CATHETERISA I N 5th, reviewed edition

Training and education to Optimise patient care Visit to find out more. What can Optimum Medical Support offer you? Education and product training by in house clinical team Male and female catheterisation training animations Clinician focus groups/web forums Dedicated clinical support web page Patient education resource Female and Male CATHETERISA I N 5th, reviewed edition Urethral and Suprapubic OMS-OMS-103 Aug 15 optimummedical Optimum Medical First floor, Unit 5, Armley Court, Armley Road, Leeds, LS12 2LB, United Kingdom Tel.: +44 (0) 8456 435 479, Fax: +44 (0) 1142 383 826 enquiries@optimummedical.co.uk www.optimummedical.co.uk constantly creating better optimummedical

ORDERING INFORMATION To order Optimum Medical products please refer to the information below. You can call +44(0)845 643 5479 or email enquiries@optimummedical.co.uk for more information about how to order. Female and Male CATHETERISA I N Urethral and Suprapubic 5th, reviewed edition CATHETERISATION JELLY WITH LOCAL ANAESTHETIC AND ANTISEPTIC CATHETERISATION JELLY WITHOUT ACTIVE INGREDIENTS CATHETER CLIP CATHETER STRAPS CATHETER SLEEVES CATHETER VALVE STERILE WATER PRE-FILLED SYRINGE 1160 FST652 366-2061 OptiLube Active 6ml syringe Box of 10 Case of 200 1161 FST654 366-2079 OptiLube Active 11ml syringe Box of 10 Case of 200 1125 FST650 373-4357 OptiLube 6ml syringe Box of 25 Case of 250 1126 FST651 373-4365 OptiLube 11ml syringe Box of 25 Case of 250 3004 FSS 1084 394-9054 Ugo Fix Gentle Catheter Clip Box of 5 Case of 100 3001 N/A 393-3371 Ugo Fix Catheter Strap - extra short (up to 35cm) Box of 5 Case of 50 3002 FSS1068 393-3389 Ugo Fix Catheter Strap - short (up to 45cm) Box of 5 Case of 50 3003 FSS1069 393-3397 Ugo Fix Catheter Strap - medium (up to 80cm) Box of 5 Case of 50 3009 FSS1070 393-3405 Ugo Fix Catheter Strap - long (up to 130cm) Box of 5 Case of 50 3010 N/A 393-3413 Ugo Fix Catheter Strap - extra long (up to 180cm) Box of 5 Case of 50 OM Code PIP Code Description Inner Pack Outer Pack 3005 394-0178 Ugo Fix Sleeve - small (24cm-39cm) Box of 4 Case of 80 3006 394-0160 Ugo Fix Sleeve - medium (36cm-55cm) Box of 4 Case of 80 3007 394-0152 Ugo Fix Sleeve - large (40cm-70cm) Box of 4 Case of 80 3008 394-0145 Ugo Fix Sleeve - extra large (65cm-90cm) Box of 4 Case of 80 3000 FSS1067 388-2388 Ugo Catheter Valve Pack of 5 Case of 100 OM Code Description Inner Pack Outer Pack 1128 OptiPure 10ml sterile water pre-filled syringe Box of 20 Case of 200 1131 OptiPure 10ml sterile water pre-filled syringe with10% glycerin Box of 20 Case of 200 CONTENTS Introduction Why do we need to catheterise someone? What is a catheter? Catheter selection Catheter materials Catheter sizes Catheter balloons Catheter tips Catheterisation lubrication Pre catheterisation assessment and consent URETHRAL CATHETERISATION What is urethral catheterisation? Complications and dangers of catheterisation Equipment needed Female catheterisation procedure Male catheterisation procedure SUPRAPUBIC CATHETERISATION What is suprapubic catheterisation? First suprapubic catheter change Subsequent suprapubic catheter changes Who may benefit from a suprapubic catheter? Who may not be suitable for a suprapubic catheter? Complications associated with a suprapubic catheter Equipment needed Suprapubic catheterisation procedure Post-catheterisation documentation Further reading Glossary 2 2 2 3 3 3 4 4 5 5 6 6 6 6 7 10 13 13 13 13 14 14 14 14 15 16 16 17

Introduction Optimum Medical specialises in creating healthcare lubricant gels and urology products. With a clear focus on achieving the best possible outcome for patients, we re always listening to our customers. We want to ensure the professionals who use our products make the most of them - which is why we have developed this catheterisation training booklet to support you with your education needs and on-going development. This booklet is intended as a guide to accompany our female and male catheterisation animated training DVD. To obtain a copy of the DVD please email marketing@optimummedical.co.uk, or alternatively you can view our selection of animations online at. Both the training booklet and animations are part of our training and education resource called Optimum Medical Support. All health care professionals must refer to their hospital or trust s catheterisation and infection control policies and procedures prior to carrying out a catheterisation. You must also have an understanding of the anatomy and physiology of the urinary system and demonstrate that you are competent to carry out the procedure. Why