Northwest Mississippi Community College
Dr. Ellen Williams
October 24, 2012
Healthcare Policy on Catheter Associated Urinary Tract Infections
The insertion of indwelling urinary catheters has been a common practice accredited to keeping the bladder empty during hospital stays, treatments and pre- or post-operative procedures. Through this practice, research has shown that many patients will acquire a catheter associated urinary tract infections. The purpose of this healthcare policy is to prove if catheterization is really necessary or is there an alternative, as a nurse what can one to do improve upon existing facility polices and where do we go from here to protect our patients. The insertion presents a strong possibility of introducing an infection and if the patient had no pre-existing infectious process, the end result may be a urinary tract infection related to the catheter. The presence of a urethral catheter bypasses many of the bladder’s natural defenses and provides a direct connection from the colonized perineum to the usually sterile bladder. Entry of bacteria into the bladder can occur either at initial catheterization or later by ascent of the catheter tubing, for example, when a catheter bag is changed (Dailly, 2011). This is the very step that we as healthcare professionals must work in unison to deem if this is really necessary and if so when should catheterization be discontinued and by whose judgment. Method
In acute care settings, urinary tract infections account for at least 35% of all hospital-acquired infections, with 80% of those being attributed to the use of indwelling catheters (Bernard, 2012). With these statistics healthcare providers must ask the question if a catheter is really necessary, but not only that they must be given a protocol to follow. Pellow, 2010 along with Critical Care Nurse 2012 have proposed the following protocol for guidelines for preventing infections associated with the use of short-term indwelling catheters. Assessing the need for catheterization: Only use indwelling urethral catheters after considering alternative methods of management. Document the need for catheterization, catheter insertion and care. Review regularly the patient’s clinical need for continuing urinary catheterization and remove the catheter as soon as possible. Selection of catheter type: Choice of catheter material will depend on clinical experience, patient assessment and anticipated duration of catheterization. Select the smallest gauge catheter that will allow free urinary outflow. A catheter with a 10ml balloon should be used in adults. Urological patients may require larger gauge sizes and balloons. Catheter insertion: Catheterization is an aseptic procedure. Ensure that healthcare workers are trained and competent to carry out urethral catheterization. Clean the urethral meatus with sterile catheter. Use an appropriate lubricant from a sterile single-use container to minimize urethral trauma and infection. Catheter maintenance: Connect indwelling urethral catheters to a sterile closed urinary drainage system. 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 recommendation. Decontaminate hands and wear a new pair of clean, non-sterile gloves before manipulating a patient’s catheter and decontaminate hands after removing gloves. Obtain urine samples from a sampling port using an aseptic technique. Position urinary drainage bags below the level of the bladder on a stand that prevents contact with the floor. Empty the urinary drainage bag often enough to maintain urine flow and prevent reflux. Use a separate and clean container for each patient and avoid contact between the urinary drainage tap and container. Do not add antiseptic or...