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Infection Prevention and Control
Procedure for Male Intermi2ent Catheterisa6on when undertaken by Healthcare Professionals or Care Staff
1 of 8 - Infection Prevention and Control Procedure for Male Intermittent Catheterisation when undertaken by Healthcare Professionals or Care Staff
Infection Prevention and Control Procedure for Male Intermi2ent Catheterisa6on when undertaken by Healthcare Professionals or Care Staff Purpose To ensure all relevant staff are aware of the principles for male intermittent catheterisation and understand the rationale that informs the principle, to prevent cross infection between service users, staff and visitors and prevent Health Care Associated Infections.
Target Group This procedure is relevant to healthcare or care staff that have received specific training in male intermittent catheterisation.
Introduction Urinary tract infection (UTI) is the most common infection acquired as a result of health care, accounting for 19% of Health Care Associated Infections, with between 43% and 56% of UTI’s associated with a urethral catheter. This guidance has been formulated to give healthcare and care staff a step by step approach to male intermittent catheterisation with a rationale for each stage, based on the current national research and guidance. This guidance should be used in conjunction with other associated infection prevention and control policies and procedures such as Hand Hygiene, Waste Management, Use of Personal Protective Equipment (PPE), Aseptic Non-Touch Technique (ANTT) Only appropriately trained and competent healthcare or care staff should carry out male intermittent catheterisation using an aseptic non touch technique
Guidance • • • •
Intermittent catheterisation is considered to be the gold standard for urine drainage (NICE, 2006) as it carries a reduced risk of infection compared to indwelling urinary catheterisation Intermittent catheterisation can be indicated as treatment for voiding problems due to disturbances or injuries to the nervous system, non- neurogenic bladder dysfunction or intravesical obstruction with incomplete bladder emptying Intermittent catheterisation can be undertaken by a healthcare or care professional or by the service user or a carer (when the procedure is termed Intermittent Self Catheterisation) (ISC) When undertaken by a healthcare or care professional the procedure must be done using aseptic non touch technique
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2 of 8 - Infection Prevention and Control Procedure for Male Intermittent Catheterisation when undertaken by Healthcare Professionals or Care Staff
Infection Prevention and Control Procedure for Male Intermi2ent Catheterisa6on when undertaken by Healthcare Professionals or Care Staff
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An assessment must be undertaken prior to commencement of intermittent catheterisation by the Urologist or Nurse specialist, who will decide the most appropriate size and type of catheter for the service user
Equipment Hand sanitiser Alcohol wipes or hard surface disinfectant wipes 2 pairs of sterile single use gloves Disposable plastic apron Sterile dressing/catheterisation pack containing sterile receiver Sodium Chloride 0.9% Single use sterile lubricant/anaesthetic gel Urinary catheter of appropriate size / length and type of material as per urologist or nurse specialist advice • Clean container (e.g. plastic envelope) for catheter • Urine specimen container for specimen if required • Clinical waste bag • • • • • • • •
Procedure Before starting procedure: cleanse the genital area with soap and water. Procedure
Rational
Perform effective hand hygiene by washing hands with soap and water or using alcohol gel if hands are visible clean
To reduce the risk of infection
Prepare equipment and ensure packaging is intact and products are within the expiry date
To ensure equipment is single use sterile and within the expiry date
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3 of 8 - Infection Prevention and Control Procedure for Male Intermittent Catheterisation when undertaken by Healthcare Professionals or Care Staff
Infection Prevention and Control Procedure for Male Intermi2ent Catheterisa6on when undertaken by Healthcare Professionals or Care Staff
Prepare in advance area where service user is to receive intervention
To facilitate service user privacy To allow dust and airborne organisms to settle before sterile field is exposed
To facilitate optimum working Using alcohol wipes, prepare a dressing conditions and minimise risk of trolley / dressing tray or prepare a clean contamination working surface
Explain and discuss the procedure with the service user
To ensure that the service user understands the procedure and gives his valid consent
Perform effective hand hygiene by washing hands with soap and water or using alcohol gel if hands are visible clean
To reduce the risk of infection
Put on a disposable plastic apron
To reduce risk of cross-infection from micro-organisms on health care/carers clothing
