Infection control catheter care

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Infection Control in Catheter CareBradford
Airedale PCT

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DOH Objectives

• To reduce HAIs by 15 within 5 years
• Improve clinical practice
• Standardise levels of care
• Ensure good patient outcomes

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THE DRIVES FOR PREVENTION OF INFECTION AND
INFECTION CONTROL

• Epic project report with recommendations (2000
  2002) (evidence based practice for preventing
  healthcare-associated infections in NHS hospitals
  in England)
• NICE Clinical Guideline - Infection control
  (2003)(national institute for clinical
  excellence)
• Winning Ways (2003) (D.O.H)
• Saving Lives (2005) (D.O.H)
• Essential Steps to Clean Safe Care (2006) (D.O.H)

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Infection Control

• Infection Prevention

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UTIs Are Common
UTI
Incidence (national UK)
Multiple (may inc. UTI)
LRTI
SWI
Other
Skin
BSI
Socio-Economic Burden of Hospital Acquired
Infection-PHLS report 2000
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Estimated Cost Of UTIs
UTI
millions
LRTI
SWI
Other
Skin
BSI
Socio-economic Burden of Hospital Acquired
Infection-PHLS report 2000
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UTI - The Problem (Hospital)

• 12.6 of acute patients are catheterised
• 20 - 30 of acute catheterised patients will
  develop Bacteriuria
• 8 of acute catheterised patients will suffer
  serious UTI symptoms
• A UTI increases the length of patient
  hospitalisation by 75 (8 to 14 days)
• A single UTI cost 1327

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Catheters provide easy access for bacteria into
a vulnerable body cavity
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Initially three types of bacteria cause the
problems
Escherichia coli Photo Dr M S
Mitchell
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Staphylococcus epidermidis
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Enterococcus faecalis
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Long term catheters may lead to the formation of
bacterial colonisation and Biofilms
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• For example
• Pseudomonas aerunginose
• Klebsiella pneumoniae
• Proteus mirabillis

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Proteus mirabilis
This bacteria can cause kidney stones and urinary
tract infections
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Kidney Stones
Produces a bio film
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Catheter encrusted with Biofilm
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How To Prevent A UTI

• DO NOT CATHETERISE!
• ASSESS OTHER ALTERNATIVES
• Sheaths
• Prophylactic treatments

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Reasons for Catheterization

• Drainage in retention
• Measurement of urine e.g. post op
• Investigations e.g. urodynamics
• Instillation e.g. chemotherapy
• Incontinence - last resort

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Catheter damaged
Normal bladder
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Skills for catheterization

• Practitioners responsibility to acquire skills
  and knowledge
• Sound knowledge of Anatomy Physiology
• Knowledge of common urinary tract diseases
• Supervised practice until competency in
  catheterization technique is acquired
• RCN Continence Care Forum Oct 1997

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Considerations when choosing a catheter

• SELECT THE CORRECT CATHETER DRAINAGE SYSTEM
• Material Length (male/ Female)
• Ch Size
• Collection bag size - Urine Meter?
• Use of catheter valves Flip Flow?
• USE ASEPTIC CATHETER INSERTION TECHNIQUE

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How To REDUCE THE RISK/ Prevent A UTI

• Maintaining a sterile, continuously closed
  urinary drainage system is central to the
  prevention of catheter associated infection
• epic guidelines

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Principle Sites Of Entry Of Pathogens
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Patient Education

• Procedure explained
• Catheter care education
• Patient / Carer able to care for catheter
• Hygiene / hand washing
• Avoiding Constipation
• Signs of complications -blockage, UTI.

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Product Liability

• Catheters and drainage equipment must be used as
  instructed by manufacturers, otherwise the nurse
  may be liable.
• Manufacturers are required to ensure that
  products conform to British Standards 1695 (1990)
• Check packaging and expiry date
• Store according to manufacturers instructions

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Documentation

• Reason for catheterization
• Date and time insertion (Days not months, i.e 28
  days not three months)
• Type of catheter- ch, length, material, balloon
  size, batch no, manufacturer
• Cleansing solution, lubricant, anesthetic agents,
  lot numbers.
• Any problems encountered
• Date for reassessment, planned change
• Signature

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How To Prevent A UTI

• Ensure that healthcare professionals wash their
  hands before and after any contact with the
  catheter and or patient and wear PPE.
• Ensure the catheter system is maintained
  according to hospital/epic guidelines
• Remove the catheter as soon as possible
• Drainage bag position/ not trailing on floor

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What is the most important action to take in
prevention of infection?

• HAND HYGIENE

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Telegraph.co.uk

• Britain's No.1 quality newspaper website
• Make us your homepage
• Tuesday 13 February 2007
• By Richard Gray, Science Correspondent, Sunday
  Telegraph
• Last Updated 1155pm GMT 25/11/2006
• Thousands of hospital staff fail to wash hands
  correctly

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What Evidence do we have regarding how effective
we are at hand washing?The following slides are
courtesy of Airedale Hospital
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Correct Hand Wash Technique
Palm to palm fingers interlaced.
Right palm over left dorsum and left palm over
right dorsum.
Palm to palm.
Backs of fingers to opposing palms with fingers
interlocked.
Rotational rubbing, backwards and forwards with
clasped fingers of right hand in left palm and
vice versa.
Rotational rubbing of right thumb clasped in left
palm and vice versa.
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Frequently Missed Areas
FRONT
BACK

Linda Taylor (1978)
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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 Clostridium difficile, soap and
  water is required

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• Where appropriate education of patients/clients,
  their carers and healthcare personnel should be
  integral to all risk elements.

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Legal Aspects

• Remember
• A Potential Claim is Likely to Succeed if a
  claimant is able to prove that

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• The Trust had failed to comply with the relevant
  infection control policy
• The policy did not conform to general guidelines
  and therefore could not be safely relied upon
  note the Code of Practice for the Prevention and
  Control of HCAIs this states that staff must be
  familiar with its contents
• There was poor, inaccurate or illegible
  documentation think about chronology of events
  and tenses
• The treatment of the infection was substandard
  that is fell below the standard expected of the
  reasonable man.

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Conclusion

• It is important to remember that everyone should
  follow local policies and procedures, standard
  precautions and the safety actions in essential
  steps as per DOH/ NPSA guidelines.