do we need to catheterise someone? Always question why you are catheterising someone and consider other options for example intermittent catheterisation. Some reasons for catheterisation include: Damage to nervous system which prevents the bladder from emptying Acute or chronic retention of urine due to obstruction During abdominal or pelvic surgery To monitor urine output following major surgery or critical care Investigations Instillation of drugs Maintain comfort and dignity at end of life Intractable incontinence What is a catheter? A catheter is a hollow tube used to drain fluid from the body. The most common catheters used for urinary drainage are indwelling Foley catheters named after Frederick Foley. In 1932 he redesigned a catheter with a self retaining balloon to prevent the catheter from falling out of the bladder. The most widely used indwelling Foley catheters are two way. They re comprised of a hollow cylindrical tube with drainage eyelets, a funnel to attach a drainage bag or valve and a port in which to inflate the balloon. Catheter selection Catheter materials Plastic/PVC For use up to 7 days. PTFE (Polytetrafluroethylene) bonded latex catheter For use up to 28 days. Silicone elastomer coated latex For use up to 12 weeks. Hydrogel coated latex For use up to 12 weeks. 100% silicone catheters For use up to 12 weeks. Catheter sizes The diameter of a catheter is measured in Charrières, also known as French gauge where 1 Charrière is equivalent to a third of a millimetre. Therefore a size 12 catheter is 4mm in diameter. The Charrière size should be written on the catheter and its packaging, and is often abbreviated as Fg, FR, F and sometimes CH or Ch. It s best practice to select the smallest sized catheter to enable adequate urinary drainage. In adults this is most commonly a size 12 or 14 Charrière. The use of larger catheters may cause pain and discomfort and lead to trauma of the urethra. Paediatric - approximately 30cm in length Female Standard - around 23-26cm in length - between 40 and 44cm in length It s imperative that for urethral catheterisation in men only standard length catheters are used. Using a shorter catheter can lead to the balloon being inflated in the prostatic bed and cause haemorrhaging. Children and ladies may prefer to use a longer length catheter for comfort. 2 3

Catheter balloons It s important to follow the manufacturer s instructions in relation to inflating the balloon, as the amount of fluid may vary. Sterile water or glycerine solutions are both suitable for inflating a catheter. Using a glycerine solution to inflate a 100% silicone catheter may prevent the balloon from premature deflation. Over inflation of the balloon may lead to the balloon bursting, causing damage to the bladder. Under inflation of the balloon can cause balloon and catheter tip distortion which may lead to occlusion of the catheter eyelets or irritation to the bladder wall. Cuffing of the balloon can occur after the water has been removed causing pain and trauma to the urethra on removal of the catheter. Cuffing can occur in all catheters but it is most common in 100% silicone catheters. It s important to allow the balloon to deflate without force. OptiPure pre-filled syringes are used for the inflation of Foley indwelling catheter balloons. They re available in two single use formats, one with the added benefit of 10% glycerine solution to reduce water loss from the Foley catheter balloon. They re presented sterile and ready to use with a measuring facility to ensure accurate application of fluid. Catheter tips OM Code Description Inner Pack Outer Pack Foley catheters are available with different tips. The most commonly used is a standard round or bullet tip which is designed to make insertion as easy as possible. A Tiemann tipped catheter has a tapered, curved tip. These are designed to negotiate the prostatic curve but can also be invaluable for commandeering difficult tracts. An open tipped catheter has the tip of the catheter removed which helps urinary drainage if there is sediment or debris present and are sometimes used over a guide wire in difficult catheterisations. 1128 1131 OptiPure 10ml sterile water pre-filled syringe OptiPure 10ml sterile water pre-filled syringe with10% glycerin Box of 20 Case of 200 Box of 20 Case of 200 Catheterisation lubrication Inserting a catheter can be an uncomfortable and potentially traumatic procedure. Discomfort can be reduced by using a single use syringe to administer a sterile water-based lubricating gel which will dilate the urethra and reduce friction from the catheter. So it helps make patients more comfortable during catheter insertion, and reduces the risk of infection. A sterile gel developed for optimum lubrication, OptiLube Active brings the added benefits of a local anaesthetic (Lidocaine 2%) and antiseptic (Chlorhexidine Gluconate 0.25%). Provided in 6ml and 11ml pre-filled sterile syringes each individually wrapped in sterile packaging. 