Assist the service user to get into the supine position with legs extended
To enable the genital area to be visible and accessible
If not possible consider suitable alternative position Maintain service users privacy by covering genital area with clean paper roll or bed linen
To maintain modesty and privacy
Place waterproof/water repellent bed protection under the service user’s buttocks and thighs
Protect bed from any spillages which may occur during the procedure
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4 of 8 - Infection Prevention and Control Procedure for Male Intermittent Catheterisation when undertaken by Healthcare Professionals or Care Staff
Infection Prevention and Control Procedure for Male Intermi2ent Catheterisa6on when undertaken by Healthcare Professionals or Care Staff Using an aseptic non touch technique, open the packages of equipment onto the sterile field
To maintain sterility and reduce contamination
Follow manufacturer’s instructions to activate lubricated coating if applicable To ensure that device is adequately (Note - some catheters require lubricated before insertion activating with water or gel, others are ready to use)
Remove paper roll or bed linen that is maintaining service user’s privacy
To provide access to the genital area
Cleanse hands with detergent/ disinfectant wipe
To reduce the risk of infection. Hands may have become contaminated by handling the outer packs
Put on 1st pair of sterile single use gloves
To reduce the risk of infection
Wrap a sterile swab around the penis, retract the foreskin if necessary, and clean the glans penis with sterile normal saline
To reduce the risk of cross-infection and introduction of skin flora;
Remove gloves, perform hand hygiene and put on a 2nd pair of sterile single use gloves
To reduce contamination following skin contact with 1st pair of sterile single use gloves
Inadequate preparation of the urethral orifice is a major cause of infection following catheterisation
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5 of 8 - Infection Prevention and Control Procedure for Male Intermittent Catheterisation when undertaken by Healthcare Professionals or Care Staff
Infection Prevention and Control Procedure for Male Intermi2ent Catheterisa6on when undertaken by Healthcare Professionals or Care Staff Hold penis with the non-dominant hand upwards towards the stomach
This action straightens the penile urethra and facilitates catheterisation
Place the sterile urinary catheter, in the sterile receiver, between the service user’s legs
To provide a temporary container to maintain sterility prior to insertion and to catch urine as it drains
Hold the catheter in the non-dominant hand, being careful not to touch the part of the catheter entering the body, and gently insert into the opening of the urethra Advance the catheter into the bladder, until urine starts to drain Slight resistance may be felt as the catheter passes through the prostate gland and into the bladder; only gentle pressure should be used When urine stops draining carefully start to withdraw, if urine starts to flow again stop withdrawing and wait for flow to stop, continue to withdraw slowly
Replace the foreskin over penis and make the service user comfortable and ensure that the area is dry
To ensure that cross contamination does not occur
Some resistance may be due to spasm of the external sphincter; straining gently helps to relax the external sphincter
To ensure complete emptying of bladder
Retraction and constriction of the foreskin behind the glans penis (paraphimosis) may occur if this is not done; If the area is left wet or moist, particularly with bodily fluids secondary infection and skin irritation may occur
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6 of 8 - Infection Prevention and Control Procedure for Male Intermittent Catheterisation when undertaken by Healthcare Professionals or Care Staff
Infection Prevention and Control Procedure for Male Intermi2ent Catheterisa6on when undertaken by Healthcare Professionals or Care Staff Clear and clean trolley and dispose of rubbish in correct waste streams
To prevent environmental contamination and to comply with waste disposal policies and guidance
Remove gloves and perform effective To reduce the risk of infection and hand hygiene washing hands with soap environmental contamination and water
Record information in service users To ensure effective and accurate record records including details of the keeping is maintained and procedure, date, time and outcome and documentation is complete any untoward events
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7 of 8 - Infection Prevention and Control Procedure for Male Intermittent Catheterisation when undertaken by Healthcare Professionals or Care Staff
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Infection Prevention and Control Gordon House, Station Road Mill Hill, London NW2 2JU
8 of 8 - Infection Prevention and Control Procedure for Male Intermittent
Telephone 020 8906 2777 Fax: 020 8906 2233 Catheterisation when undertaken by Healthcare Professionals or Care Staff www.infectionpreventionsolutions.co.uk