Systemic and topical antimicrobial agents in the prevention of catheter-associated bacteriuria and its consequences

Bacterial resistance and topical antimicrobial wash products

Current scientific evidence has not shown that a link exists between the use of topical antimicrobial formulations and antiseptic or antibiotic resistance. As a result of the extensive history and varied use of antiseptic products and ingredients, any selective pressure for antibiotic resistance that may be occurring or may be uncovered in the future because of antiseptic use would be expected to be insignificant compared with the selective pressure because of antibiotic use. This review illustrates the effectiveness of topical antimicrobial wash products against antibiotic-resistant and antiseptic-resistant bacteria in use settings as well as the studies performed (antiseptic, deodorant, and oral care) demonstrating the lack of development of resistance in long-term clinical studies. Although these studies illustrate that the use of topical antimicrobial products have not been shown to play a role in the fluctuations of the specific composition or resistance of the skin flora, changes in skin flora have been shown to occur. Based on current knowledge, the benefit from use of topical antimicrobial wash products in combination with standard infection control and personal hygiene practices far outweighs the risk of increased antibiotic resistance.

Development of a catheterised bladder model to evaluate urinary drainage equipment

A catheterised bladder model was developed to examine the design features of urinary drainage bags. The drainage bag of 4 commonly used products was inoculated with either Escherichia coli or Proteus mirabilis. The speed of retrograde contamination towards the "bladder" was determined over 96 h. The effect of lifting the drainage bag above the level of the "bladder" was examined also. Within 4 days micro-organisms were detected in the backflow valves/drip chambers of all products, but contamination had not progressed as far as the catheter. Ps. mirabilis appeared to migrate more rapidly than Esch. coli. Lifting the drainage bag had no effect on the migration of either organism. The implications of these results for clinical practice are discussed.

Effective management of urinary drainage systems in critical care areas

Many invasive procedures are used in the care of critically ill people. These potentially increase the risks of infection which may be fatal, as such patients usually have reduced efficiency of normal defence mechanisms. Urethral catheterisation and continuous urinary drainage is one such procedure which is commonly necessary and is known to carry a considerable risk of urinary tract infections. Effective management should reduce the incidence of these. In some units no rationally-based protocols are available to guide nursing management of urinary drainage and thus minimise this risk. This paper is based on a time-limited literature search undertaken as a basis for producing the guidelines recommended, which are research-based where possible though there is as yet no experimental evidence on some aspects of care.

Indwelling catheterization and related nursing practice

A survey of patients with an indwelling urethral catheter was conducted over a 14-day period in five randomly selected district general hospitals in England. The demographic characteristics of the patients and the types of catheter and urinary drainage bags used were recorded. Observational techniques were used to describe nursing care during meatal cleansing and bag emptying Over the 14-day study period 294 patients were catheterized giving an overall daily incidence of catherization of 11.2 per 1000 of the average daily population. Nurses inserted over 50% of catheters and subsequently maintained all closed urinary drainage systems. The closed system was broken for 42% of patients and only 48% of drainage bags were always observed in the correct position. Techniques aimed at preventing infection were observed more frequently when meatal cleansing was performed separately from daily hygiene. The frequency of hand washing, both before and after meatal cleansing and bag emptying, was low. It is concluded that the procedures and practices involved in the care of the urinary drainage system require re-evaluation and re-emphasis.