Catheter Use and UTI Prevention: Essential Tips

Preventing UTIs When Using Catheters: A Comprehensive Guide Introduction:

Urinary Tract Infections (UTI) occur when bacteria enter the urinary system. This may result in frequent urination, discolored or strong-smelling urine, a burning sensation, incontinence, fever, and more.

If the bladder is emptied fully and consistently, UTIs may be prevented. However, if the bladder is not drained properly, the technique for ISC is non-compliant, or if there is trabeculation of the bladder, a UTI could result. Trabeculation means the bladder walls have thickened, creating cavities/folds in the bladder that become a collecting ground for bacteria. Trabeculation often occurs if the bladder is not managed or emptied regularly and properly.

UTIs can pose additional medical complications, including increased spasticity, autonomic dysreflexia, sepsis, and more. Managing the infection risks associated with UTI is critical for maintaining bladder and overall health. If the bladder is not properly managed, the kidneys may stop filtering blood. Ensure the bowel program is also properly implemented. Constipation has a direct correlation to bladder function and can put individuals at a higher risk for UTI.

Understanding UTIs and Catheter-Associated Urinary Tract Infections (CAUTIs)

UTI: Urinary Tract Infection: an infection resulting from bacteria entering the urinary system.

CAUTI: Catheter Acquired Urinary Tract Infection: a urinary tract infection caused by a catheter. Research shows that CAUTI is one of the most common healthcare-acquired infections, with 70-80% of those infections being attributed to an indwelling catheter (urethral vs surgical).

Essential Hygiene Practices

Importance of hand washing:

– Harmful bacteria/germs are removed with proper hand hygiene techniques, using soap and water OR an antibacterial. For wheelchair users, be cognizant of cross-contamination (washing your hands, touching wheels, public restroom surfaces, etc.)

– Gloves are provided in some closed system catheter packages to further manage infection risk.

– Proper cleaning of the insertion area: Clean technique for ISC: The urethral meatus should be cleaned using soap and water, or a BZK wipe, or any preferred wipe (be sure it balances with pH).

– Sterile/aseptic technique: 3 betadine swabs or an antiseptic/cleaning solution are used in a specific pattern to sterilize the area prior to ISC.

– Maintaining a clean environment during catheter insertion and care: Be sure the catheter does not touch any other surface prior to urethral insertion (draping across clothing, dropping, setting on the counter, etc.

Proper Catheter Insertion Techniques

Sterile vs. Clean Technique for Catheter Insertion

Sterile technique is primarily used in institutionalized settings (hospitals, SNF, etc) and it’s completed by a nurse. It includes a closed system catheter, gloves, betadine for cleansing, a drape, and sometimes more. Gloves must be put on, betadine must be used in a specific pattern, it’s a lot of parts/pieces and could be cumbersome.

Clean technique is the preferred method by individuals. It encompasses washing their hands, cleaning the urethral meatus (soap/water, baby wipe, BZK wipe), and inserting the catheter. 

Tips for reducing contamination risk

Be mindful of cross-contamination following hand hygiene; proper hand hygiene is crucial during ISC.

– Be sure the catheter does not touch any other surface prior to urethral insertion (draping across clothing, dropped, set on the counter, etc.

– If the catheter being used has an introducer tip, it is important that the tip is inserted directly into the urethra before the catheter is advanced. The purpose of this special tip is to bypass the distal urethra, where bacteria collects; this allows the catheter to be inserted into a “cleaner” portion of the urethra and prevents the bacteria from being dragged through the urethra to the bladder.

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Catheter Care and Maintenance

Proper drainage bag care: If using a closed system with a drainage bag, the bag can be torn to drain the urine into the commode. If unable to empty the bag for any reason, it can be disposed of in the trash.

Hydration and Nutrition for UTI Prevention

A consistent fluid intake will help to dilute the urine and flush harmful bacteria out of the bladder.

Foods and drinks that may help prevent UTIs

– Any probiotics: yogurt, sauerkraut, kombucha, pickles

– Garlic

– Blueberries

– Green tea

– Water

– Bananas

– Foods high in fiber

– Cranberry juice

–Avoid foods and drinks that have a high sugar content (energy drinks, sodas, candy, etc), coffee, caffeine, alcohol, and spicy food

– Avoid highly acidic foods: oranges, lemons/limes if you have an active UTI as it can further irritate your bladder; however, foods high in vitamin C (strawberries, green peppers, spinach) can help prevent future infections.

– Supplements that may support urinary tract health: D Mannose, Probiotics, Cranberry supplements and Vitamin D

Recognizing Early Signs of UTIs

Common early symptoms to watch for

– Increased spasticity (for individuals with SCI)

– Fatigue/malaiseIncontinenceDecreased urine output

– Darker urine with an odor

When to seek medical attention

– Symptoms worsen/do not improve

– UTIs can last days to weeks without antibiotics; if symptoms continue for more than a week, antibiotics are usually necessary

– Fever chills, nausea/vomiting

– Back pain

– Blood/pus in urine

– Pregnant with a UTI

Diabetic with a UTI

Importance of prompt treatment

– May cause Autonomic Dysreflexia in individuals with SCI

– May result in a kidney infection, permanent kidney damage, sepsis, leading to organ failure, and organ failure could lead to death.

– Before the introduction of urinary catheters and antibiotics, the neurogenic bladder was one of the main culprits for death in those patients with SCI.

Additional Prevention Strategies

Considering different catheter types (e.g., antimicrobial catheters)

– The lubricant on the catheter should react positively to the individual’s pH.

– If the catheter is not properly lubricated, or there is an adverse pH response to the lubricant, the catheter may become “sticky”, potentially resulting in urethral trauma and UTI.

Catheter features:

– Gripper: prevents the catheter from being touched during insertion, and promotes ease with insertion.

– Introducer tip: The tip is inserted directly into the urethra before the catheter is advanced/exposed. The purpose of this special tip is to bypass the distal urethra, where bacteria collects; this allows the catheter to be inserted into a “cleaner” portion of the urethra and prevents the bacteria from being dragged through the urethra to the bladder. Hydrophilic catheters: Research does show that using a hydrophilic catheter reduces the chance of UTI compared to uncoated catheters.

– Closed system catheters: The catheter is enclosed in the drainage bag on enclosed in a protective sheath.

– Proper storage of catheter supplies

Store catheters in a convenient location: closet, bathroom cabinets, etc.

Consider temperature: do NOT leave catheters in your car in the summer, or in your garage in the winter. Temperature changes will impact the chemical compounds of the lubricant, thus affecting the integrity of the catheter. Catheters should remain at room temperature in a dry environment.

Always remember to consult with your healthcare providers for personalized advice. By following these tips and maintaining a vigilant approach, you can significantly prevent and reduce UTIs.

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