Novel surface biochemical modifications of urinary catheters to prevent catheter-associated urinary tract infections

More than 70% of hospital-acquired urinary tract infections are related to urinary catheters, which are commonly used for the treatment of about 20% of hospitalized patients. Urinary catheters are used to drain the bladder if there is an obstruction in the tube that carries urine out of the bladder (urethra). During catheter-associated urinary tract infections, microorganisms rise up in the urinary tract and reach the bladder, and cause infections. Various materials are used to fabricate urinary catheters such as silicone, polyurethane, and latex. These materials allow bacteria and fungi to develop colonies on their inner and outer surfaces, leading to bacteriuria or other infections. Urinary catheters could be modified to exert antibacterial and antifungal effects. Although so many research have been conducted over the past years on the fabrication of antibacterial and antifouling catheters, an ideal catheter needs to be developed for long-term catheterization of more than a month. In this review, we are going to introduce the recent advances in fabricating antibacterial materials to prevent catheter-associated urinary tract infections, such as nanoparticles, antibiotics, chemical compounds, antimicrobial peptides, bacteriophages, and plant extracts.

Implementation of a patient-held urinary catheter passport to improve catheter management, by prompting for early removal and enhancing patient compliance

Over the past few years a number of strategic initiatives to improve catheter management and reduce associated infections have been introduced. This paper details the introduction of a patient-held catheter passport and an improved documentation record using the PDSA (Plan, Do, Study, Act) cycle of change implementation in one large acute National Health Service (NHS) trust and local health economy (NHS Institute for Innovation and Improvement, 2008).

The effects of a catheter clamping protocol on bladder function in neurosurgical patients: a controlled trial

There is scant evidence-based literature on the best strategies for short-term urinary catheter removal. This clinical trial explored the effects of an early urinary catheter clamping protocol on bladder function in neurosurgical patients. Eligible patients were divided into observation and control groups. Those in the observation group had their catheter clamped postoperatively on return to the ward and unclamped at dedicated intervals. The control group received standard care; the catheter was on free drainage during the entire time in situ. The mean catheter indwelling time was 2.6 days. Compared with the control group, the observation group experienced shorter time to first postoperative urination, less residual urine volume and better subjective perception during their first postoperative urination. For patients undergoing neurosurgery and associated short-term indwelling urinary catheterization, an early catheter clamping protocol is effective in facilitating bladder function, reducing the rate of dysuria and making patients feel more comfortable after catheter removal.

Catheter valves: a welcome alternative to leg bags

Catheterisation is commonly used to manage long-term bladder drainage. If intermittent catheterisation is not possible an indwelling urethral or suprapubic catheter will be used. There are a choice of drainage systems for use with indwelling urinary catheters including bed bags, link systems and catheter valves. Catheter valves are not suitable for everybody and patient assessment is vital: only patients with the cognitive ability and manual dexterity to operate a valve should be offered this option for bladder drainage. Catheter valves offer a number of advantages over drainage bags including improved privacy and dignity, prevention of bladder-neck trauma, reduced catheter encrustation and maintenance of normal detrusor muscle function. A number of catheter valves are available, including the EZ-Flow valve, and patient choice is important when selecting an appropriate product.

Addressing the problems of long-term urethral catheterization: part 2

This is the second of a two-part article and addresses the problems encountered throughout the life of a catheter from those relating to its insertion, through the time when it is in situ, to those associated with its removal. Catheters can cause discomfort and reasons for this are discussed including latex allergy, atrophic changes in women, blockage or bypass. The draft National Institute for Health and Clinical Excellence infection control guidance is discussed with reference to catheter maintenance solutions. Sexuality can be an unvoiced concern to patients with catheters in situ and clinicians are encouraged to discuss such issues with the patient, where relevant. Issues including catheter expulsion, bladder spasm and difficulties in catheter removal, including the non-deflating balloon and cuffing are addressed. The article concludes that although every patient is an individual with a unique set of problems, learning how to address one series of difficulties will help when dealing with subsequent challenges.

The need for best practice in catheterization

Catheterization is a common procedure undertaken hundreds of times every day in a variety of healthcare settings. It is estimated that approximately 25% of the 9 million adults treated by the NHS every year will be catheterized at some point (Nazarko, 2009). The majority of these catheterizations are performed by nurses and nursing students. As this is such a common procedure, it is very easy to become complacent and blasé, yet this is one of the most intimate procedures that we, as nurses, can carry out.