1160 FST652 366-2061 OptiLube Active 6ml syringe Box of 10 Case of 200 1161 FST654 366-2079 OptiLube Active 11ml syringe Box of 10 Case of 200 To give clinicians more choice for catheterisation, we also offer OptiLube sterile lubricating jelly in 6ml and 11ml syringes. The sterile lubricating jelly is water soluble, and has no additional active ingredients so it s ideal for patients with known allergies or contraindications. 1125 FST650 373-4357 OptiLube 6ml syringe Box of 25 Case of 250 1126 FST651 373-4365 OptiLube 11ml syringe Box of 25 Case of 250 Pre-catheterisation assessment and consent Standard round/ Bullet tip Tiemann tip Open tip The patient s welfare must be at the core of all decision making and a full explanation must be given to the patient including the risks and benefits of all options, allowing the opportunity for the patient to ask questions. Informed consent must be obtained prior to the procedure. An assessment must include: Full continence and medical assessment Mobility and dexterity Mental capacity Ongoing catheter management and care Past catheterisations and medical history Medications Allergies Sexual activity Please refer to page 16 for post-catheterisation documentation procedure. 4 5

URETHRAL CATHETERISATION What is urethral catheterisation? Urethral catheterisation is the insertion of a urinary catheter into the bladder through the urethra to drain urine. It may be performed in hospital in acute situations or for short periods (hours or days) following surgery or investigations. It s also performed routinely in the community in patients homes who need a catheter long term (months or years). Complications and dangers of catheterisation Catheterisation is a highly invasive procedure and carries many risks to the patient including death. Other risks include: Urethral trauma, haematuria Urinary tract infection, bacteraemia, septicaemia Bypassing of urine around catheter Urethral stricture formation Encrustation Pain and discomfort Bladder spasm Reduced bladder capacity and muscle tone Catheter blockage Altered body image and sexuality Equipment needed When it s time to carry out the procedure, identify a suitable environment. This may be on the patient s bed or in a clinical treatment area. Make sure you are fully prepared and have everything you require for the procedure. Identify and clean a suitable surface to lay out your equipment, in a hospital setting this is usually a dressing trolley, in a patient s home it may be a tray or similar flat surface. Female catheterisation procedure Preparing to catheterise It s good practice for the patient to bathe or shower prior to the catheterisation procedure. Cover the patient with a sheet to maintain their dignity until you are ready to undertake the procedure. Take the trolley and equipment to the patient, and wash your hands. Put on the apron and open your catheter pack and equipment using a non-touch technique and position a waste bag. Remove the sheet covering the lower half of the body and position a towel or disposable pad under the patient s bottom to protect the bed. Assist the patient into a suitable position for you to carry out the procedure. A supine position is usually best, with knees bent, hips flexed and feet about 60cm apart. Alternatively it may be easier to catheterise the patient with her lying on her side. Carrying out the procedure Wash your hands and put on a pair of sterile gloves. Place a sterile towel between the legs to create a sterile field. Gather the equipment required: A disposable apron 2 pairs of sterile gloves A sterile procedure pack A suitable solution to clean the genital area (check your local policy to make sure you are using an approved solution) Sterile lubricating jelly e.g. OptiLube Active / OptiLube The correct catheter A syringe to remove the existing catheter if needed A syringe with a suitable solution to inflate the balloon e.g. OptiPure A urinary drainage bag or catheter valve e.g. Ugo Catheter Valve, and suitable catheter and leg bag fixation devices e.g. Ugo Fix Gentle, Ugo Fix Catheter Strap, Ugo Fix Sleeve Remember to re-assure the lady and explain each step of the procedure to ease any anxiety she may be feeling. 6 7

