Hot Topics in Health & Care - Update of Urinary Catheter Care Mandy Butler Lead Continence/Urodynamic Nurse Specialist Gloucestershire Continence Service

Urinary Catheterisation can KILL ‘While essential for some patients, this invasive procedure is sometimes unjustified and even forgotten once in place’ Saint et al 2005 ‘It is one of the most common healthcare interventions but carries the risk of significant danger to patients from infection’ Pratt et al 2001

SHOULD WE BE SURPRISED THAT INDWELLING CATHETERS CAUSE PROBLEMS? Whether transurethral or supra-public: We breach the body’s physical barrier into a sterile cavity Catheterisation is a traumatic procedure –both insertion and removal We insert a device that can be contaminated either extra or intra-luminally with the body’s own flora Cross contamination from other patients can occur through poor practices (hand hygiene, handling, emptying, etc.) Physically there will always be a reservoir of urine in the bladder due to the balloon –potential for a bacterial soup We use materials that are conducive to biofilm formation

Small tube – big problem There is growing evidence that urinary catheters are over-used and that many could be avoided 1in 5 people staying in hospital will have an indwelling catheter In the BBC (scrubbing up ) health report last year (4/7/15) Small tube – big problem

These documents support implementation of local policy (updated 2015) What evidence- based guidelines do we have for preventing Healthcare-Associated Infections (HCAI)? Epic Guidelines (2001,2004,updated 2014) National Institute for Clinical Excellence (NICE 2003) Department of Health (2007) - Saving Lives (care bundle no.6) These documents support implementation of local policy (updated 2015)

Epic Guidelines - preventing infections associated with the use of indwelling urethral catheters Assessing the need for catheterisation Selection of catheter type and system Catheter insertion Catheter maintenance Education of patients, relatives and healthcare workers epic2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England

CAUTI NICE (2012) developed infection control guidelines for primary and community care which addressed the prevention of infections during long term urinary catheterisation.

How are we ensuring compliance with best evidence-based practice How are we ensuring compliance with best evidence-based practice ? Supporting strategies to monitor progress: Safety Thermometer Patient Safety First 2011 (Safety Express) Energise for Excellence (E4E)

STOP ! THINK ! CONSIDER ! Catheterising patients places them in significant danger of acquiring a urinary tract infection (CAUTI) The per day risk of the development of bacteriuria appears comparable throughout catheterisation (3-6%) but the cumulative risk increases with duration of catheterisation Around 50% of hospitalised patients catheterised longer than 7-10 days contact bacteriuria 20-30% of these patients will develop symptoms of catheter-associated urinary tract infection UTI Many of these infections are serious and lead to significant morbidity and mortality epic2:National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England

CAUTI There is likely to be Bacteria in the bladder after 14 days Generally resistant to antibiotic therapy Only treat if symptomatic as the bladder and catheter are colonised by more than one organism

Continuing progress for the COUNTY of GLOUCESTERSHIRE Catheter Care Plans Countywide Catheter care passport

What is the Catheter Passport ? Provides information for patients about their indwelling urinary catheter & how to care for it A tool to improve communication between healthcare professionals and can be taken to healthcare appointments or hospital stay Developed to improve continuity of good catheter care for our patients in Gloucestershire.

Key messages in Passport Catheter care & tips on living with a catheter Personal hygiene Prevention of infection – including hand hygiene Avoiding dehydration Trouble shooting How to seek help Dates of when catheter inserted Record of CAUTIs

Catheterisation details

Prevention of dehydration This can also be used in partnership with a drinks tracker in the community GHNHSFT currently testing and trialing

Nurse documentation if CAUTI confirmed

IN SUMMARY Urinary catheterisation is an unavoidable necessity in many patients Catheterisation is not without costs –both financial and personal We need to justify every insertion and determine there are no alternative solutions We need to justify every day (in an acute setting) that a catheter is not removed Patients must not be allowed to get lost ”in the system” All patients with long term indwelling catheters must be followed up in the Community with plans for continuing care – TWOC’s inplace and catheter passports The patient must be educated in the care of themselves to minimise the risk of infection

Adult Continence Service Contacts Helpline for professional advice on continence problems phone 0300422 5306 or Email Gloucestershire.continenceservice@nhs.uk For queries on home delivery of continence products Phone 0300422 5305 ( Mon - Fri 0900– 1530) Fax 0300422 5311 Website on intranet A-Z under Continence.

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