Great Catheter Care: Preventing Infections

Good catheter care is the biggest factor in preventing catheter-associated urinary tract infections.  Here are some tips for great catheter care.

• Wash your hands.  It sounds simple, but this is the single most important step in preventing infections.  Wash your hands BEFORE and AFTER putting on gloves.
• Use catheters sparingly—only when necessary.
• Use the smallest catheter that will do the job.
• When inserting the catheter, lay out a sterile field and maintain it.  If a person is obese or has contractures you may need two people to insert the catheter while maintaining a sterile field.
• Lubricate the tip of the catheter to prevent damage to the urethra during insertion.
• Use good lighting.  If you accidentally insert the catheter in the vagina, leave it there as a marker until you have placed a second, sterile catheter.
• Keep the system (catheter, tubing and bag) closed if possible.  The system should never be opened simply for convenience.
• Keep the drainage bag below the level of the bladder (but not lying on the floor).  Use clean technique when emptying the bag.
• Secure the catheter to prevent bleeding, trauma, tissue damage or bladder spasms that can be triggered by the catheter or balloon.  Tape can be hard on the skin; use a commercial device when possible.
• Keep the perineum clean.  Treat the catheter area like any other part of the body, washing as you would any other body part.
• If the resident is also incontinent of stool, check frequently to prevent stool from contaminating the catheter.
• Keep residents with catheters away from residents with infections.

Suspected infection:

If you suspect a urinary tract infection, remove the catheter and replace it with a new one.  Get a urine sample for culture and sensitivity from the new catheter.  Antibiotics should only be used for infections that are symptomatic.

Leakage

If catheter leakage occurs, check that the balloon is inflated and that the catheter is in the right place.  Make sure the balloon is inflated completely.  It is never acceptable to use a 30 cc balloon partially inflated.  Before changing to a larger catheter, keep in mind that constipation and fecal impaction may also contribute to leakage.  Larger catheters with larger balloons can damage the neck of the bladder.

YOU are the key to good catheter care that can prevent infections and discomfort, and save time and money.

How Common Are Medical Errors?

Researchers at the University of Utah led by Dr. David Classen found that about one of every three patients hospitalized in the US will experience some sort of mistake during their stay.  The findings indicate the error rate may be as high as 10 times greater than estimated using older methods. 

“It’s clear that we still have a great deal of work to do in order to achieve a health care system that is consistently high-quality -- that is, safe, effective, patient-centered, efficient, timely, and devoid of disparities based on race or ethnicity,” said Susan Dentzer, editor-in-chief of Health Affairs, a peer-reviewed journal that explores health policy issues of current concern that published the research.

The medical errors found ranged from decubitus ulcers and staph infections to objects left in the body after surgery.  It is estimated that medical errors that cause harm to patients annually cost $17.1 billion in 2008 dollars.

“A key challenge has been agreeing on a yardstick for measuring the safety of care in hospitals,” the researchers wrote.  To find the best yardstick, the team tested three methods of tracking errors on the same set of medical records from three different hospitals.

Among the 795 patient records reviewed, voluntary reporting detected four problems, the Agency for Healthcare Research’s (AHR) quality indicator found 35, and the Institute for Healthcare Improvement’s tool detected 354 events -- 10 times more than AHR’s method.

“Our findings indicate that two methods commonly used by most care delivery organizations and supported by policy makers to measure the safety of care ... fail to detect more than 90% of the adverse events that occur among hospitalized patients,” the team wrote.

The research was supported by the Robert Wood Johnson Foundation, which focuses on U.S. healthcare issues.