Clean the meatal area using a solution according to your local policy, ensuring you work from top to bottom using one swab per wipe to avoid contamination from the vagina and anus, finishing with the urethral meatus. Take hold of the 6ml syringe of lubricating gel and apply a little gel to the meatal opening. The gel sometimes aids identification of the urethra. Gently insert the nozzle of the syringe into the urethra and slowly instil the 6ml of gel. If using a gel with a local anaesthetic, such as OptiLube Active, wait for 3-5 minutes before inserting the catheter. You may have to hold the syringe in place to prevent the gel from leaking out while you wait. Tear off the plastic sleeve at the tip of the catheter, ensuring the tip remains sterile. Part the labia with your non-dominant hand and gently insert the tip of the catheter into the meatus. Gently advance the catheter along the urethra until urine starts to flow. Insert the catheter a further 2-3cm to ensure the catheter is not resting in the bladder neck. If resistance is met at the sphincter, ask the lady to give a little cough or to relax as if they are going to pass urine. Inflate the balloon according to the manufacturer s instructions then withdraw the catheter slightly to ensure the catheter sits at the bladder base. Attach the catheter to a suitable drainage system and ensure the catheter is supported with a catheter fixation device, such as the Ugo Fix Catheter Strap or Ugo Fix Gentle, to minimise the risk of trauma to the urethra and bladder neck. Make sure you clean off any excess gel from the meatal area. Check that the patient is comfortable, and that their leg bag is effectively secured by a fixation device such as the Ugo Fix Sleeve. Help them get dressed if required. Remove your gloves, wash your hands and put on another pair of sterile gloves. Take hold of the catheter in its plastic sleeve and a container to collect the urine (a urine drainage bag may be pre-connected to the funnel). Place the container on the sterile sheet taking care you do not contaminate your gloves and place the funnel end of the catheter in the container. Dispose of the waste materials. Measure the urine drained from the bladder. Dispose of your gloves and wash your hands. Document procedure in patient s notes. 8 9

Male catheterisation procedure Preparing to catheterise It s good practice for the patient to bathe or shower prior to the catheterisation procedure. Cover the patient with a sheet to maintain their dignity until you are ready to undertake the procedure. Take the trolley and equipment to the patient, and wash your hands. Put on the apron and open your procedure pack and equipment using a non-touch technique and position a waste bag. Remove the sheet covering the lower half of the body and position a towel or disposable pad under the patient s bottom to protect the bed. Assist the patient into a suitable position for you to carry out the procedure. Carrying out the procedure Wash your hands and put on a pair of sterile gloves. Place a sterile towel across the thighs and under the penis to create a sterile field (alternatively tear a hole in the centre of the paper towel and pull the penis through). Hold the penis firmly below the glans. Take hold of the 11ml syringe of lubricating gel and apply a little to the meatal opening, then gently insert the nozzle of the syringe into the urethra and slowly instil the 11ml of gel. Apply gentle pressure around the shaft of the penis with the swab in your non-dominant hand to prevent the gel from running out. If using a gel with a local anaesthetic, such as OptiLube Active, wait for 3-5 minutes before inserting the catheter. Remove your gloves, wash your hands again and put on another pair of sterile gloves. Take hold of the catheter in its plastic sleeve and a container to collect the urine. (A urine drainage bag may be pre-connected to the funnel.) Place the container on the sterile sheet taking care not to contaminate your gloves and place the funnel end of the catheter in the container. Tear off the plastic sleeve at the tip of the catheter, ensuring the tip remains sterile. Using a swab, take hold of the penis with your non-dominant hand and retract the foreskin, if present. Clean the meatal area using a solution according to your local policy. Using one swab per wipe to avoid contamination, and finishing with the urethral meatus. Hold the penis upright and apply gentle traction to reduce the curve of the urethra at the peno-scrotal junction. Gently insert the tip of the catheter into the meatus. 10 11

