Academic journal article Cross - Cultural Communication

Switching from Saline Solution to an Antimicrobial Solution for Pre-Catheter Skin Cleansing

Academic journal article Cross - Cultural Communication

Switching from Saline Solution to an Antimicrobial Solution for Pre-Catheter Skin Cleansing

Article excerpt

Abstract

The Infection Prevention and Control team at Rotherham Foundation Trust made the decision to switch from saline solution to an antimicrobial solution for skin cleansing prior to urinary catheterisation. The first stage of the switch has taken place in the community, with secondary care likely to follow suit at a later stage. The rationale for the switch, the two year journey it took to implement the changes and the parameters by which the success of the switch will be evaluated, are discussed in this article.

Catheter-associated urinary tract infections (CAUTI) are a cause of considerable concern and any measures which can be taken to potentially reduce the rate of CAUTI's should be given careful consideration. In 2012 the Infection Prevention and Control team at Rotherham Foundation Trust switched from saline solution to an antimicrobial solution (Octenilin® cleaning solution sachets) for skin cleansing prior to urinary catheterisation to try to reduce CAUTI's. Initially, Octenilin cleansing solution sachets were intended for use solely for patients with a current or historical confirmed result of MRSA in the urine and/or other sites. However, use has been extended to other patients, including those with a history of E. coli or Klebsiella, Gram-negative organisms frequently identified as a source of UTI's. Early feedback from using Octenilin cleansing solution sachets in place of saline solution has indicated a high level of satisfaction from both patients and health-care professionals. Reports of catheterisation-associated trauma have reduced significantly and no CAUTI's have been identified to date.

Key words: MRSA; Urinary catheter encrustation; Antimicrobial solution; Catheter associated urinary tract infection (CAUTI's)

INTRODUCTION

Urinary catheterisation is a key aspect of patient care. A prevalence study from the Hospital Infection Society estimates that around 32% of patients in hospital have a urinary catheter (Hospital Infection Society 2007). In the acute setting, urinary catheterisation is likely to be on a short-term basis (less than 14 days).

In the community, long-term urinary catheterisation (i.e. longer than 28 days) is estimated to be used in the management of around 4% of patients undergoing domiciliary care (Nation Institute of Health and Care Excellence (NICE) 2003). Long-term catheterisation of the bladder is often used in the care of older patients and those with neurological conditions. Patients with urinary retention or urinary incontinence may require continuous bladder drainage using a urethral or suprapubic catheter.

Indwelling catheters place patients at significant risk of acquiring a urinary tract infection. It is estimated that 19% of all health-care associated infections are urinary tract infections (Loveday et al, 2014) and catheter-associated urinary tract infections (CAUTIs) account for between 43% and 56% of these infections (Loveday et al, 2014).

The longer a catheter is in place, the greater the likelihood of a urinary tract infection developing. In the acute setting, 20-30% of catheterised patients develop bacteriuria, with the risk increasing by approximately 5% for each day of catheterisation (Loveday et al, 2013). A US study demonstrated that the use of indwelling urinary catheters was associated with higher colonisation rates of methicillin-resistant Staphylococcus aureus (MRSA). Of the 51 nursing home residents in the study who had an indwelling catheter, 28 (55%) were colonised with MRSA at any site. Residents who had urinary catheters were 2.8 times as likely to be colonised with MRSA as those in the control group without a urinary catheter (Mody 2007).

The patient's own colonic flora are likely to be the cause of most infections, as the urethral catheter provides a direct entry point for bacteria into the bladder. When the bacteria attach to the surface of the catheter, they may mutate into biofilms.

Urinary tract infections, tissue damage and encrustation of the catheter (which may block the catheter) are all complications that can arise during longterm catheterisation. …

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