Best Practice Guidelines BPG 5 Catheter Care

Transcription

1 Best Practice Guidelines BPG 5 Catheter Care BGP 5 1

2 DOCUMENT STATUS: Reviewed DATE ISSUED: March 2014 DATE TO BE REVIEWED: AMENDMENT HISTORY VERSION DATE AMENDMENT HISTORY V1 March 2014 New Guideline V2 February 2015 Review V3 September 2015 Review REVIEWERS This document has been reviewed by: NAME TITLE/RESPONSIBILITY DATE VERSION Practice Development Group CCG March 2014 V1 Practice Development Group CCG February 2015 V2 Vanessa Whatley Head of Nursing - Infection Prevention RWT 12 th November 2015 V3 APPROVALS This document has been approved by: GROUP/COMMITTEE DATE VERSION Practice Development Group March 2014 V1 Quality & Safety Committee March 2014 V2 Practice Development Group 29 th Sept 2015 V3 DISTRIBUTION This document has been distributed to: Distributed To: Care and Nursing Home Staff and Managers Distributed by/when Care Home Managers Development events in April, July, Oct 2015 Paper or Electronic Paper Document Location Resource Folders Care Home Managers Mailshot December 2015 Electronic WCCG Intranet BGP 5 2

3 DOCUMENT STATUS This is a controlled document. Whilst this document may be printed, the electronic version posted on the intranet is the controlled copy. Any printed copies of the document are not controlled. RELATED DOCUMENTS These documents will provide additional information: REF NUMBER DOCUMENT REFERENCE NUMBER TITLE 1. BPG 1 Pressure Ulcer Prevention & Management Final 2. BPG 2 Enteral feeding Final 3. BPG 3 Prevention and Management of Malnutrition Final 4. BPG 4 Infection Prevention Final 5. BPG 6 Aseptic technique Final 6. BPG 7 VTE Final 7. BPG 8 Management and Prevention of Falls Final 8. BPG 9 Medicines Management Final 9. BPG 10 Care Risk Assessment Final 10. BPG 11 Care of the deteriorating Resident Final 11. BPG 12 Care of resident with Diabetes Final 12. BPG 13 Good record Keeping Final VERSION RELATED REFERENCES Links to these documents will provide additional information: REFERENCES Addison R, (1999) Vol 8, No 9, Pgs British Journal of Nursing Department of Health (2007) Saving Lives reducing infection delivering clean safe care. High Impact Intervention No 6 Urinary Catheter Care Bundle. RCN Catheter Care Guidance for Nurses The Royal Marsden Hospital manual of Clinical Practice Loveday HP, Wilson JA, Pratt RJ et al; 2014; epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. NICE; 2012; Healthcare-associated infections: prevention and control in primary and community care: NICE guidelines [CG139] 1.0 Introduction The complication of infection in a catheterised resident is a serious issue which can lead to increased morbidity and mortality and contribute to the evolving development of multi-resistant infection and an ever-diminishing range of antibiotics to treat them. It is imperative that the critical topic of infection prevention and control becomes part of all catheter care education. BGP 5 3

4 Refer to local infection prevention and control policy regarding the use of personal protective equipment (PPE). Gloves must be worn when in contact with body fluids such as urine, pus and blood (Addison, 1999). What you need to know: knowledge of the causes of urinary tract infection from bacteria and how to minimise this in all care settings knowledge of the importance of applying standard precautions for infection control and the potential serious life threatening consequences of poor practice knowledge of when to undertake urinalysis and when to obtain a catheter specimen of urine (CSU) 1.1 Using the guideline This guideline is designed to be used and implemented by care homes (nursing and residential) across Wolverhampton. 1.2 Specialist Advice and Support The Royal Wolverhampton NHS Trust has a dedicated Continence Care Team who are able to advise on risks associated with urinary catheters as are the Infection Prevention Team and Tissue Viability Team all of whom are accessible to the Care Home. The Clinical Commissioning Group (CCG) has a dedicated Quality Nurse Advisor Team who will support the implementation of this guideline and can offer specialist advice for any specific queries. Contact the Quality Nurse Advisor Team on or WOLCCG.Qualitynurseadvisorteam@nhs.net 1.3 Accountability The guideline applies to all staff in Care Homes to ensure high quality catheter care is delivered. Care Home Managers are responsible for ensuring that the guideline is implemented and that staff follows best practice. In addition, the Care Home Managers must ensure staff access and attend appropriate mandatory training. The accountability for the nursing care delivered in the care home rests with the senior person on duty who may delegate care to the health care assistant so long as they are assured of the care assistant s competency. Healthcare workers should be trained and competent in the appropriate use, selection, insertion, maintenance and removal of short-term indwelling urethral catheters (EPIC 3, 2014). BGP 5 4