Gently advance the catheter along the urethra until urine starts to flow. Insert the catheter a further 2-3cm to ensure the catheter is not resting in the bladder neck. If resistance is felt at the external sphincter, ask the gentleman to give a small cough or ask him to attempt to pass water to relax the sphincter muscle. If resistance is still felt, this may be due to an enlarged prostate gland. If this happens, carefully withdraw the catheter and seek advice from a physician to prevent damage to the urethra. Inflate the balloon according to the manufacturer s instructions then withdraw the catheter slightly to ensure the catheter sits at the bladder base. Attach the catheter to a suitable drainage system, making sure the catheter is supported with a catheter fixation device, such as the Ugo Fix Catheter Strap or Ugo Fix Gentle, to minimise the risk of trauma to the urethra and bladder neck. Ensure the meatal area and penis are cleaned of any excess gel and the foreskin is repositioned over the glans to prevent paraphimosis. Make sure the patient is comfortable, and that their leg bag is effectively secured by a fixation device such as the Ugo Fix Sleeve. Help them get dressed if required. Dispose of the waste materials. Measure the urine drained from the bladder. Dispose of your gloves and wash your hands. Document procedure in patient s notes. SUPRAPUBIC CATHETERISATION What is suprapubic catheterisation? Suprapubic catheterisation is the insertion of a urinary catheter into the bladder through an artificial tract in the lower abdominal wall, just above the pubic bone. The initial insertion of a suprapubic catheter is done in hospital under local anaesthetic through a small midline incision using a trocar (a sharp surgical instrument). This initial procedure is done when the bladder is distended and often under the guidance of ultrasound. Sometimes suprapubic catheterisation is necessary in acute and chronic conditions when urethral catheterisation is contra indicated or not physically possible. For other examples please see who may benefit from a suprapubic catheter overleaf. First suprapubic catheter change It s important to follow your local policy and procedure for the first and subsequent changes of a suprapubic catheter as it may vary. The initial suprapubic catheter needs to remain in place to allow the artificial cystostomy site to establish and heal depending on local policy this can be 4 to 8 weeks. The first suprapubic catheter change usually takes place in the urology department of a hospital but this may vary according to local policy. Should a patient s initial suprapubic catheter require changing before the planned first change then they should be referred to the hospital urology department. Subsequent suprapubic catheter changes Subsequent uncomplicated suprapubic catheter changes are usually undertaken in the community by a nurse. Never remove a suprapubic catheter unless it is going to be changed immediately or removed permanently 12 13

Who may benefit from a suprapubic catheter? Patients who need a catheter long term may benefit from a suprapubic catheter as an alternative to a urethral catheter for the following reasons: Reduced risk of urethral trauma Easier access for self care if immobile Sexuality Who may not be suitable for a suprapubic catheter? Patients who have the following contraindications may not be suitable for a suprapubic catheter however all patients suitability should be assessed on an individual basis: Undiagnosed haematuria Bladder tumours Obesity Confusion Personal choice Complications associated with a suprapubic catheter Suprapubic catheterisation remains a highly invasive procedure like urethral catheterisation therefore complications remain the same (with exception of urethral trauma and stricture). In addition some patients may be at risk of: Urine leakage from the urethra or around cystostomy site Over granulation of skin around the catheter Inflamed or infected skin tissue around catheter site Catheter balloon cuff formation on catheter removal can cause pain/trauma Closure of cystostomy channel during catheter change if change not swift enough Difficulty accepting altered body image Equipment needed Bladder training with a valve following urological/gynaecological surgery Ascites Blood clotting disorders Small bladder capacity Previous lower abdominal /pelvic surgery or cancer The same equipment is needed for a suprapubic catheterisation as you would need for a urethral catheterisation (see page 6). It s important that you check that the catheter and lubricating gel are both