Infection Prevention & Control Care Champion (IPCCC) Forum Infection Prevention & Control Team E: InfectionPrevention@lancashire.gov.uk W: http://www.lancashire.gov.uk/practitioners/health/infection-prevention-and-control.aspx Twitter: @LancsIPC
Catheters & UTI’s
Introduction Housekeeping Presentation IPC care champion responsibilities Evaluation forms & certificates
Contents • Basics of IPC • Catheter care and maintenance • Urine samples • Urinary tract infections (UTI) • Scenario • Quiz
The Chain of Infection Infectious agent Susceptible Reservoir host Portal Portal of of entry exit Means of transmission Breaking any link in the chain will assist in preventing the spread of micro-organisms.
Hand hygiene • Bare below the elbows • Short / unvarnished nails / no false nails or nail art • Skin integrity / cuts and abrasions covered • Soap / water – to be used on visibly contaminated hands / positioning of dispensers for soap, paper towels, foot operated bin • Hand gels – require risk assessment / free standing, wall mounted dispenser, individual bottles / not sporicidal / not to be used on visibly contaminated skin • Hand creams to maintain skin integrity
Catheter passport • Have you heard of them? • Is your resident on one? • Do you know if there is one stored within their notes? • Have you seen one completed?
Catheter audit tools Taken from Infection Prevention Society High Impact Interventions
Guidance Catheter Maintenance Leave the closed system alone! Maintaining a sterile, continuously closed urinary drainage system is central to the prevention of catheter-associated infection. The risk of infection reduced from 97% with an open system to 8-15% when a sterile closed system was employed as standard practice. However, breaches in the closed system such as unnecessary emptying of the urinary drainage bag or taking a urine sample increase the risk of catheter-related infection and should be avoided. Hands must be decontaminated and healthcare workers should wear clean, non-sterile gloves before manipulation. Reflux of urine is associated with infection and, consequently, best practice suggests catheters are secured to avoid trauma and drainage bags should be positioned in a way that prevents back-flow of urine. Expert opinion also recommends that urinary drainage bags should be supported in such a way that prevents contact with the floor. For night drainage, a link system should be used to maintain the original closed system, i.e., a bag attached to the end of the day system. Drainable urinary drainage bags should be changed in line with the manufacturer’s recommendations, generally every 5 -7 days, or sooner if clinically indicated, e.g. malodorous or damaged. Bags that are non-drainable should be used once, e.g., overnight, and emptied before disposal.
Maintenance of a catheter • Indwelling catheters should be connected to a sterile closed urinary drainage system or catheter valve. • Healthcare workers should ensure that the connection between the catheter and the urinary drainage system is not broken except for good clinical reasons, (for example changing the bag in line with manufacturer’s recommendations). • Healthcare workers must decontaminate their hands and wear a new pair of clean, non- sterile gloves before manipulating a patient’s catheter, and must decontaminate their hands after removing gloves. • Patients managing their own catheters, and their carers, must be educated about the need for hand decontamination before and after manipulation of the catheter, in accordance with the recommendations in the standard principles section • Urine samples must be obtained from a sampling port using an aseptic technique. • Urinary drainage bags should be positioned below the level of the bladder, and should not be in contact with the floor. • A link system should be used to facilitate overnight drainage, to keep the original system intact. • The urinary drainage bag should be emptied frequently enough to maintain urine flow and prevent reflux, and should be changed when clinically indicated. Appropriate maintenance minimises infections
Cleaning a catheter • Personal hygiene, including cleaning the meatus which should be washed daily with soap and water as part of routine daily personal hygiene. • Healthcare workers must decontaminate their hands and wear a new pair of clean, non-sterile gloves before manipulating a person's catheter, and must decontaminate their hands after removing gloves.
CSU’s
MSU’s
Clean catch specimen
UTI • The classic symptoms of a UTI are burning pain and frequent urination • UTI’s may not cause these classic symptoms in older adults • Instead, older adults, especially those with dementia, may experience symptoms such as confusion
Signs & symptoms of lower UTI • Dysuria (painful or difficulty passing urine) • Increased frequency or urgency • Nocturia (excessive urination at night) • Dribbling incontinence (especially in men) • Feeling of incomplete bladder emptying • Cloudy, bloody or offensive smelling urine • Confusion (new or worsening) • Mild fever (37- 38 ˚C)
Signs & symptoms of upper UTI • Any of the signs and symptoms of a lower UTI • A high fever (over 38˚C) • Nausea or vomiting • Shaking or chills • Confusion – new or worsening • Pain in the lower back – usually one sided
Red flags • Haematuria – blood in the urine ( requires prompt treatment ) • Can be either insignificant or potentially life threatening • Catheters – residents with catheters who develop fever, rigors, chills, vomiting and confusion should seek medical attention without delay
Scenario 1 • There is a 75 year old lady; Elsie who has only been living in your care home for 2 weeks. She was discharged to your home following a long hospital stay. She is self caring, mobile, has capacity and has a catheter in situ. • The catheter falls out during the night and she calls you for help. • What would your immediate and mid term action be?
Scenario 2 • James has just celebrated his 80 th birthday with his family and friends in your care home. You organised an afternoon tea party for him. He ate sandwiches and birthday cake and his family brought in his favourite beer, of which he drank one bottle. • James enjoyed his birthday BUT 2 days later he complained of urgency and pain on passing urine. He has never had a urinary tract infection. • It is also a hot summer’s day • What would you do?
So to summarise…. • Remember the basic principles of IPC • Leave the catheter closed system alone! • Urine samples must be obtained from a sampling port using an aseptic technique • Urinary drainage bags should be positioned below the level of the bladder, and should not be in contact with the floor. • Appropriate maintenance minimises infections • Daily personal hygiene is important! • The classic symptoms of a UTI are burning pain and frequent urination • UTI’s may not cause these classic symptoms in older adults • Residents with catheters who develop fever, rigors, chills, vomiting and confusion should seek medical attention without delay
Infection Prevention & Control Team E: InfectionPrevention@lancashire.gov.uk W: http://www.lancashire.gov.uk/practitioners/health/infection- prevention-and-control.aspx Twitter: @LancsIPC
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