1. Infection Control In Care Homes Catheter Care
Infection Prevention & Control
NHS Kirklees

2. What’s wrong with this picture?

3. Aims and Objectives:
To increase your knowledge of the bacteria that can cause an infection
To be able to identify how bacteria can enter a catheter
To understand the importance of hand hygiene
To address how you can prevent catheterised patients from developing an infection.

4. Infection Prevention & Control
Infection Control
Infection Prevention & Control

5. What is a Urine Tract Infection?
Is the 2nd most common type of infection
Women are more prone to UTI’s
Affects millions of people every year
A UTI develops when part of the urinary tract becomes infected, usually by bacteria
There are 2 types of UTI:
Lower Tract
Upper UTI
1 – Lower Tract
Bladder and Urethra
Bladder is a balloon shaped organ that stores urine.
Urethra is the tube in which urine passes from the bladder
2 – Kidney’s and Ureter
Kidneys extract waste from blood and convert it into urine
Ureters are the tubes that run from the kidneys to the bladder

6. Symptoms of a urine tract infection
Cloudy or dark coloured urine
Pain and burning sensation
High temperature-Rigors/fever- flush face/headache/lethargy
Increased Confusion
Abdominal discomfort
So 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 catheter
Those catheterised for > 75% of year
–3x more likely to be hospitalised
–3x more likely to die
–3x more likely to receive antibiotics
Tsan et al 2008, Kunin et al 1992

14. What is a catheter
A catheter is a hollow tube that drains urine from the bladder into a drainage bag
An indwelling catheter is one that stays in place all the time
An intermittent catheter is inserted at regular intervals during the day to drain the bladder and is then removed
A catheter may be inserted into the bladder via the urethra or through a specially made hole in the abdomen called a suprapubic catheter

15. This is unused catheter equipment

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 possible
Avoid if possible
Document assessment

18. Indications for catheterisation for patients in care homes
Urinary tract obstruction eg.prostate problems
Acute or chronic retention of urine eg. due to Parkinson’s disease.
Management of urinary incontinence when all other methods are not applicable
What are the indications to catheterise? (Ask the audience)

19. Reducing the risks of catheter-associated urinary tract infection
Avoiding unnecessary catheterisation
Use Aseptic non touch technique
Maintaining a closed drainage system
Correct Catheter care- use stands, a clean dry receptacle.
Prevent catheter tube from pulling
Good hygiene
Education of patients, nurses and care staff
What can you do to minimise the risk? (Ask the audience)

20. Quiz Questions
A. 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 port
Reason – the seal is broken each time the needle is inserted
Identification of Entry Points
Entry point - 1
Catheter - meatal junction
Reason
perineal region - moist damp area of body heavily colonised with microbes normally carried in large intestines
Entry point - 2
Catheter-draining bag junction
Reason
The closed system is broken when connecting / disconnecting the bag
Entry points
Why? (Ask the audience)
Entry point 4
Drainage tap junction
Reason
Microbes 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 women
frequent cleansing if patient faecally incontinent
- male patients, retract prepuce and clean underneath
Entry point - 1 Insertion – performed only by appropriately trained staff to prevent urethral trauma
smallest possible size catheter to minimise urethral trauma
smallest balloon size – 10mls
sterile 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 trauma
cleaning of perineum and external meatus
insertion directly into urethra
aseptic connection of catheter to drainage bag
What is the ongoing management? (Ask the audience)

24. Catheter – drainage Bag Junction / Sampling Port
Entry point - 2
Catheter-draining bag junction
aseptic 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 gloves
Entry point 3
Urine sampling port
strict hand hygiene / use of gloves
Smallest gauge needle
- disinfection of port

25. Drainage Tap Junction Drainage Tap Junction Entry point 4
Drainage tap junction – emptying drainage bag
hand hygiene before and after procedure / gloves
separate jug for each patient
- no contact between jug and tap
- empty bag as needed to maintain urine flow
- wipe tap to remove drips
Additional measures
hang bag evenly on stand
position bag below bladder level
no kinking of tube
- no placing of bag in / on bed
What additional measures can you take to prevent infection? (Ask the audience)

26. How To Prevent A UTI
Ensure that all healthcare staff wash/decontamination their hands before and after any contact with the catheter and/or patient.
Keep a closed catheter system
Ensure the catheter system is maintained according to guidelines and policies
Remove 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

28. Engagement Ring

29. Watch

30. False nails

31. Long finger nails

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.

34. Frequently Missed Areas
FRONT
BACK
Least frequently missed
Less frequently missed
Most frequently missed

35. 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 diahorrea or vomiting, use soap and water.

36. Guidance 2006 Recommendations unchanged: •Education •Assessing need
•Drainage options
•Insertion & maintenance
Recommendations changed:
•Catheter type
•Bladder instillations and washouts
•Antibiotics at catheter change

38. Any questions?