suitable for use in suprapubic catheterisation. Suprapubic catheterisation procedure Suprapubic catheterisation is an aseptic procedure. Prepare your patient, equipment and sterile field as as you would for urethral catheterisation and assist the patient into a comfortable supine position. Removal of catheter Wash and dry your hands, put on an apron and apply a pair of sterile gloves Place a protective towel across the patient s abdomen Clean around the cystostomy site using a solution according to your local policy Attach an empty 10ml syringe to the catheter balloon inflation valve and allow the balloon to fully deflate naturally without force Hold the catheter between your thumb and finger at the skin surface Gently remove the catheter in an upward direction with a slight rotation to assist with the removal of the deflated balloon observe the length of the catheter removed Dispose of the old catheter and gloves Insertion of new catheter It s important the new catheter is inserted without delay to ensure the cystostomy site does not close. Wash and dry your hands and apply a new pair of sterile gloves Clean around the cystostomy site again using a solution according to your local policy Administer a small amount of OptiLube sterile lubricating jelly into the cystostomy site Hold the new catheter between your thumb and finger at the observed length of the catheter which was removed Slowly introduce the catheter via the cystostomy channel and into the bladder at the observed length of the catheter which was removed. Ensure urine drains from the catheter and then advance the catheter a further 2-3cm to ensure the catheter is fully in the bladder Inflate the balloon according to the manufacturer s instructions then withdraw the catheter slightly to ensure the balloon is resting against the bladder wall Clean any excess lubricating gel from the cystostomy site Attach the catheter to a suitable drainage system e.g. Ugo Catheter Valve 3000 FSS1067 388-2388 Ugo Catheter Valve Pack of 5 Case of 100 14 15

Ensure the catheter and drainage system is supported with a catheter fixation device, such as the Ugo Fix Catheter Strap, Ugo Fix Sleeve or Ugo Fix Gentle to minimise the risk of trauma Make sure the patient is comfortable and help them get dressed if required Measure the urine drained from the bladder Dispose of your gloves and wash your hands Document procedure in patient s notes Post-catheterisation documentation Make sure you document the following in the notes after the procedure: The reason for catheterisation The details of the catheter including the make, size, length, batch number and expiry date The details of the fluid used to inflate the balloon, volume, batch number and expiry date The details of the lubricating gel used including type, volume, batch number and expiry date Details of any problems during the catheterisation process The date when the catheter should be reviewed and planned change The amount and description of the urine which drained from the bladder Any other relevant information - for example whether a specimen of urine was take Further reading National Clinical Guideline Centre. 2012. Clinical Guideline 2 Infection: prevention and control of healthcare-associated infections in primary and community care. [PDF] London: National Clinical Guideline Centre. Available at: <http://www.nice.org.uk/nicemedia/live/13684/58654/58654.pdf> [Accessed 19th November 2013]. Loveday, H.P et al. 2014. Epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. The journal of Hospital Infection. 86S1 S1-S70. Available at: http://www.journalofhospitalinfection.com/article/s0195-6701(13)60012-2/abstract [accessed 5th March 2014] Royal College of Nursing, 2012. Catheter care [pdf] Royal College of Nursing. Available at:< http://www.rcn.org.uk/ data/assets/pdf_file/0018/157410/003237.pdf> [Accessed 11the November 2013]. The Association of Safe Aseptic Practice (ASAP) 2011. ANTT Guidelines: The ANTT Clinical Guidelines for Indwelling Urinary Catheterisation. Rationale and supporting evidence.