KEYWORDS:
30 JCN
CATHETERISATION
Many people transferring from
hospital to primary care will
have a urinary catheter still in
place (Seymour, 2007). Similarly,
many patients seen regularly by
community nurses, such as elderly
patients in nursing homes, will
have a long-term catheter in situ.
Therefore, community nurses need
to understand the basic principles
behind this common procedure.
The purpose of urinary
catheterisation is to drain urine from
the bladder into a collection device,
such as a catheter bag. The catheter
itself comprises a flexible tube,
usually manufactured from silicone,
which is inserted through the urethra
or sometimes via an abdominal
incision (suprapubic catheterisation).
In order to perform catheterisation,
the clinician guides the catheter into
the bladder permitting urine to flow
into the drainage device (Ghaffary et
al, 2013).
Urinary catheters can be in place
for either a short time or be used as
a longer-term measure.
Reasons for short-term
catheterisation might include:
Post surgery when anaesthetic
has interfered with bladder
function
CONTINENCE
CAUTI
CAUTI is a frequent and
problematic HCAI, which causes
discomfort and can result in serious
health problems if left undetected.
These infections often develop
because of inadequate skin cleansing
before the catheter is inserted, or
from cross-contamination from the
hands of healthcare workers, such
as community nurses (Pratt et al,
2007). It has often been debated
whether the use of an antimicrobial
on the skin before insertion could be
effective in reducing the likelihood
of infection.
Bacteria colonise a catheter and
form biofilms, which involve clusters
of cells covered in a protective matrix
of polysaccharide polymers (Kirker,
2009; Greener, 2011). Another
problem is that some of bacteria
may include antibiotic-resistant
pathogens, including Escherichia
coli, Klebsiella sp., Enterobacter sp.,
Proteus sp. and Citrobacter sp., and
Pseudomonas aeruginosa, which
makes them difficult to treat
(Sandle, 2013).
CONTINENCE
Octenilin incorporates
octenidine dihydrochloride as its
active ingredient, which acts as
a broad-spectrum antimicrobial
and is suitable for use on skin,
mucous membrane and for wound
antisepsis. Octenilin also contains
ethylhexylglycerin (a conditioning
agent and preservative), which
reduces the skins surface tension,
providing optimal moistening and
cleansing, even on difficult-toreach areas.
Table 1: A summary of the experimental data, showing the average values obtained for the
octenilin cleaning solution (study A) and saline studies (study B) compared with the control counts
Study A:
octenilin cleaning solution
Study B:
0.9% saline solution
Control counts
144 CFU
121 CFU
13 CFU
55 CFU
Maximum count
31 CFU
98 CFU
Minimum count
0 CFU
12 CFU
91%
55%
Results
CONCLUSION
Community nurses visit a large
variety of patients in a wide
range of settings and one of the
commonly encountered problems
is that of CAUTI. This article
has discussed the problems
associated with catheterisation in
the community, and highlighted
some of the measures that can
be taken by community nurses
to reduce the contamination risk,
including cleansing the skin before
catheterisation as well as during
any catheter-related intervention.
In an independent study, the
use of an antimicrobial solution
demonstrated superior microbial
reduction properties compared
with a saline rinse. Based on this,
it would be prudent for community
nurses to consider the use of an
antimicrobial before the insertion or
management of a catheter. JCN
REFERENCES
Brusch JL (2013) Catheter-Related Urinary
Tract Infection. Available online at:
http://emedicine.medscape.com/
article/2040035-overview (accessed 23
October, 2013)
Chenoweth CE, Saint S (2011) Urinary
tract infections. Infect Dis Clin North Am
25(1):10315
Evans E, Painter D (2001) Blocked urinary
catheters: nurses preventive role. Nurs
Times 97(1): 37
Ghaffary C, Yohannes A, Villanueva C,
Leslie SW (2013) A practical approach
to difficult urinary catheterizations. Curr
Urol Rep [epub ahead of print]
Greener M (2011) Octenidine:
antimicrobial activity and clinical efficacy.
Wounds UK 7(3): 748
JCN
33
CONTINENCE
KEY POINTS
The
presence of urinary
catheters and the length of
time they remain in situ are
both contributory factors to
the development of catheterassociated urinary tract
infection.
assessment as part of an
holistic process
Leg ulcer management: old
challenges, new outcomes
Common dermatological
conditions explained
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