CATHETER ASSOCIATED URINARY TRACT INFECTION after edit.ppt

URINARY CATHETER CARE

1. Catheter associated
Urinary tract infections
(CAUTI)

2. I.Safe insertion
II.Safe maintenance :
1.A sterile, continuously closed drainage system should be
maintained
2.Periodic Cleaning of the perineal area and Catheter tubing l
3.Proper technique of Emptying the foley bag
4.Disinfection of urine receptacle(Urinal)
5.Restrict irrigation of Urinary bladder to absolute indications &
ensure safe
irrigation technique
1.Daily assessment of necessity and removal of Unnecessary Urinary
Catheters Safe removal technique
2. Urine Sample collection

3. •The urinary tract is normally sterile.(bacteria come from
contamination by ant. Urethra)(so urine from catheter is sterile)
Urinary tract infections cover a range of
syndromes from asymptomatic cystitis to
pyelonephritis and sepsis.(it is usually beningn infection except if
complication happened)
Urinary tract infections are the most common
healthcare-associated infections. (The indwelling
urinary catheter is one of the most commonly used medical
devices)

4. About 95 percent of all UTIs are a single isolated bacterium.
In uncomplicated UTs and pyelonephritis, 70 to 95 percent of the
isolated organisms are E. coli.
It may also caused by gram positive m.o. as (coagulase negative staph)
Source of CAUTI :
-extra luminal (mostly by early at insertion)
(transmit bacteria from ant. Urethra to bladder, note if full
bladder: bacteria will pass down with urine.. If empty bladder:
bacteria will stay and feed on urine when come)
-intra luminal (break in closed drainage,,, or contamination of
collection urine bag)

6. Indwelling
Straight(without baloon)
Suprapubic
Condom (use in appropriate pt. ,, it may cause stricture and prostattic
pressure)

7. 1.Space: Procedure room, or bedside
2.Technique: Aseptic /Sterile
3.HH & Patient skin preparation
HCP
▪ antiseptic hand hygiene
▪
Patient
▪ Skin disinfection with betadine
4.Instruments :
cotton -cleaning solution-forceps-
idophores-sterile drapes-
lubricating gel (closed)-sterile
water syringe- catheter
4.PPE:
clean then Sterile gloves (or use non
touch technique)
•sterile drape fenestrated over perineum
5.Trash: Sharp container , biohazard
waste container.
Position : - female: frog-leg pose
- male: supine pose.

8. 1- Pour cleansing solution over three cotton balls (freshly prepared to avoid
contamination) 2-
Male : Male :
-- Retract the foreskin, if present, and hold the shaft of the penis with the non-
dominant hand.
-- Grasp one solution-soaked cotton ball with the forceps.
-* Using a circular motion, wipe the glans from the meatus outward and
Discard the cotton ball away from the sterile field.
-* Repeat with two more cotton balls.
-- Then wipe the area dry with the dry cotton balls.
Female:Female:
- Separate the labia using the non-dominant hand and visualize the meatus.
-Grasp one cotton ball with the forceps,
* Wipe one side of the labia from top to bottom and discard the cotton ball
away from the sterile field.
* Repeat on the opposite side by second cotton ball and
* Then wipe down the middle using the third cotton ball.
- Then wipe the area with dry cotton balls.

9. Repeat previous cleansing steps using iodophore
Let dry for 2-5 minutes( 4 minute)
Apply sterile drapes fenestrated over perinium
( prevent normal flora from come to this site)

10. Before insertion: Before insertion:
1- Dispense 2.5-5 ml (in female ,, 12 ml in male)of anaesthetic
lubricating gel into the kit tray,
2-Remove the outer plastic sleeve from the catheter
3- Remove the upper and lower end of the inner sterile catheter
sheath
4-Lock the sterile water syringe into the balloon port
((DO NOT PRE-INFLATE THE BALLOON PRIOR TO INSERTION.))
5- Perform antiseptic hand wash or hand rub
6- Apply sterile gloves ( or non touch technique) and use strict
sterile technique for the insertion procedure.
7- Use the dominant, sterile hand to handle the foley catheter:
8- Cover the tip of the catheter with lubricant.
9- Proceed to Insert the foley through the urethra into the
bladder.

