1. Medical institutions should improve the rules and regulations, develop and implement the prevention and control of catheter-associated urinary tract infections and operating procedures, and clarify the responsibilities of relevant departments and personnel.
2. Medical personnel should receive training and education on aseptic technique, catheterization, maintenance of indwelling catheters, and catheter-related urinary tract infection prevention, and proficiency in the relevant operating procedures.
3. Medical staff should assess the risk factors for catheter-related urinary tract infections in patients and implement work measures to prevent and control catheter-related urinary tract infections.
4. Medical institutions should gradually carry out targeted monitoring of catheter-related urinary tract infections, continuous improvement, and effective reduction of infection rates. 1. Before catheterization
(1) Strictly grasp the indications for indwelling urinary catheter, avoid unnecessary indwelling catheterization.
(2) Check the sterile catheterization bag carefully, if the catheterization bag is outdated, the outer package is broken or wet, it should not be used.
(3) Choose a catheter of appropriate size and material according to the patient's age, gender, and urethra to minimize urethral injury and urinary tract infection.
(4) For patients with indwelling urinary catheters, a closed drainage device should be used.
(5) Inform the patient of the purpose of indwelling urinary catheter, the key points of cooperation and the precautions after the catheter.
2. When placing the catheter
(1) Medical personnel should strictly follow the Code of Hand Hygiene for Medical Personnel, wash their hands carefully, and then wear sterile gloves to perform urinary catheterization.
(2) Strictly follow the principles of aseptic operation technique to retain the catheter, the action should be gentle, to avoid damage to the mucosa of the urethra.
(3) Correctly spread the sterile towel to avoid contamination of the urethral opening and to maintain the maximum sterile barrier.
(4) Sterilize the urethral opening adequately to prevent contamination. To disinfect the urethral opening and the surrounding skin mucosa using the appropriate disinfectant cotton balls, cotton balls can not be reused. Men: first wash the foreskin and the coronary groove, and then from the urethral opening, glans outward rotating wipe disinfection. Women: first wash the vulva according to the principle of top to bottom, inside to outside, then wash and disinfect the urethral opening, vestibule, both sides of the labia majora and minora, and finally the perineum and anus.
(5) The catheter is inserted at a suitable depth, and after insertion, 10-15 ml of sterile water is injected into the bladder, and the catheter is gently pulled to make sure that it is securely fixed and will not come out.
(6) During catheterization, the patient is instructed to relax and coordinate to avoid contamination, and the catheter should be replaced if it is contaminated.
3. After catheterization
(1) Properly fix the catheter to avoid folding and bending, ensure that the height of the urine collection bag is lower than the level of the bladder, and avoid touching the ground to prevent retrograde infection.
(2) Keep the urine drainage device closed, open and intact, and clip the drainage tube closed when moving or handling to prevent retrograde flow of urine.
(3) The urine collection bag should be emptied in a timely manner using a personalized collection container. When emptying the urine collection bag, follow the principle of aseptic operation and avoid touching the collection container with the outlet of the bag.
(4) When a small amount of urine specimen is retained for microbial pathogenetic testing, the catheter should be sterilized and a sterile syringe should be used to extract the specimen for testing. When retaining a large amount of urine specimen (this method cannot be used for general bacterial and fungal examination), it can be collected from the urine collection bag, avoiding the opening of the interface between the catheter and the urine collection bag.
(5) Bladder irrigation or irrigation with solutions containing disinfectants or antimicrobials should not be routinely used to prevent urinary tract infections.
(6) The urethral opening should be kept clean, and patients with fecal incontinence should also be disinfected after cleaning. The urethral opening should be cleaned or flushed daily while the catheter is in place.
(7) The catheter should be protected when the patient is bathing or scrubbing, and should not be immersed in water.
(8) Patients with long-term indwelling urinary catheters should not change the catheter frequently. If the catheter is blocked or inadvertently dislodged, and if the sterility and tightness of the indwelling catheterization device is disrupted, the catheter should be replaced immediately.
(9) When a patient develops a urinary tract infection, the catheter should be replaced promptly and urine should be retained for microbial pathogenetic testing.
(10) The necessity of indwelling urinary catheter should be evaluated daily, and the catheter should be removed as soon as possible when it is not needed, so as to minimize the duration of indwelling urinary catheter.
(11) Bladder function should be trained when removing a catheter in a patient who has had a catheter in place for a long period of time.
(12) Hand hygiene should be strictly enforced by healthcare workers when maintaining catheters.