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Urinary Tract Infections Reducing the Risks of Infections

Community Infection Control NursesLeicestershire, Northamptonshire & Rutland PCT’s

Health Protection Agency NursesLeicestershire, Northamptonshire & Rutland

Social Care Providers Leicestershire, Northamptonshire & Rutland

2006

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Urinary Tract Infections

Urinary Tract Infections (UTI’s) are the largest single group of Healthcare Associated Infections (HCAI’s) and the presence of a urinary catheter and the duration of its insertion are contributory factors to the development of a UTI

(Emmerson 1996, cited in Essential steps to safe, clean care 2006)

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What is a Urinary Catheter• A urinary catheter is a hollow tube that drains

urine from the bladder into a special drainage bag.

• An indwelling catheter is one that is in place all the time.

• Usually the catheter is inserted through the urethra (the tube where urine normally comes out).

• Sometimes a catheter is inserted into the bladder through a specially made hole in the side of the abdomen (this type of catheter is called a ‘suprapubic catheter).

• A small balloon keeps the catheter in place inside the bladder

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Types of Urinary Catheters

• Indwelling urethral/urinary catheter – a catheter that is inserted into the bladder via the urethra and remains in place for a period of time.

• Suprapubic catheter – a catheter that is inserted through the abdominal wall into the bladder. Urine can then be drained directly from the bladder into a bag through the catheter

• Intermittent catheter – a catheter that is inserted into the bladder at regular intervals or when the client feels the need to pass urine

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Possible entry points for bacteria to cause infection

• Hands of staff/carers/clients• Jug/bottle used to collect urine• Drainage outlet valve• Reflux from the bag to the tubing• Sampling port• Junction of catheter with tubing• Meatal (where the urethra opens to the

outside of the body) junction

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Infection

Infection may occur • At the time of catheterisation, • Immediately following catheterisation OR• at a later time due to colonisation becoming

invasive (NICE Guidelines 2003).

Infection is only indicated if all or some of the signs and symptoms of infection are also present.

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Signs and Symptoms of Infection include:

• Pain – Supra-pubic (above the pubic bone)– Lower abdomen (section below navel)– Lower back– Loin (the area at the back, just above

the pelvis)• Pyrexia (a raised temperature)• Confusion/worsening confusion• Visible haematuria (blood in the urine)

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Reducing the Risks of Infections

The risk of developing a urinary tract infection can be reduced by the following actions:

– Hands must be washed before and after handling the catheter or drainage bag.

– Clean the place where the catheter enters the body daily using soap and water and then dry.

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Maintaining a Closed System

• Keep the drainage bag or catheter valve connected to the catheter at all times, except when changing the bag. This closed system reduces the risk of infection.

• Carers/staff/clients should ensure that the connection between the catheter and the urinary drainage system is not broken, except for good clinical reasons (for changing the bag in line with the manufacturers instructions).

• The night time drainage bag should be added without breaking the closed system.

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Prevention of Infection relies upon

• Drainage bags should be kept lower than the bladder to allow urine to drain.

• Urinary drainage bags should be hung on an appropriate stand that prevents the bag touching the floor (Epic Guidelines 2001, NICE Guidelines 2003). Contact with the floor can increase the risk of infection.

• The drainage bag should be emptied whenever necessary - when it is full

when the client feels uncomfortable

when it pulls on the catheter • Breaches in the closed system will increase

the risk of catheter-related infection

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Prevention of infection relies upon

• Clients/staff and carers trained in the techniques of:

Hand HygieneInsertion of Intermittent Catheterisation (where relevant)Catheter Management

• Good standards of patient personal hygiene -routine personal hygiene is all that is needed to maintain meatal hygiene (Epic Guidelines 2001)

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Hand Hygiene

• Staff/carers must wash their hands and wear a new pair of clean, non-sterile, powder-free, latex gloves before manipulating a client’s catheter, and must wash their hands after removing gloves and aprons.

• Hand washing is the cheapest and most cost effective method of reducing the spread of infection.

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How to wash your hands

• Wet hands prior to applying soap (reduces irritation to skin)

• Friction minimum, 10-15 seconds (Epic Guidelines 2001)

• Expose all areas• Rinse hands under running water• Dry hands with a paper towel• Dispose of paper towel into a bin using foot

pedal

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The six steps to hand hygiene

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Facilitating good hand hygiene

• Keep nails short and clean• No artificial nails or nail polish• No wrist watches• No rings with ridges or stones• No bracelets• No long sleeves

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Hand Hygiene

• Wet hands are more likely to transfer micro-organisms (germs) more effectively than dry ones

• Friction caused by using paper towels helps remove remaining bacteria (germs)

• Communal towels promote cross infection• Hot air hand driers circulate air loaded with

bacteria

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Hand Care

• Bacterial counts increase when the skin is damaged, so it is important to keep your skin in a good condition

• Apply hand cream occasionally• Cover all cuts/abrasions with a waterproof

plaster/dressing

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Emptying the Catheter Bag

• Wash hands and apply gloves and aprons• Use disposable bottle/designated clean jug to

collect the urine• Reusable catheter bags should be cleaned

with water and stored dry in accordance with the manufacturers instructions.

• Remove gloves and wash hands• Gloves and aprons should be worn as single

use items for one procedure or episode of client care and then discarded.

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Waste Disposal

Wearing personal protective clothing:• Empty contents of catheter bag into the

toilet/slop hopper.• Double wrap the bag and place into domestic

waste bin in patients own home/residential homes.

• Remove plastic apron and gloves

• Wash hands

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Waste Disposal

If using single-use catheter bags:• Wear gloves and aprons• Using a designated pair of scissors carefully

cut the edge of the catheter bag.• Dispose of urine into the toilet• Dispose of bag into domestic waste in patients

own home/residential homes

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Clients’ Personal Hygiene

• This should be carried out at least daily. When there is a urethral discharge it may be needed more often.

• Wash hands and apply gloves and apron• Taking a clean bowl and using clean water,

client’s own soap and disposable wipes, thoroughly wipe and dry the genital area and 10-15cms of the catheter

• Remove gloves and aprons and wash hands

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Cleaning body fluid spills• Any spillages should be dealt with immediately• Apply gloves and aprons• Clean the area using warm water and detergent• Rinse• Disinfect using a chlorine-releasing agent i.e.

Milton• Rinse and dry• Alternatively, shampoo the carpet as soon as

possible

The use of a chlorine-based solution may take the colour out of some fabric materials

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Any Questions