Aseptic Technique
Aseptic technique is used as a method of preventing or minimizing the risk of introducing harmful microorganisms into sterile areas of the body when undertaking clinical procedures. This technique aims at preventing wound and other susceptible body sites from being contaminated.
Effects of Improper Asepsis
Poor asepsis can lead to the risk of cross transmission of microorganisms from the healthcare workers hands and/or the equipment to susceptible patient sites, which can result in serious life threatening infections.
Urinary Catheterization
Urinary catheterization is an aseptic procedure but is also the most common cause of hospital-acquired infections, which can occur during insertion or removal of the catheter. Repeated catheterization causes trauma and results in infection.
Insertion and Maintenance of a Urinary Catheter
Catheterization places patients at great risk of acquiring a urinary tract infection. The risk of infection is associated with the insertion method, the duration of catheterization, and the quality of the catheter used. Catheter associate urinary tract infection is the most common Health Care Associated Infection in hospitals. Most of the bacteria gain access to the urinary tract when the catheter is inserted either from contamination of the healthcare worker’s hands or from the patient’s perineal flora. Contamination can also occur as a result of reflux of bacteria from a contaminated urine drainage bag. Bacteria develop into colonies that adhere to the catheter surface and the urine drainage bag. These bacteria are highly resistant to antibiotics. Encrustation of the catheter can develop and is usually as a result of long term catheterization. New evidence suggests using catheters that are impregnated with antiseptic or antimicrobial agents can prevent or delay the onset of catheter associated infection, compared with standard ones. Smaller gauge catheters with a 10 ml balloon minimize urethral trauma and residual urine in the bladder which contribute to infection.
Asses the Need for Catheterization
1. Only consider using indwelling catheters as a last resort when no other management methods can be employed
2. Document the need, the catheter type, catheter insertion date, and catheter change dates on the care plan.
3. Review the need regularly and remove the catheter as soon as possible.
Catheter Selection
1. Catheter choice will depend on patient assessment and the duration of catheterization.
2. Always use the smallest gauge e.g. 10 ml for adults.
3. Only urological patients will need a larger gauge, which will only be used on the recommendation of a urologist.
Catheter Insertion
Catheterization is a skilled aseptic procedure and must be inserted using sterile equipment and an aseptic technique as outlined in sections 1-5 above. Expert opinion suggests that there is no need to use antiseptic preparations for cleaning the urethral meatus prior to insertion (Pratt et al 2007).
1. Inform the patient and explain the indication and the procedure of catheterization.
2. Lay all necessary equipment on a trolley.
3. Select a catheter that fits the urethra without traumatizing the patient
4. Wash hands thoroughly with an antiseptic hand wash preparation.
5. Put on sterile gloves and use a “no touch” technique.
6. If the patient is male, draw back the foreskin and clean the glans thoroughly with soap and water to remove secretions, followed by swabbing the area with antiseptic. If the patient is a woman, clean the periurethral area by separating the labia and cleanse the vulva, using front to back technique.
7. Insert 2-3 ml of the lubricant (e.g.anesthetic jelly into the urethra).
Multiple-use tubes are not recommended because they become contaminated and increase cross-infection.
8. Insert the catheter gently – advance it by holding the inner sterile sleeve. A “no touch technique” should be used in which the operator has no contact with the sterile shaft of the catheter.
9. Collect the urine in a suitable container.
10. Inflate the balloon by instilling the manufacturer’s recommended amount of sterile water.
11. Anchor the catheter to the patient’s thigh.
12. Connect the catheter to the closed drainage bag and hang it below the level of the bed to stop reflux.
13. Wash and dry hands.
Catheter Maintenance
Maintaining a sterile closed system is central to the prevention of infection. Breaches e.g. when unnecessary emptying of the bag or taking a urine sample can increase the risk of infection. Bladder irrigation or washouts may cause toxic effects and contribute to the development of resistant microorganisms (Davis et al 1987).
1. Always connect the urinary catheter to a sterile closed urinary drainage system.
2. Ensure that the connection between the catheter and the drainage system is not broken.
3. Change the bag in line with the manufacturer’s recommendations.
4. Decontaminate the hands and wear clean non-sterile gloves before manipulating a patient’s catheter. Decontaminate hands as outlined in the trust hand hygiene policy.
5. Position the drainage bag below the level of the patient’s bladder on a stand to prevent contact with the floor.
6. Empty the bag frequently, enough to maintain the flow of the urine and to prevent reflux.
7. Use a separate clean container for each patient and avoid contact with the end of the drainage tap.
8. Do not add antiseptics solutions into the urinary drainage bag.
9. Avoid unnecessary bag changing and always adhere to the manufacturer’s guidelines.
10. Patients and their relatives should be given information and educated about prevention of urinary catheter infection.
References
Aseptic Technique Guidelines (2007). NHS: Hertfordshire Partnership. Retrieved September 5, 2008, from
http://www.hertspartsft.nhs.uk/_uploads/documents/the-trust/trust-papers/policies/infection-control/aseptic-technique-guidelines.pdf
Aseptic Technique Policy (2007). NHS: North East London. Retrieved September 5, 2008, from
http://www.nelmht.nhs.uk/downloads/Aseptic%20technique%20%20catheter%20care.pdf
Aseptic Techniques (2008). Science Communication Network. Retrieved September 5, 2008 from
http://www.ems.org.eg/esic_home/data/giued_part1/Aseptic_Techniques.pdf
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