**6. Catheter maintenance techniques**

	- Maintain closed drainage system
	- Keep urine flow unobstructed:
	- **◦** Avoid kinking
	- **◦** Keep collecting bag below level of bladder at all times
	- **◦** Empty the collecting bag regularly and avoid contact of the drainage spigot with the collecting container

– Further research is needed on the prophylactic use of urinary antiseptics such as methen‐ amine (unresolved issue).

**•** Do **NOT** use antiseptic solutions to clean the periurethral area while the catheter is in place. Routine hygiene (e.g., cleaning the meatal surface during daily bathing/showering) is appropriate (Category IB)

**•** Do **NOT** irrigate the catheter unless obstruction is anticipated, such as after prostate or bladder surgery where blood and debris is present within the system. If this is necessary, use closed continuous irrigation. (all Category II)

**• Management of obstruction: if this occurs and it is likely that the catheter material is**

Prevention of Urinary Tract Infections in the Outpatient and Inpatient Settings

http://dx.doi.org/10.5772/56709

17

**◦** Benefit of irrigating catheter with acidifying solutions or use of oral urease inhibitors in

**◦** Use of portable bladder scanners to evaluate for obstruction in patients with indwelling

– For culture: obtain these aseptically by aspirating the urine from the needleless sampling

– Large volumes or urine for analysis (not culture) can be obtained aseptically from the

When implemented, there is good evidence that these programs can reduce the risk of CAUTI.

**•** To identify and remove catheters that are no longer needed: Alerts or reminders within the medical record that identify patients with catheters in place and note how many days they have been in have been shown to increase the removal rate of catheters. Even placing a sticker on the patient's chart reminding physicians to discontinue unnecessary foleys is beneficial. This simple intervention in a community hospital caused a significant reduction in the rate of CA-UTI after 3 months (7.02 vs 2.08; P <.001) and 6 months post-intervention

**◦** Procedure specific guidelines for catheter placement preoperatively and post-operative

**◦** Protocols for management of postoperative urinary retention, such as nurse directed use

of intermittent catheterization and use of ultrasound bladder scanners.

**◦** Use of methenamine to prevent encrustation in patients at high risk for obstruction

patients with long -term indwelling catheters and frequent obstructions.

**contributing to obstruction, change the catheter (Category IB)**

port with a sterile syringe after cleaning the port with disinfectant

**•** To ensure adherence to hand hygiene and proper care of catheters.

**•** Guidelines for peri-operative catheter management:

– Unresolved issues:

drainage bag.

catheters and low urine output

**• Specimen collection: (both Category IB)**

**7. Quality Improvement (QI) programs**

(Category IB). Their purpose should be:

**•** To assure appropriate use of catheters

(7.02 vs 2.72; P <.001) [46].

removal

– Routine irrigation of bladder with antibiotics is not recommended

– Routine instillation of antiseptic or antimicrobial solutions into the urinary drainage bag is not recommended

– Further research is needed on the use of bacterial interference (bladder inoculation with a nonpathogenic bacterial strain) to prevent UTI in patients requiring long term urinary catheterization (Unresolved issue)

**• Catheter materials:** there are antimicrobial catheters available that are coated with silver alloy or antibiotics and may reduce or delay the onset of bacteruria. This is an unresolved issue, but the CDC does recommend consideration of these catheters if the CAUTI rate is not decreasing in an institution despite the implementation of a comprehensive preventive strategy. (Category IB)

– Silicone catheters might reduce the risk of encrustation in long-term catheterized patients with frequent obstruction (Category II)

– Hydrophilic catheters, (catheters designed to be lubricated when moistened with water, which eases friction on the urethra upon insertion) might be preferable to standard catheters for patients using CIC (Category II)

– The benefit of catheter valves in reducing the risk of CAUTI is unclear and further research is needed (unresolved issue). Catheter valves (see Figure 1) are small tubes usually 8 to 12 cm in length with a stopcock mechanism that fit on the end of a foley catheter, replacing the drainage bag. This allows the patient to self empty the catheter in a typical voiding fashion at regular intervals, doing away with the need for a drainage bag. They should not be used by patients with detrusor instability, as bladder wall contractions against a closed bladder outlet could lead to reflux. They also cannot be used by patients with cognitive impairment or limited manual dexterity

**Figure 1.** Colpoplast catheter valve

### **• Management of obstruction: if this occurs and it is likely that the catheter material is contributing to obstruction, change the catheter (Category IB)**

– Unresolved issues:

**•** Do **NOT** irrigate the catheter unless obstruction is anticipated, such as after prostate or bladder surgery where blood and debris is present within the system. If this is necessary,

– Routine instillation of antiseptic or antimicrobial solutions into the urinary drainage bag

– Further research is needed on the use of bacterial interference (bladder inoculation with a nonpathogenic bacterial strain) to prevent UTI in patients requiring long term urinary

**• Catheter materials:** there are antimicrobial catheters available that are coated with silver alloy or antibiotics and may reduce or delay the onset of bacteruria. This is an unresolved issue, but the CDC does recommend consideration of these catheters if the CAUTI rate is not decreasing in an institution despite the implementation of a comprehensive preventive

– Silicone catheters might reduce the risk of encrustation in long-term catheterized patients

– Hydrophilic catheters, (catheters designed to be lubricated when moistened with water, which eases friction on the urethra upon insertion) might be preferable to standard catheters

– The benefit of catheter valves in reducing the risk of CAUTI is unclear and further research is needed (unresolved issue). Catheter valves (see Figure 1) are small tubes usually 8 to 12 cm in length with a stopcock mechanism that fit on the end of a foley catheter, replacing the drainage bag. This allows the patient to self empty the catheter in a typical voiding fashion at regular intervals, doing away with the need for a drainage bag. They should not be used by patients with detrusor instability, as bladder wall contractions against a closed bladder outlet could lead to reflux. They also cannot be used by patients with cognitive impairment

use closed continuous irrigation. (all Category II)

is not recommended

strategy. (Category IB)

catheterization (Unresolved issue)

16 Recent Advances in the Field of Urinary Tract Infections

with frequent obstruction (Category II)

for patients using CIC (Category II)

or limited manual dexterity

**Figure 1.** Colpoplast catheter valve

– Routine irrigation of bladder with antibiotics is not recommended


– For culture: obtain these aseptically by aspirating the urine from the needleless sampling port with a sterile syringe after cleaning the port with disinfectant

– Large volumes or urine for analysis (not culture) can be obtained aseptically from the drainage bag.
