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Infection Prevention and Control
Procedure for Female Intermi2ent Catheterisa6on when undertaken by Healthcare or Care Staff
1 0f 8 Infection Prevention and Control Procedure for Female Intermittent catheterisation
Infection Prevention and Control Procedure for Female Intermi2ent Catheterisa6on when undertaken by Healthcare or Care Staff Purpose To ensure all relevant staff are aware of the principles for female 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 female 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 female 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 female 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 0f 8 Infection Prevention and Control Procedure for Female Intermittent catheterisation
Infection Prevention and Control Procedure for Female Intermi2ent Catheterisa6on when undertaken by Healthcare or Care Staff •
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 sanitizer 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 Procedure
Rationale
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
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
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3 0f 8 Infection Prevention and Control Procedure for Female Intermittent catheterisation
Infection Prevention and Control Procedure for Female Intermi2ent Catheterisa6on when undertaken by Healthcare or Care Staff
Use a dressing trolley/ dressing tray or prepare a clean working surface
To facilitate optimum working conditions and minimise risk of contamination
Explain and discuss the procedure with the service user
To ensure that the service user understands the procedure and gives her 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 knees bent, hips flexed and feet resting about 60 cm apart
To enable the genital area to be visible and accessible
If not possible consider suitable alternative position 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
Using an aseptic non touch technique, open the packages of equipment onto the sterile field
To maintain sterility and reduce contamination
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4 0f 8 Infection Prevention and Control Procedure for Female Intermittent catheterisation
Infection Prevention and Control Procedure for Female Intermi2ent Catheterisa6on when undertaken by Healthcare or Care Staff
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) Cleanse hands with alcohol hand rub
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
Take the sterile towel, place across the service user’s thighs
To provide a sterile field
Using non-dominant hand clean the labia majora and then the labia minora with Sodium Chloride 0.9% using downwards strokes with a clean piece of gauze for each stroke
To reduce the risk of cross-infection and introduction of skin and meatal flora
Separate vulva using non-dominant hand then swab urethral meatus using dominant hand
Remove gloves, perform hand hygiene and put on a 2nd pair of sterile single use gloves
Inadequate preparation of the urethral orifice is a major cause of infection following catheterisation
To reduce contamination following skin and meatal contact with 1st pair of sterile single use gloves.
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5 0f 8 Infection Prevention and Control Procedure for Female Intermittent catheterisation
Infection Prevention and Control Procedure for Female Intermi2ent Catheterisa6on when undertaken by Healthcare or Care Staff NB: Local anaesthesia may not always be required in service users who routinely undertake intermittent catheterisation or intermittent selfcatheterisation. Insert the sterile nozzle of the anaesthetic lubrication gel into the urethra. Squeeze the gel into the urethra, remove the nozzle and discard the tube. Wait 5 minutes for the anaesthesia to take effect
Place the sterile urinary catheter, in the sterile receiver, between the service user’s legs Gently introduce the tip of the catheter into the urethral orifice. Advance the catheter 5-6cm or until urine starts to flow. When urine stops draining, carefully start to withdraw if urine starts to flow again stop withdrawing and wait for the flow of urine to stop, continue to withdraw slowly
Adequate lubrication helps to prevent urethral trauma.
Use of a local anaesthetic minimizes the service user’s discomfort
To provide a temporary container for urine as it drains
To ensure drainage of the bladder and by advancing gently, to minimise discomfort or trauma to the service users urethra
Make the service user comfortable and ensure that the area is dry.
If the area is left wet or moist, particularly with bodily fluids secondary infection and skin irritation may occur.
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
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6 0f 8 Infection Prevention and Control Procedure for Female Intermittent catheterisation
Infection Prevention and Control Procedure for Female Intermi2ent Catheterisa6on when undertaken by Healthcare or Care Staff 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 0f 8 Infection Prevention and Control Procedure for Female Intermittent catheterisation
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Infection Prevention and Control Gordon House, Station Road
 Mill Hill, London NW2 2JU Telephone 020 8906 2777 Fax: 020 8906 2233
 8 0f 8 Infection Prevention and Control Procedure for Female Intermittent catheterisation www.infectionpreventionsolutions.co.uk