Preventing the risk of catheter-associated urinary tract infections

Urinary tract infections are among the most widespread of hospital-acquired infections, accounting for over 20 percent alongside postoperative wound infections and infections of the lower respiratory tract such as pneumonia^2,3 In non-surgical specialties, urinary tract infections are actually the most common type of hospital-acquired infection.⁴ Hospital-acquired urinary tract infections can be acquired in the hospital itself or shortly after hospitalisation.

Around 80 percent of hospital-acquired urinary tract infections are catheter-associated.² 15 to 25 percent of all patients have a catheter placed during their hospital stay, and the percentage is even higher in intensive care units.³ As these figures show, the issue is relevant for all hospital personnel.

Uncomplicated urinary tract infections are also among the most common outpatient infections⁵ and pose a risk to individuals self-catheterising at home.

The term “urinary tract infection” refers to inflammations of the urinary tract. They are mainly caused by bacteria. The main cause of uncomplicated urinary tract infections (77%) is gram-negative E.coli bacteria. Gram-positive bacteria such as Staphylococcus aureus and other staphylococci can also trigger the infections.⁶

There is a higher risk of infection in patients who

• are older
• have diabetes
• suffer from bladder function disorders or
• chronic urinary retention.²

Most hospital-acquired urinary tract infections occur after diagnostic or therapeutic measures such as catheterisation in the lower urinary tract.¹ Infections are generally triggered by endogenous bacteria in the gastrointestinal tract, urogenital tract and the perianal region.²
In some circumstances, however, hospital-acquired urinary tract infections can also be caused by exogenous pathogens. There are four main causes of catheter-associated urinary tract infections:^7,8

If a catheter-associated urinary tract infection remains undetected the pathogens may continue to spread and cause inflammation of the renal pelvis (pyelonephritis) or in the worst case sepsis.7,8 Placing the catheter thus requires constant care and attention: Thorough disinfection of the genital area prior to inserting the catheter with mucous membrane antiseptics such as octenisept^® is extremely important for preventing infection.

You should always follow three basic principles to keep the risk of infection as low as possible as part of a prevention strategy:

• clean working methods: This is particularly important when placing the catheter to prevent exogenous pathogens from entering the urinary tract. Professional hand washing and disinfection is essential as is the use of sterile materials. Use closed urine drainage systems only, as far as possible.
• keeping catheter in situ periods short: In general catheters should only remain in situ for as long as absolutely necessary. Shortening the period they remain in the body reduces the risk of infection³ For this reason it is best if the indication is reviewed by the treating physician on a daily basis.
• regular replacement: Replace the catheter as prescribed. This can reduce the risk of catheter-associated urinary tract infections by up to 65 percent.³

Bladder catheters are used for both diagnostic and therapeutic purposes. They can be divided:

• by placement method: transurethral (via the urethra) and suprapubic catheters (via the abdominal wall)
• by period in situ: single-use and permanent catheters

There are a number of different indications for placing a bladder catheter, from monitoring renal function, for urinary retention or post-operative care after major surgery such as a prostatectomy. For this reason treating physicians must make case-by-case decisions for all of their patients.

Transurethral catheters are inserted slowly through the urethra until they reach the bladder. They are classified into two types depending on how long they remain in the bladder:⁹

Permanent catheters are predominantly used if there is a high risk of urinary retention recurring, further treatments or surgery are required. Single-use catheters and intermittent catheters can also be placed by the patients themselves (self-catheterisation), unlike permanent catheters. Patients must be instructed by a profession in how to self-catheterise.

The German KRINKO (the Commission for Hospital Hygiene and Infection Prevention) states that single-use catheters should always be chosen over permanent catheters whenever possible.¹⁰

Single-use catheterisation takes place around six times a day as needed.¹¹ A special catheter set is required for both self-catheterisation and catheterisation by a member of staff.
Alternatively, a permanent catheter may also be used.

Hygiene has utmost priority when placing the catheter. Disinfection is therefore particularly important: An antiseptic mucous membrane disinfectant such as octenisept^® is essential for disinfecting the outer genital area, as well as a suitable hand disinfectant such as desmanol^®.

Other consumables may be used depending on the type of catheterisation.

Some patients prefer self-catheterisation Instructions for self-catheterisation to catheterisation by medical personnel External catheterisation as it allows them to remain or return to being mobile, independent and able to live without assistance.¹²

Important user information

octenisept^®  Active substances: octenidine dihydrochloride, phenoxyethanol (Ph.Eur.). Composition: 100 g solution contain: 0.1 g octenidine dihydrochloride, 2.0 g phenoxyethanol (Ph.Eur.). Other ingredients: cocamidopropylbetaine, sodium D gluconate, glycerol 85%, sodium chloride, sodium hydroxide, purified water. Indications: For repeated, short-term antiseptic treatment of mucous membranes and adjacent tissues prior to diagnostic and surgical procedures - in the ano-genital region including the vagina, vulva and glans penis as well as prior to bladder catheterization - in the oral cavity. For short-term supporting therapy of interdigital mycotic infections and adjuvant antiseptic wound treatment. Contraindications: octenisept^® may not be used in cases of hypersensitivity to any of the components of the preparation. octenisept^® should not be used for rinsing the abdominal cavity (e.g. intra-operatively) or the bladder, nor the tympanic membrane. Undesirable effects: rare: burning, redness, itching and warmth at the application site, very rare: allergic contact reaction, e.g. temporary redness at the application site; frequency unknown: after lavage of deep wounds with a syringe, persistent edema, erythema and also tissue necrosis have been reported, in some cases requiring surgical revision. Rinsing of the oral cavity may cause a transitory bitter sensation. Revision 11/22

To prevent possible tissue injury, the product must not be injected into the deep tissue using a syringe. The product is intended for superficial use only (application by swab or spray pump).

Schülke & Mayr GmbH, 22840 Norderstedt, Germany, Tel. +49 40 52100-666, info@schuelke.com