11. Insertion Technique:Insertion Technique:
If patient is conscious
1- Ask her to bear down as if to void or take inspiration to open internal
sphincter
(If resistance is met do not attempt forceful catheter insertion)
2 – in female in female : Insert approximately 7.5 cm Or Until urine flows,,, Then
advance another 2.5-5 cm before inflating balloon.
Some centers recommend advancement of catheter to the bifurcation
EVEN in females
- in malein male: Grasp the penis in an upright position
Insert the lubricated catheter firmly into the meatus,Advance the
catheter to the bifurcation at the catheter.
((A slight lean toward the umbilicus may be necessary if resistance in
advancing the catheter is met at the prostate.))
((The return of urine does not assure that the catheter is
placed correctly, since there is residual urine in the penis.
, so Inserting the catheter to the bifurcation of the Y
is the standard for assurance of proper placement.))

12. 3- Inflate balloon
((If the patient is conscious instruct him to
say if he feels discomfort or pain with
inflation of the balloon,,
If discomfort is felt, the catheter is most
probably in the urethra, you will:
a-Deflate the balloon
b-Advance the catheter
c-Then re-inflate the balloon slowly, using
the entire 10 cc of sterile water.
((If catheter placement is in question:
No urine return or Unable to fully insert
the catheter …STOP ……..DO NOT
INFLATE THE BALLOON AND CONTACT A
SENIOR PHYSICIAN.))
4- Then withdraw the catheter slowly to
the point of resistance at the bladder
neck

13. 5-SECURE THE CATHETER
-Secure the catheter to the patient’s
thigh .
- To: Prevent movement, Irritation, and
Decrease risk of infection.
((To improve urine flow, some men may
need to have the catheter secured slightly
upward.))
((For males with long-term catheters, the
catheter should be taped to the abdomen
to prevent damage to the inferior
urethra)).

14. 6- POSITION THE BAG
- to avoid: Urine reflux into the
bladder, Kinking, Or gross
contamination of the bag.
- Position the bag hanger on the bed
rail
- Keep the bag below the level of the
bladder at all times to prevent the
backflow of urine and decrease the risk
for infection.
- Never leave the catheter hanging
to be pulled by the weight of the bag
6.B. MAINTAIN POSITION OF DRAINAGE
BAG DURING TRANSPORTING PATIENT
- The catheter bag should be emptied
prior to transport to prevent reflux
-Transport personal should be instructed to wash their hands
prior to and following any manipulation of the urinary
catheter or drainage bag.
- Maintain position of drainage bag
below the level of the patient’s
bladder, To prevent reflux of contaminated urine
from the bag to the bladder.
- Fix the urine collection bag in mobile
patients on either:
-The leg in males Or The thigh in
females

15. 1.A sterile, continuously closed drainage system should be
maintained
2.Periodic Cleaning of the perineal area and Catheter tubing l
3.Proper technique of Emptying the foley bag
4.Disinfection of urine receptacle(Urinal)
5.Restrict irrigation of Urinary bladder to absolute indications &
ensure safe
irrigation technique

16. -To ensure that urine is flowing freely.
-If a standing column of urine is observed:

▪
Check for (correct positioning of the bag Then for a physical
▪
obstruction, such as a kink in the tubing)
. 2.b. Periodic Cleaning of the perineal
area and Catheter tubing
- Perform hand hygiene immediately before and after any
manipulation of the catheter site or drainage bag.
- Clean the perineal area and Catheter tubing proximal to distal,
with: Foam body cleanser Or Ready cleansing wipes ((DAILY and ((DAILY and
AFTER EVERY bowel movement)).AFTER EVERY bowel movement)).
- The meatal area should not be aggressively cleansed or cleansed
with antiseptic solutions as this can lead to: •Meatal irritation and
•Increase the likelihood of infection.

17. -A sterile, continuously closed drainage system should be -A sterile, continuously closed drainage system should be
maintainedmaintained.
(If the catheter must be disconnected from the tubing, Disinfect the catheter-
tubing junction before separating.)
- Every 8 hours, OR when The drainage bag is 2/3 full,
To avoid traction on the catheter from the weight of the drainage bag and prevent
infection (from reflux)
-Take care not to contaminate the drainage port by touching: The collection
container or Floor when emptying.

