How do you prevent infection from a catheter?

Catheter-associated urinary tract infections routinely top the list of most commonly reported device-associated hospital-acquired infections. Prolonged use of the urinary catheter represents an important risk factor for developing such an infection. Urinary catheters may be necessary for conditions such as an inability to urinate. They are also commonly used to measure urine output when a patient is critically ill.

Medical caregivers at Cedars-Sinai take many precautions to prevent these infections, including:

• Properly cleaning hands before putting in the catheter
• Carefully avoiding contamination of the drainage spigot when emptying
• Always positioning tubing and bags below bladder level, off the floor
• Checking the system for closed connections and obstructions/kinks
• Ensuring closed and intact seals, and replacing the complete system if a seal is broken or otherwise nonaseptic
• Removing the catheter when no longer needed

By carefully monitoring the rate of central line infections, Cedars-Sinai lives up to its commitment to improving the quality of care for patients.

As a legal requirement, California hospitals report these infections to the California Department of Public Health and the National Healthcare Safety Network, part of the Centers for Disease Control and Prevention. The California department adjusts the data for risk factors according to the federal network's protocols. The risk adjustment is required, and uses national data to compare the actual number of infections to the expected number, based on the age and health of the surgery patients.

The chart below shows the rate of catheter-associated urinary tract infections that occurred in patients in the Adult Intensive Care Units at Cedars-Sinai vs. the expected number.

The standardized infection ratio is a summary measure used to track infections at a national, state or local level over time. The ratio compares the actual number of infections reported to a predicted number, adjusting for risk factors significantly associated with differences in infection incidence. A lower number is better.

The National Healthcare Safety Network instituted the new 2015 baseline time period for the number predicted calculation. The data included in the 2015 baseline will serve as a new reference point for comparing progress. The federal Centers for Disease Control and Prevention expects that hospital standardized infection ratios will increase and shift closer to 1. This shift reflects nationwide improvement in infection prevention from the previous baseline time period.

If you have questions or wish to learn more about quality measures at Cedars-Sinai, please send us a message.

Overview

A urinary catheter is a flexible plastic tube that's used to drain urine from your bladder when you can't urinate on your own. The catheter allows urine to drain from the bladder into a bag.

Two types of drainage bags may be used with a urinary catheter.

• A bedside bag is a large bag that you can hang on the side of your bed or on a chair. You can use it overnight or anytime you will be sitting or lying down for a long time.
• A leg bag is a small bag that you can use during the day. It is usually attached to your thigh or calf and hidden under your clothes.

Having a urinary catheter increases your risk of getting a urinary tract infection. Germs may get on the catheter and cause an infection in your bladder or kidneys. The longer you have a catheter, the more likely it is that you will get an infection. You can help prevent this problem with good hygiene and careful handling of your catheter and drainage bags.

How can you help prevent infection?

Take care to stay clean

• Always wash your hands well before and after you handle your catheter.
• Clean the skin around the catheter daily using soap and water. Dry with a clean towel afterward. You can shower with your catheter and drainage bag in place unless your doctor told you not to.
• When you clean around the catheter, check the surrounding skin for signs of infection. Look for things like pus and irritated, swollen, red, or tender skin around the catheter.

Be careful with your drainage bag

• Always keep the drainage bag below the level of your bladder. This will help keep urine from flowing back into your bladder.
• Check often to see that urine is flowing through the catheter into the drainage bag.
• Empty the drainage bag when it is half full. This will keep it from overflowing or backing up.
• When you empty the drainage bag, do not let the tubing or drain spout touch anything.
• Keep the cap that comes with the tubing, and cover the tip of the tubing when not in use.

Be careful with your catheter

• Do not unhook the catheter from the drain tube until you are ready to change the tubing and bag. That could let germs get into the tube.
• Make sure that the catheter tubing does not get twisted or kinked.
• Do not tug or pull on the catheter. And make sure that the drainage bag does not drag or pull on the catheter.
• Do not put powder or lotion on the skin around the catheter.
• Talk with your doctor about your options for sexual intercourse while wearing a catheter.

How do you empty the bag?

If your doctor has asked you to keep a record, write down the amount of urine in the bag before you empty it.

Wash your hands before and after you touch the bag.

