Dr Sharon Eustice Consultant Nurse RN DN NMP MSc BPhil PhD Advanced Level Nursing Practice Credential RCN Scope of IUC use 90000 communitydwelling people mostly older adults andor affected by neurological conditions ID: 1040708
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1. Indwelling urinary catheters (IUC): maximising safety and reducing burdenDr Sharon Eustice Consultant NurseRN, DN, NMP, MSc, BPhil, PhDAdvanced Level Nursing Practice Credential (RCN)
2. Scope of IUC use~ 90,000 community-dwelling people, mostly older adults and/or affected by neurological conditions During 21/22, 359.1 people per 100,000 of the registered GP population were prescribed a catheter (source: https://model.nhs.uk/home/clinicalimprovement/populationhealth).~ 2000 people with IUC in CIOSMean cost £102 – Total cost £204,000
3. Burdens of the IUCLong-term IUC associated with a wide range of urological complications recurrent CAUTIsbiofilm formationcatheter blockages stone disease acute kidney injurySourced from: Feneley, R.C., Hopley, I.B. and Wells, P.N., 2015. Urinary catheters: history, current status, adverse events and research agenda. Journal of medical engineering & technology, 39(8), pp.459-470.
4. Why can an IUC cause harm?IUC disrupts host defence mechanisms easier access of uropathogens to the bladder. facilitates colonisation with uropathogens by providing a surface for the attachment of host cell binding receptors recognised by bacterial adhesins, thus enhancing microbial adhesion. uroepithelial mucosa is damaged, exposing new binding sites for bacterial adhesions, and residual urine in the bladder is increased through pooling below the catheter bulb/balloon.CAUTIs are often polymicrobial and caused by multiple uropathogens.https://uroweb.org/guidelines/urological-infections
5. Impact of CAUTIthe risk of developing bacteriuria increases by 5% for each day of catheterisationapproximately 24% of bacteriuric patients will develop CAUTI, and of these, up to 4% develop a severe secondary infection. CAUTIs can contribute to other problems, fallsdeliriumphysical and psychological discomfort accidental dislodgementpaingenital injury may result from catheterisationSaint S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am JInfect Control. 2000 Feb;28(1):68–75.Hazelett SE, Tsai M, Gareri M, Allen K. The association between indwelling urinary catheter use inthe elderly and urinary tract infection in acute care. BMC Geriatr. 2006 Oct 12;6:15.Lee EA, Malatt C. Making the Hospital Safer for Older Adult Patients: A Focus on the IndwellingUrinary Catheter. Perm J. 2011;15(1):49–52.V. Genget al Catheterisation Indwelling catheters in adults - Urethral and Suprapubic [Internet].European Association of Urology Nurses - EAUN. [cited 2017 Apr 3]. Available from:http://nurses.uroweb.org/guideline/catheterisation-indwelling-catheters-in-adults-urethral-andsuprapubic/ RCN (2021) Catheter Care: Guidance for Healthcare professionals
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7. How can we maximise safety?“…..a difficult and distressing experience….”Catheter care educational activitiesCatheter ChampionsInfrastructure and culture to support good catheter careTop Tips for Catheter CareSpread innovations and new ideasNever Event?Get It Right First Time
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9. Innovations and new ideasUrethral Catheterisation Device (Urethrotech UCD)https://www.penninehealthcare.co.uk/ward-and-theatre-consumables/urology/urethral-catheterisation-device-ucd/#:~:text=The%20integrated%20non%2Dtraumatic%20UCD,and%20cost%2Deffective%20patient%20care. Hexicathis a sterile wipe containing 0.1% chlorhexidine, for cleansing procedure of the urethral meatus prior to urethral catheterisation. UroShieldis an ultrasound device designed to reduce the risk of catheter-associated urinary tract infection (UTI) by reducing bacterial colonisation and biofilm formation on indwelling urinary catheters.Fasugba, O., Cheng, A.C., Gregory, V., Graves, N., Koerner, J., Collignon, P., Gardner, A. and Mitchell, B.G., 2019. Chlorhexidine for meatal cleaning in reducing catheter-associated urinary tract infections: a multicentre stepped-wedge randomised controlled trial. The Lancet Infectious Diseases, 19(6), pp.611-619.NICE (2022) https://www.nice.org.uk/guidance/mtg69/resources/uroshield-for-preventing-catheterassociated-urinary-tract-infections-pdf-64372185108421
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11. HOUDINIHaematuria- visibleObstructionUrology surgeryDecubitus ulcer (pressure sore) - open sacral or perineal wound in patient with incontinenceInput/Output fluid monitoringNursing care only/ end of life care/Immobility e.g., unstable fractureIf none of the above are present the catheter should be removed.
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13. 11 interventions….evidence-based documentation and toolschoice of catheter materials, length and sizecatheter passportscatheter care documentationclinical reviewspost-infection reviewscatheter securementdrainage systemsoff the floorTWOCAlternatives to EDAnsell, T., Lawton, S., & Hopper, A. (2017). Reducing harm from urinary catheters: A collaborative approach in South London. Health Innovation Network, London, 1-31.
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16. SummaryJoin the fight to reduce IUC harms eliminate misuse and overuse of urinary catheters apply evidence-based guidelines reduce catheter daysconsider alternative bladder drainage techniquesnational drivers