18. - After emptying After emptying the receptacle:
* The gloves should be discarded &Hands washed
and dried thoroughly
* The urine receptacle (urinal) should be: Heat
disinfected if possible and If heat labile, chemical
disinfection could be used( Fill it with a 0.5% chlorine
(5000 parts per million (ppm),, let Stand for 15
minute,, Discard,, Let dry
It should be stored dry after each use.

19. -Do not irrigate a Foley catheter UNLESS Indicated for: Post urology
/genitourinary trauma, surgery, Or In the ICU to relieve obstruction.
-A closed system for irrigations can be performed on:
Intermittent OR Continuous basis To Maintain catheter patency
Without disrupting sterility
5.b. changing catheter
-If foley catheter is to remain indwelling for >30 days:
Change foley catheter and bag at 30 day intervals ( to avoid injury and entering
of m.o. if multiple change the catheter)
- Indications for continued Foley usage:
•Unresolved urinary retention, •Urinary tract obstruction,
•Critically ill patients, •Acute renal insufficiency fluid challenge,
•Comfort care of the terminally ill,
•To promote healing on an area of skin breakdown,
•To provide medications directly to the bladder,
•For the management of neurogenic bladder.

20. -If a Foley catheter has been in place for 3 days or longer, Provide daily
reminders to the physician recommending the removal of the Foley
catheter, Unless the Foley catheter is still indicated.
-- Removal of Urinary Catheter:- Removal of Urinary Catheter:
-By Deflate the catheter balloon by negative pressure..
-•Prior to attachment of the syringe to the balloon port:
- Move the plunger of a 10 ml syringe by up and down within the syringe
barrel. Pull back 0.5 ml air in the syringe to prevent adherence of the plunger
to the end of the syringe barrel
-•Then insert the syringe into the balloon port.
-•This allows for Automatic flow of instilled water & Balloon deflation via
negative pressure in the syringe. ((Allow 30 seconds for the balloon to
deflate.))
-(( NEVER carry out vigorous aspiration of water into the syringe as this may collapse
the inflation lumen, preventing balloon deflation.))
-(( If there is slow or no deflation: Re-seat the syringe gently... If the retention
balloon still does not deflate, Reposition the patient to ensure that the catheter
is Not in traction OR compressed within the bladder… If this fails, contact the
head nurse or the physician.))

21. Following removal of the Urinary catheter .. If the patient does
not void within 4-6 hours of removing the Foley catheter, a
bedside bladder scan ultrasound should be done.
…. If:
1. bladder scan indicates that the bladder volume is less than 500mL :
* Encourage the patient to void by using techniques to stimulate
bladder reflex: Cold water to abdomen, Stroke inner thigh, Run
water, Flush toilet
•Continue to assess the patient and repeat the bladder scan in 2
hours if the patient has not voided.
2. If bladder scan indicates that the bladder volume is greater than
500mL :
* Catheterize for residual urine volume rather than place an indwelling
foley catheter.

22. - Required supplies: Alcohol Hand rub- clean Gloves-
Sterile syringe- Clamp- clean Dressing- Alcohol swab ( alcohol and
cotton balls)- Waste collection containers: Sharp box-Medical
waste-general waste
1- Apply a clamp for approximately10 MINUTES to the collection
tube
2- Place a clean dressing under the Urinary catheter
3-Disinfect the catheter sheath with 70% alcohol
4-Aspirate 5 to 10 ml urine sample using a sterile needle and
syringe
5- Transfer collected urine sample into a sterile container.
6- Discard the syringe in sharp box
7- Wipe & Disinfect aspiration site dry, & with alcohol swab in case of
any ooze of urine drops
8- Discard the dressing
- Immediately transport urine sample to microbiology laboratory
If delay is anticipated in transportation or prior to culture in the
laboratory refrigerate at 4 ͦC the urine sample
Maximum duration of refrigeration prior to culture should not
exceed 24 hrs

23. Most Important
Least Important
These
“5 “
rules
Hold
for all
devices