1. Remove the drain spout from its sleeve at the bottom of the drainage bag.
2. Open the valve on the drain spout. Let the urine flow out into the toilet or a container. Be careful not to let the tubing or drain spout touch anything.
3. After you empty the bag, close the valve. Then put the drain spout back into its sleeve at the bottom of the collection bag.

How do you switch to a bedside bag for overnight use?

Wash your hands before and after you handle the bags.

1. Empty the leg bag that is attached to the tubing and catheter.
2. Put a clean towel under the tubing attached to the leg bag.
3. Use an alcohol wipe to clean the tip of the tubing attached to the bedside bag.
4. To stop the flow of urine, pinch the catheter with your fingers just above the tubing connection.
5. Use a twisting motion to disconnect the leg bag tubing from the catheter.
6. Then securely connect the catheter to the tubing from the bedside bag.

How do you clean a bedside bag?

Many people clean their bedside bag in the morning if they switch to a leg bag.

Before you start, clean and disinfect the area where you will be working, such as the sink and counter. Then follow these steps:
1. Wash your hands really well with soap and water or use alcohol-based hand rub.
2. Make sure you have everything you need:

· Clear liquid soap (regular dish soap is fine).
· A clean measuring cup.
· 1:1 water and vinegar solution. Mix together 1 part white vinegar and 1 part water (for example, 1 cup of vinegar and 1 cup of water).
· A clean, 60 mL catheter-tip syringe or a squeeze bottle.
· A clean towel or paper towels for a clean workspace.
· Clean examination gloves (optional).
· Alcohol or chlorhexidine swabs.

3. Put on the gloves (if worn).
4. Empty the drainage bag and disconnect the tube. Connect alternate drainage bag.
5. Add a few drops of liquid soap to 1 cup of water in the squeeze bottle.
6. Squeeze the soapy water into the drainage bag.
7. Gently shake the soapy water around in the drainage bag to loosen anything that might be stuck inside. Rub and shake the sides of the bag. Make sure the whole bag is clean, including the drainage spout and tubing.
8. Pour out the soapy water through the drainage spout and tubing. Flush the drainage bag with tap water, until the water runs clear through tubing and spout. Check to make sure there is no soap left in the bag, spout, and tubing.
9. Put the vinegar and water solution in the syringe or squeeze bottle, and squeeze it into the drainage bag to rinse it out. Shake the bag around and let it sit for 15 minutes. Then rinse the bag out with cool tap water and let it air dry.
10. Empty and wash the squeeze bottle or syringe after every time you use it. Wash it with hot, soapy water, then rinse it and let it air dry. Throw out the syringe or squeeze bottle if it:

· Looks damaged or broken.
· Changes colour (discoloured).
· Feels different than usual (for example, it feels harder, more brittle, or softer).

11. Take off the gloves (if you wore them) and wash your hands. Make any notes your healthcare provider asked you to make.

Important things to remember

When cleaning, check the drainage bag for damage (such as holes or tears) and to see if it’s discoloured.
Throw out the drainage bag and use a new bag every 7 days. Use a new bag right away if the one you’re using is:

· Damaged.
· Discoloured.
· Stiff and brittle.
· Smelly even after you clean it.

Let the drainage bag, spout, and tubing dry on a clean, dry surface after you clean them. Make sure the spout, connector, and tubing don’t touch anything. Wipe all ends with alcohol or chlorhexidine swabs before you reconnect them.

1. Remove the bedside bag and attach the leg bag.
2. Fill the bedside bag with 2 parts vinegar and 3 parts water. Let it stand for 20 minutes.
3. Empty the bag, and let it air dry.

When should you call for help?

Call your doctor or nurse call line now or seek immediate medical care if:

• You have symptoms of a urinary infection. These may include:
  • Pain or burning when you urinate.
  • A frequent need to urinate without being able to pass much urine.
  • Pain in the flank, which is just below the rib cage and above the waist on either side of the back.
  • Blood in your urine.
  • A fever.
• Your urine smells bad.
• You see large blood clots in your urine.
• No urine or very little urine is flowing into the bag for 4 or more hours.

Watch closely for changes in your health, and be sure to contact your doctor or nurse call line if:

• The area around the catheter becomes irritated, swollen, red, or tender, or there is pus draining from it.
• Urine is leaking from the place where the catheter enters your body.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

Enter U010 in the search box to learn more about "Learning About Indwelling Urinary Catheter Care to Prevent Infection".

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