3 Aims and Objectives:To increase your knowledge of the bacteria that can cause an infectionTo be able to identify how bacteria can enter a catheterTo understand the importance of hand hygieneTo address how you can prevent catheterised patients from developing an infection.
4 Infection Prevention & Control Infection ControlInfection Prevention & Control
5 What is a Urine Tract Infection? Is the 2nd most common type of infectionWomen are more prone to UTI’sAffects millions of people every yearA UTI develops when part of the urinary tract becomes infected, usually by bacteriaThere are 2 types of UTI:Lower TractUpper UTI1 – Lower TractBladder and UrethraBladder is a balloon shaped organ that stores urine.Urethra is the tube in which urine passes from the bladder2 – Kidney’s and UreterKidneys extract waste from blood and convert it into urineUreters are the tubes that run from the kidneys to the bladder
6 Symptoms of a urine tract infection Cloudy or dark coloured urinePain and burning sensationHigh temperature-Rigors/fever- flush face/headache/lethargyIncreased ConfusionAbdominal discomfortSo what are the symptoms? (Ask the audience)
8 There are 3 main types of bacteria that cause problems
9 Escherichia coli Photo: Dr M S Mitchell Most strains of Escherichia coli form part of the normal intestinal micro flora in humans and warm-blooded animals. However, some strains have the ability to cause disease in humans.These diseases include food poisoning, e.g. E. coli O157, or infections outside the intestinal tract such as urinary tract infections (UTIs), and bacteraemia. E. coli are also becoming an important reservoir of extended-spectrum beta-lactamases (ESBLs).Extended-Spectrum Beta-Lactamases (ESBLs) are enzymes that can be produced by bacteria making them resistant to cephalosporins e.g. cefuroxime, cefotaxime and ceftazidime - which are the most widely used antibiotics in many hospitals.Escherichia coli Photo: Dr M S Mitchell
10 Staphylococcus aureus is a bacterium that is a common colonizer of human skin and mucosa. Staphylococcus aureus can cause disease, particularly if there is an opportunity for the bacteria to enter the body.Most strains of this bacterium are sensitive to many antibiotics, and infections can be effectively treated. Some S. aureus bacteria are resistant to the antibiotic meticillin, termed meticillin-resistant Staphylococcus aureus (MRSA).Staphylococcus
11 Enterococcus faecalis Enterococci are bacteria that are commonly found in the bowel of normal healthy individuals. They can cause a range of illnesses including urinary tract infections, bacteraemia (blood stream infections) and wound infections.Enterococcus faecalis
12 Catheters provide easy access for bacteria into the body and can result in patients dying.
13 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 catheterThose catheterised for > 75% of year–3x more likely to be hospitalised–3x more likely to die–3x more likely to receive antibioticsTsan et al 2008, Kunin et al 1992
14 What is a catheterA catheter is a hollow tube that drains urine from the bladder into a drainage bagAn indwelling catheter is one that stays in place all the timeAn intermittent catheter is inserted at regular intervals during the day to drain the bladder and is then removedA catheter may be inserted into the bladder via the urethra or through a specially made hole in the abdomen called a suprapubic catheter
16 Would you like to think this was inside your body!
17 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 possibleAvoid if possibleDocument assessment
18 Indications for catheterisation for patients in care homes Urinary tract obstruction eg.prostate problemsAcute or chronic retention of urine eg. due to Parkinson’s disease.Management of urinary incontinence when all other methods are not applicableWhat are the indications to catheterise? (Ask the audience)
19 Reducing the risks of catheter-associated urinary tract infection Avoiding unnecessary catheterisationUse Aseptic non touch techniqueMaintaining a closed drainage systemCorrect Catheter care- use stands, a clean dry receptacle.Prevent catheter tube from pullingGood hygieneEducation of patients, nurses and care staffWhat can you do to minimise the risk? (Ask the audience)
20 Quiz QuestionsA. What are the signs and symptoms of a urine infection?B. Where are the four ports that could allow bacteria to enter the catheter?
21 Identify 4 Entry Points for Bacteria on this Diagram of an Indwelling Urinary Catheter Split into groups and get them to identify the 4 points.
22 Identification of Entry Points Urine sampling portReason – the seal is broken each time the needle is insertedIdentification of Entry PointsEntry point - 1Catheter - meatal junctionReasonperineal region - moist damp area of body heavily colonised with microbes normally carried in large intestinesEntry point - 2Catheter-draining bag junctionReasonThe closed system is broken when connecting / disconnecting the bagEntry pointsWhy? (Ask the audience)Entry point 4Drainage tap junctionReasonMicrobes introduced here can ascend up to the bladder and cause infection
23 Catheter – urethral Junction Ongoing management- daily cleansing of perineum to remove encrustation, esp. in womenfrequent cleansing if patient faecally incontinent- male patients, retract prepuce and clean underneathEntry point - 1 Insertion – performed only by appropriately trained staff to prevent urethral traumasmallest possible size catheter to minimise urethral traumasmallest balloon size – 10mlssterile 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 traumacleaning of perineum and external meatusinsertion directly into urethraaseptic connection of catheter to drainage bagWhat is the ongoing management? (Ask the audience)
24 Catheter – drainage Bag Junction / Sampling Port Entry point - 2Catheter-draining bag junctionaseptic connection- disconnect only when changing (only done in certain circumstances) or for irrigation (not recommended as a routine maintenance of drainage- strict hand hygiene / use of glovesEntry point 3Urine sampling portstrict hand hygiene / use of glovesSmallest gauge needle- disinfection of port
25 Drainage Tap Junction Drainage Tap Junction Entry point 4 Drainage tap junction – emptying drainage baghand hygiene before and after procedure / glovesseparate jug for each patient- no contact between jug and tap- empty bag as needed to maintain urine flow- wipe tap to remove dripsAdditional measureshang bag evenly on standposition bag below bladder levelno kinking of tube- no placing of bag in / on bedWhat additional measures can you take to prevent infection? (Ask the audience)
26 How To Prevent A UTIEnsure that all healthcare staff wash/decontamination their hands before and after any contact with the catheter and/or patient.Keep a closed catheter systemEnsure the catheter system is maintained according to guidelines and policiesRemove the catheter as soon as possible
27 Why Should We Wash Our Hands? The following slides provide clear evidence of why hand hygiene is so important.Ask the audience
32 What is the most important action to take in prevention of infection? HAND HYGIENE
33 Correct Hand Wash Technique Palm to palm.Right palm over left dorsum and left palm over right dorsum.Palm to palm fingers interlaced.Backs of fingers to opposing palms with fingers interlocked.Rotational rubbing of right thumb clasped in left palm and vice versa.Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa.
35 Alcohol Hand Gels and Rubs Alcohols kill germs rapidlyRub in thoroughlyDo not use paper towels, allow to dry naturallyDo no use if hands look physically dirty or if the patient has diahorrea or vomiting, use soap and water.
36 Guidance 2006 Recommendations unchanged: •Education •Assessing need •Drainage options•Insertion & maintenanceRecommendations changed:•Catheter type•Bladder instillations and washouts•Antibiotics at catheter change