5 2.0 Guidance for catheter care Maintaining a sterile, closed system is central to the prevention of infection. Unnecessary emptying or changing of the bag or taking a urine sample can increase the risk of contamination and subsequent infection. 1.1 Indwelling urinary catheters should be used only after alternative methods of management have been considered (NICE, Always connect the urinary catheter to a sterile, closed urinary drainage system. 1.3 Ensure the connection between the catheter and the drainage system is not broken. 1.4 Change the bag in line with manufacturer s instructions. 1.5 Always wash your hands using soap and water prior to and after providing catheter care and always use disposable gloves. (Colley, 1999; Pratt et al., 2006). 1.6 Obtain consent from the patient/resident and inform them you will be supporting them either in washing the area close to where the urinary catheter enters the body, known as the urethral meatus, or ask them if they wish to do this themselves. 1.7 Mental care and observation is best undertaken during daily hygiene practices. Only soap and water are needed to maintain mental hygiene (Pratt et al., 2006). 1.8 Drainage bags with taps must be emptied often enough to maintain urinary flow and prevent reflux. The bag must be placed either as a leg bag or at a point lower than the bladder using a catheter stand; never in the bed. 1.9 Ensure that the catheter bag is no more than 2/3 rd full Clean the catheter tap using an alcohol wipe prior to emptying the catheter bag A separate container must be used for each patient in order to empty the catheter bag and contact between the tap and the container avoided. (EPIC 3, 2014) Drainage bags must be changed when they become discoloured, contain sediment, smell offensive or are damaged. All bags must be changed at least every seven days in line with manufacturer guidelines Never wash urine bags and reconnect them in any care setting Antiseptic or antimicrobial solutions must not be added to drainage bags (EPIC 3, 2014) A link system should be used to facilitate overnight drainage, to keep the original system intact (NICE, 2012). 2.1 General Nursing Principles BGP 5 5

6 Always discuss the need for catheterisation and catheter usage (DH, 2007) with the registered GP. Always review your own competence and challenge others where you have concerns; all staff involved in catheter care must be trained and competent (Pratt et al., 2006). Observation of health care workers delivering catheter care is a high priority within nursing (DH, 2007). Insert the smallest size of catheter necessary to maintain adequate drainage (Royal Marsden). Change the catheter according to manufacturer s guidelines usually 12 weeks. Change the catheter according to manufacturer s guidelines usually 12 weeks for long term catheters. Only use catheters and associated products prescribed for the individual patient. Decontaminate hands and wear a new pair of clean non-sterile gloves before touching each patient s catheter. Decontaminate hands immediately following the removal of gloves (EPIC 3, 2014). 2.2 Obtaining a urine specimen from an indwelling urinary catheter Clinical indicators of a urinary tract infection include; a raised temperature (greater than 37.5 o C, rapid pulse (tachycardia) greater than 88 beats per minute, urine characteristics such as discolouration, strong fishy odour, silt in the tubing or dark urine noted. Medical attention should be sought and a sterile specimen obtained The process of obtaining a sample of urine from a patient or resident with a catheter must be done from the sampling port. The sample must be obtained using aseptic non touch technique (ANTT) (DoH, 2003) Ensure the sampling port is cleaned using an alcohol wipe prior to obtaining a urine sample and allowed to dry or 30 seconds The port is normally situated in the tubing, proximal to the drainage bag which ensures cleanest sample as possible Specimens must not be collected from a tap or from removing the drainage bag A specimen is obtained using a syringe from the port and ensuring the urine is placed in an appropriately labelled specimen pot for collection and the syringe appropriately disposed of. NB: all urine collection bags should have needle free ports for urine specimen collection Document the sample has been obtained in the patients/residents notes Ensure all patient information is written on microbiology request form before sending to Microbiology Laboratory including recent use of antibiotics. BGP 5 6

7 3.0 Dissemination The care home manager is responsible for ensuring this guideline is disseminated to all staff and can evidence that staff have read it. This can be done via team or individual meetings. 4.0 Monitoring Arrangements Implementation will be monitored utilising Wolverhampton CCG quality monitoring framework e.g. Internal audits Quality Indicators returns Quality monitoring visits BGP 5 7