use sterile equipment and an aseptic technique. Clean the urethral meatus prior to insertion, using soap and water (antiseptic preparations are not necessary). Using a sterile lubricant in both male and female patients should reduce urethral trauma, thus decreasing the risk of
infection.

• Antibiotic prophylaxis is NOT indicated in most patients. However, in some individual cases, it may be beneficial, e.g. recent culture-positive midstream urine (MSU).
Ongoing management of a catheterized patient
• Review the need for the catheter daily. Remove it as soon as possible.

• empty the urinary drainage system frequently, to ensure adequate flow and prevent reflux. Use a separate container for each patient,and avoid contact between the drainage tap and container. The drainage bag should only be changed when necessary, according to the manufacturer’s instructions.

• Management of the drainage bag requires universal precautions. Wash your hands, and wear a new pair of gloves before manipulating the catheter. Always position the drainage bag below the level of the bladder (to prevent backflow). If this is not possible, e.g. when the patient is being moved, clamp the drainage tube, and ensure that the clamp is removed as soon as dependent drainage can be resumed.

• Clean the catheter urethral meatus junction daily with soap and water.

Do not use antiseptic creams, as these may increase infection. Advise the patient to have a shower, rather than a bath.

• Maintain the connection between the urinary catheter and the drainage system, and only break it for good clinical reasons.

• Only flush a drainage bag if there is a clear indication (e.g. after some surgical procedures, or to manage obstructive problems).

• Do not change a catheter routinely—assess each patient’s needs.

• Record ongoing management in the care plan/nursing notes.

Obtaining a urine sample from a catheterized patient

Clean the sampling port with an alcohol swab, then use sterile equipment and an aseptic no-touch technique. If there is no sampling port available, send a sample from the drainage bag (and label it as such).

Other useful resources
• ePIC guidelines for urinary catheter management, including insertion and management of short-term indwelling urinary catheters in acute care (available through the PHe websitOther articles worth readinge).