[pdf] The Association of Safe Aseptic Practice (ASAP) Available at: <www.antt.org.uk>[acessed 19th November 2013]. Optimum Medical Solutions, 2014. Training and Education to Optimise Patient Care [online] Available at:<http://optimummedical.co.uk/omsupport/> [Acessed 3rd January 2014]. Mangnall, J. 2012.Optilube Active. The role of Lubricants in urinary catheterisation. British Journal of Community Nursing, 17 (9), p414-420. European Association of Urology, 2012. Catheterisation: Indwelling catheters in adults Urethral and Suprapubic [pdf]. Available at: <http://nurses.uroweb.org/guideline/catheterisation-indwelling-catheters-in-adults-urethral-and-suprapubic > [Accessed on 19.08.2015]. Glossary Aseptic non touch technique (ANTT ): A specific type of aseptic technique with a unique theory and practice framework (www.antt.co.uk). Aseptic techniques : An aseptic technique ensures that only uncontaminated equipment and fluids come into contact with susceptible body sites. It should be used during any clinical procedure that bypasses the body s natural defences. Using the principles of aspepsis minimises the spread of organisms from one person to another. Autonomic dysreflexia: Autonomic dysreflexia, also known as hyperreflexia, is where a stimulus, such as overstretching or irritation of the bladder wall, causes an over-activity of the sympathetic part of the autonomic nervous system resulting in remarkably high blood pressure (often 200mm/Hg systolic). Bacteraemia: The presence of bacteria in the bloodstream. Bacteriuria: The presence of bacteria in the urine with or without associated symptoms of infection. In the absence of symptoms this is referred to as asymptomatic bacteriuria or, in the case of a patient with an indwelling catheter, catheter colonisation. Bare below the elbows: The GDG defined this as not wearing false nails or nail polish when delivering direct patient care. Not wearing a wrist-watch or stoned rings. Healthcare workers garments should be short sleeved or be able to roll or push up sleeves when delivering direct patient care and performing hand decontamination. Bladder instillation: Introducing a sterile therapeutic liquid into the bladder and leaving it there for a variable holding time to dissolve particulates/encrustation, altering ph, or suppressing bacterial growth. Bladder irrigation: The continuous introduction of a sterile fluid into the bladder via a three way catheter to allow for the drainage of blood and debris from the bladder. Bladder washout : The introduction into the bladder of a sterile fluid which is allowed to drain more or less immediately, for the purpose of diluting the bladder contents/unblocking an obstruction to restore free catheter drainage. Blood borne viruses: A virus that is carried in the bloodstream, and transmitted via contact with infected blood e.g. HBV, HCV and HIV. Bodily fluid contamination: Contamination with any bodily fluid which would include urine, faeces, saliva or vomit and could result in transmission of infection. Carer (caregiver): Someone other than a health professional who is involved in caring for a person with a medical condition. Catheter blockage: Blockage either by deposits and encrustations or by mechanical means, such as occlusion of catheter due to kinking of the tube, that prevents urine from draining out of the bladder. Catheter encrustation: Deposits of gritty urine crystals on the catheter tube which can increase the risk of blockage and infection. Catheter valve: A valve connected to the catheter outlet allowing the bladder to be used to store urine. Urine is drained by opening the valve at regular intervals. Catheter-associated Urinary Tract Infection: The occurrence of local, or distant, clinical symptoms or signs attributable to bacteria present either within the urinary tract, or in the bloodstream (with the urinary tract as the source). Infection may arise: either at the time of, or immediately following catheter insertion; or subsequently, because the colonising flora within the catheterised urinary tract becomes invasive (this may occur spontaneously, or follow catheter manipulation). 16 17

Clean procedure: Hands are decontaminated before and after the procedure and key parts are not touched. Clean technique : A technique that is designed to prevent the introduction of microorganisms, but in recognition that the site is already colonised with bacteria it is not aseptic. Non sterile gloves may be used. Clinical effectiveness: The extent to which an intervention produces an overall health benefit in routine clinical practice. Clinician: A healthcare professional providing direct patient care, for example doctor, nurse or physiotherapist. Direct patient care: Hands-on or face-to-face contact with patients. Any physical aspect of the healthcare of a patient, including treatments, self-care, and administration of medication. Evidence: Information on which a decision or guidance is based. Evidence is obtained from a range of sources including randomised controlled trials, observational studies, and expert opinion (of clinical professionals and/or patients). Expert opinion: Opinion