Urinary Tract Infections Reducing the Risks of Infections Community Infection Control Nurses Leicest

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Urinary Tract Infections Reducing the Risks of
InfectionsCommunity Infection Control
NursesLeicestershire, Northamptonshire Rutland
PCTsHealth Protection Agency NursesLeicestershi
re, Northamptonshire RutlandSocial Care
Providers Leicestershire, Northamptonshire
Rutland2006
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Urinary Tract Infections

• Urinary Tract Infections (UTIs) are the
  largest single group of Healthcare Associated
  Infections (HCAIs) 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 Hygiene
• Insertion 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 clients 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,
  clients 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