Infection Control In Care
Homes
Catheter Care
Infection Prevention & Control
NHS Kirklees
02-02-12
What’s wrong with this picture?
Aims and Objectives:
• To increase your knowledge of the
bacteria that can cause an infection
• To be able to identify how bacteria can
enter a catheter
• To understand the importance of hand
hygiene
• To address how you can prevent
catheterised patients from developing
an infection.
Infection Control
Infection Prevention &
Control
What is a Urine Tract Infection?
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Is the 2nd most common type of infection
Women are more prone to UTI’s
Affects millions of people every year
A UTI develops when part of the urinary tract
becomes infected, usually by bacteria
• There are 2 types of UTI:
1. Lower Tract
2. Upper UTI
Symptoms of a urine tract infection
• Cloudy or dark coloured urine
• Pain and burning sensation
• High temperature-Rigors/fever- flush
face/headache/lethargy
• Increased Confusion
• Abdominal discomfort
There are 3 main types of
bacteria that cause
problems
Escherichia coli
Photo: Dr M S Mitchell
Staphylococcus
Enterococcus faecalis
Catheters provide easy access
for bacteria into the body
and can result in patients
dying.
Long term Urinary Catheterisation
A study of 1,540 patients living in care homes
revealed•10.5% catheterised at entry, 10% more during year
•Stepwise increase in risks with duration of catheter
Those catheterised for > 75% of year
–3x more likely to be hospitalised
–3x more likely to die
–3x more likely to receive antibiotics
Tsan et al 2008, Kunin et al 1992
What is a catheter
• A catheter is a hollow tube that drains urine from the
bladder into a drainage bag
• An indwelling catheter is one that stays in place all
the time
• An intermittent catheter is inserted at regular
intervals during the day to drain the bladder and is
then removed
• A catheter may be inserted into the bladder via the
urethra or through a specially made hole in the
abdomen called a suprapubic catheter
This is unused catheter
equipment
Would you like to think this
was inside your body!
Assessment
• Full assessment is required by an
appropriate professional
• The need for catheterisation should be
reviewed regularly and the urinary
catheter removed as soon as possible
• Avoid if possible
• Document assessment
Indications for catheterisation for
patients in care homes
• Urinary tract obstruction eg.prostate problems
• Acute or chronic retention of urine eg. due to
Parkinson’s disease.
• Management of urinary incontinence when all
other methods are not applicable
Reducing the risks of catheterassociated urinary tract infection
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Avoiding unnecessary catheterisation
Use Aseptic non touch technique
Maintaining a closed drainage system
Correct Catheter care- use stands, a clean dry
receptacle.
• Prevent catheter tube from pulling
• Good hygiene
• Education of patients, nurses and care staff
Quiz Questions
• A. What are the signs and symptoms of
a urine infection?
• B. Where are the four ports that could
allow bacteria to enter the catheter?
Identify 4 Entry Points for Bacteria on this
Diagram of an Indwelling Urinary Catheter
Identify 4 Entry Points for Bacteria on this
Diagram of an Indwelling Urinary Catheter
Urine sampling port
Reason – the seal is broken
each time the needle is
inserted
Identification of Entry Points
Identification of Entry Points
Entry point 3
Entry point - 2
Catheter-draining bag
junction
Reason
The closed system is
broken when connecting /
disconnecting the bag
Entry point - 1
Catheter - meatal junction
Reason
-perineal region - moist damp
area of body heavily colonised
with microbes normally carried
in large intestines
Entry point 4
Drainage tap junction
Reason
Microbes introduced here can
ascend up to the bladder and
cause infection
Catheter – urethral Junction
Ongoing management
- daily cleansing of
perineum to remove
encrustation, esp. in
women
- frequent cleansing if
patient faecally incontinent
-- male patients, retract
prepuce and clean
underneath
Entry point - 1 Insertion – performed only
by appropriately trained staff to prevent
urethral trauma
- smallest possible size catheter to
minimise urethral trauma
- smallest balloon size – 10mls
- sterile equipment / strict aseptic
technique
-- adequate light to get a clear vision of
urethra
-- anaesthetic lubricating gel to urethra for
easy passage of catheter and prevent
trauma
-cleaning of perineum and external meatus
- insertion directly into urethra
-aseptic connection of catheter to drainage
bag
Catheter – drainage Bag Junction /
Catheter – drainage Bag
Sampling Port
Junction / Sampling Port
Entry point - 2
Entry point 3
Catheter-draining bag junction
Urine sampling port
- aseptic connection
-strict hand hygiene
/ use of gloves
-- disconnect only when
changing (only done in certain
circumstances) or for
irrigation (not recommended
as a routine maintenance of
drainage
-Smallest gauge
needle
-- disinfection of
port
-- strict hand hygiene / use of
gloves
Drainage Tap Junction
Drainage Tap Junction
Additional measures
-hang bag evenly on stand
-position bag below bladder
level
- no kinking of tube
- no placing of bag in / on
bed
Entry point 4
Drainage tap junction –
emptying drainage bag
- hand hygiene before
and after procedure /
gloves
- separate jug for each
patient
-- no contact between
jug and tap
-- empty bag as needed
to maintain urine flow
-- wipe tap to remove
drips
How To Prevent A UTI
Ensure that all healthcare staff
wash/decontamination their hands before and
after any contact with the catheter and/or
patient.
Keep a closed catheter system
Ensure the catheter system is maintained
according to guidelines and policies
Remove the catheter as soon as possible
Why Should We Wash Our
Hands?
The following slides provide clear
evidence of why hand hygiene is so
important.
Engagement Ring
Watch
False nails
Long finger nails
What is the most important action to take in
prevention of infection?
HAND HYGIENE
Correct Hand Wash Technique
Palm to palm.
Backs of fingers to
opposing palms with
fingers interlocked.
Right palm over left
dorsum
and left palm over right
dorsum.
Rotational rubbing of
right thumb clasped in
left palm and vice versa.
Palm to palm
fingers interlaced.
Rotational rubbing,
backwards and
forwards with
clasped fingers of
right hand in left
palm and vice versa.
Frequently Missed Areas
FRONT
BACK
Least frequently
missed
Less frequently missed
Most frequently
missed
Alcohol Hand Gels and Rubs
• Alcohols kill germs rapidly
• Rub in thoroughly
• Do not use paper towels, allow to dry
naturally
• Do no use if hands look physically dirty or
if the patient has diahorrea or vomiting,
use soap and water.
Guidance
2006 Recommendations unchanged:
•Education
•Assessing need
•Drainage options
•Insertion & maintenance
Recommendations changed:
•Catheter type
•Bladder instillations and washouts
•Antibiotics at catheter change
Any
questions?