derived from seminal works and appraised national and international guidelines. This also includes invited clinical experts. Hand washing: Washing hands with plain (i.e. nonantimicrobial) soap and water. Healthcare-associated infection: Infections that occur as a result of contact with the healthcare system in its widest sense in community and hospital settings. Previously, when most complex healthcare was hospital based, the term hospital acquired (or nosocomial) infection was used. (See Nosocomial infection) Healthcare worker: Any person employed by the health service, social service, local authority or agency to provide care for sick, disabled or elderly people. Hydrophilic catheter: Hydrophilic urinary catheters are coated with a water absorbent polymer. When exposed to water the coating becomes wet and slippery, reducing friction between the catheter surface and the urethral mucosa during insertion. Hydrophilic catheters are sterile and are either packaged with an activated coating (i.e. ready to use) or a dry coating which requires immersion in water for 30 seconds in order to activate the coating. Indwelling (urethral) catheter: A catheter that is inserted into the bladder via the urethra and remains in place for a period of time. Link system: An extension attached to the drainage outlet of the day urine collection bag and connected to a larger capacity night drainage bag. Long-term catheterisation: The use of a catheter (indwelling or intermittent) for a period greater than 28 days. Night drainage bag: Bags used for overnight urine collection. Nosocomial: Related to hospital or care, e.g., nosocomial infection is a hospital-acquired infection. Personal Protective Equipment (PPE): All equipment which is intended to be worn or held by a person to protect them from risks to health and safety whilst at work. Examples of PPE include gloves, aprons and eye and face protection. Primary care: Healthcare delivered to patients outside hospitals. Primary care covers a range of services provided by general practitioners, nurses, dentists, pharmacists, opticians and other healthcare professionals. Risk assessment: Making a suitable and sufficient assessment of risks. This will involve identifying the hazards (something with the potential to do harm), and evaluating the extent of risks (the likelihood that the harm from a particular hazard is realised); and identifying measures needed to comply with legal requirements. Self-catheterisation: Intermittent self-catheterisation: urinary catheterisation is undertaken by the patient to drain the bladder with the immediate removal of the catheter. Intermittent catheterisation: urinary catheterisation is performed by a carer with the immediate removal of the catheter. Septicaemia: Invasion of the bloodstream by virulent microorganisms (including bacteria, viruses, or fungi) from a focus of infection that is accompanied by acute systemic illness. Also called blood poisoning. Single-use: The medical device/item/equipment is intended to be used on an individual patient during a single procedure and then discarded. The device is not intended to be reprocessed or reused. Single-patient use: Items that can be used several times but are reserved for the use of one patient only. Sterile: Free from any living microorganisms, eg, sterile gloves, sterile catheter. Sterile technique: A technique that prevents any possibility for the transmission of microorganisms. Glossary is an extract from source below: Suprapubic catheter/catheterisation: Suprapubic catheterisation creates a tunnel from the abdominal wall to the bladder. Urine can then be drained directly from the bladder into a bag through a catheter inserted into this tunnel. Symptomatic UTI: An urinary tract infection causing symptoms which may include: dysuria, loin pain, supra pubic tenderness, fever, pyuria and confusion. Transient microorganisms: Micro-organisms acquired on the skin through contact with surfaces. The hostile environment of skin means that they can usually only survive for a short time, but they are readily transferred to other surfaces touched. These can be removed by washing with soap and water or inactivated by alcohol handrub and antiseptic agent. National Clinical Guideline Centre. 2012. Clinical Guideline 2 Infection: prevention and control of healthcare-associated infections in primary and community care. [PDF] London: National Clinical Guideline Centre. Available at: <http://www.nice.org.uk/nicemedia/live/13684/58654/58654.pdf> [Accessed 5th March 2014]. 18 19

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