Quality statement 4: Urinary catheters

Quality statement

People who need a urinary catheter have their risk of infection minimised by the completion of specified procedures necessary for the safe insertion and maintenance of the catheter and its removal as soon as it is no longer needed.

Rationale

Catheter-associated urinary tract infections comprise a large proportion of healthcare-associated infections, and can occur whether a person has either a short-term or a long-term catheter. There is a strong association between duration of urinary catheterisation and risk of infection, and catheters are sometimes inserted inappropriately or there is a delay in removing them. This risk is greatly reduced by complying with all parts of the process for safe catheter insertion, maintenance and removal as soon as it is no longer needed. This is important in terms of both infection prevention and patient comfort and experience.

Quality measures

Structure

Evidence of a written protocol to ensure that people who need a urinary catheter have their risk of infection minimised by the completion of specified procedures necessary for the safe insertion and maintenance of the catheter and its removal as soon as it is no longer needed.

Data source: Local data collection.

Process

a) Proportion of people with a short-term urinary catheter who had their risk of infection minimised by the completion of specified procedures necessary for the safe insertion and maintenance of the catheter and its removal as soon as it is no longer needed.

Numerator – the number of people in the denominator for whom all of the specified procedures were completed for the safe insertion and maintenance of the catheter and its removal as soon as it is no longer needed.

Denominator – the number of people who have had a short-term urinary catheter.

Data source: Local data collection.

b) Proportion of people with a long-term urinary catheter who had their risk of infection minimised by the completion of specified procedures necessary for the safe insertion and maintenance of the catheter and its removal as soon as it is no longer needed.

Numerator – the number of people in the denominator for whom all of the specified procedures were completed for the safe insertion and maintenance of the catheter and its removal as soon as it is no longer needed were completed.

Denominator – the number of people who have had a long-term urinary catheter.

Data source: Local data collection. Audit standards on catheter maintenance are contained in NICE clinical guideline 139 clinical audit tool – catheter maintenance.

Outcome

a) Incidence of healthcare-associated infection.

Data source: 2014/15 NHS Outcomes Framework indicator 5.2 and 2014/15 CCG Outcome Indicator Set indicators 5.3 and 5.4 measure incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile. Data are derived from the mandatory reporting of healthcare-associated infections to Public Health England, which are published by Public Health England and also reported by the Health and Social Care Information Centre through their Indicator Portal.

b) Incidence of catheter-associated urinary tract infection.

Data source: Local data collection. Health and Social Care Information Centre NHS safety thermometer.

What the quality statement means for service providers, healthcare workers and commissioners

Service providers ensure that systems and facilities are in place to enable staff to complete specified procedures necessary for the safe insertion and maintenance of the catheter and its removal as soon as it is no longer needed, in order to minimise the risk of infection.

Healthcare workers ensure that they complete specified procedures necessary for the safe insertion and maintenance of the catheter and its removal as soon as it is no longer needed, in order to minimise the risk of infection.

Commissioners ensure that they commission services in which specified procedures necessary for the safe insertion and maintenance of the catheter and its removal as soon as it is no longer needed are completed, in order to minimise the risk of infection.

What the quality statement means for patients, service users and carers

People who need a urinary catheter have their risk of infection minimised by healthcare workers carrying out procedures to make sure that the catheter is inserted, looked after and removed correctly and safely. These procedures include things like cleaning hands, using a lubricant when inserting the catheter, emptying the drainage bag when necessary, and removing the catheter as soon as it is no longer needed. A urinary catheter is a thin flexible tube used to drain urine from the bladder.

Definitions of terms used in this quality statement

Urinary catheter

A urinary catheter is a catheter that is inserted in the urethra and remains in place until it is no longer needed. Both short-term (used for 28 days or less) and long-term (used for more than 28 days) urinary catheters are used. [Adapted from NICE clinical guideline 139 – full version and epic3: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England]

Specified procedures necessary for the safe insertion, maintenance and appropriate removal of urinary catheters

Assessing the need for catheterisation
  • Catheterisation should be used only after considering alternative methods of management. The person's clinical need for catheterisation should be reviewed regularly and the urinary catheter removed as soon as possible. The need for catheterisation, as well as details about insertion, changes and care should be documented.

Hand hygiene
  • Healthcare workers must decontaminate their hands and wear a new pair of clean, non-sterile gloves before manipulating a person's catheter, and must decontaminate their hands after removing gloves.

Catheter insertion
  • The meatus should be cleaned before the catheter is inserted, in accordance with local guidelines or policy (for example, with sterile normal saline).

  • An appropriate lubricant from a single-use container should be used during catheter insertion to minimise urethral trauma and infection.

Catheter maintenance
  • Indwelling catheters should be connected to a sterile closed urinary drainage system or catheter valve. Healthcare workers should ensure that the connection between the catheter and the urinary drainage system is not broken, except for good clinical reasons (for example, changing the bag in line with the manufacturer's recommendations).

  • Urinary drainage bags should be positioned below the level of the bladder, and should not be in contact with the floor. The urinary drainage bag should be emptied frequently enough to maintain urine flow and prevent reflux, and should be changed when clinically indicated. A separate and clean container should be used for each person. Contact between the urinary drainage tap and container should be avoided.

  • Urine samples must be obtained from a sampling port using an aseptic technique.

  • The meatus should be washed daily with soap and water as part of routine daily personal hygiene.

[Adapted from NICE clinical guideline 139 and epic3: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England]