1. Infection Control In Care HomesCatheter Care Infection Prevention & Control NHS Kirklees 02-02-12

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 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

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

8. There are 3 main types of bacteria that cause problems

9. Escherichia coli Photo: Dr M S Mitchell

10. Staphylococcus

11. 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

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

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 Identify 4 Entry Points for Bacteria on this Diagram of an Indwelling Urinary Catheter

22. Entry point 3 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 Identification of Entry Points Entry point - 2 Catheter-draining bag junction Reason The closed system is broken when connecting / disconnecting the bag 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

24. Catheter – drainage Bag Junction / Sampling Port 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

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.

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 BACK FRONT 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?