urinary catheterisation

Urinary Catheterisation: Management, Care and Prevention of Infection

Workbookto record your training and personal development

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Acknowledgements

NHS Education for Scotland would like to acknowledge the support received from NHS Health Boards, Health Protection Scotland, Healthcare Improvement Scotland, Infection Prevention Society (Scottish Branch) and the Association for Continence Advice in the development of Urinary Catheterisation: Management, Care and Prevention of Infection e-learning programme and this workbook.

© NHS Education for Scotland 2017 You can copy or reproduce the information in this document for use within

NHSScotland and for non-commercial educational purposes. Use of this document for commercial purposes is permitted only with the written permission of NES.

Urinary Catheterisation: Management, Care and Prevention of Infection 2

Introduction to Urinary Catheterisation Management, Care and Prevention of Infection e-Learning Programme

The NHS Education for Scotland programme is titled Urinary Catheterisation: Care, Management and Prevention of Infection.

Urinary tract infections (UTIs) are the most common infections acquired in hospitals and long-term care facilities, and the major predisposing factor for healthcare-associated UTI is the presence of an indwelling urethral catheter. Research studies have demonstrated that a number of factors may result in a catheter-associated urinary tract infection (CAUTI) including:

• A history of previous catheter use

• The duration the catheter is in situ

• The length of hospital stay prior to catheter insertion

• The reason for and location of catheter insertion (Bryan and Reynolds 1984, Garibaldi et al 1974, Leone et al 2003, Stamm 1991).

In the last point prevalence survey (PPS) carried out in 2016, urinary tract infection (UTI) was the most common healthcare associated infection (HAI) in the acute sector, accounting for 24.5% of all HAI. Similarly, in non-acute hospitals UTI was the most common infection accounting for 39% of HAI (Health Protection Scotland (HPS) 2012: 29, 65).

A prevalence survey in long term care facilities was carried out by (Health Protection Scotland, 2017). The most common type of HAI was UTI accounting for 52.7% of all infections (HPS 2011: 18).


Programme Content

The programme is comprised of seven units outlined below:

Unit 1 Legislation, policy and good practice

Unit 2 Anatomy and physiology of the Urinary Tract System

Unit 3 Indications for Catheterisation

Unit 4 Urinary Catheterisation

Unit 5 Catheter Care and Management

Unit 6 Collecting a Urine Sample and Antibiotic Prescribing

Unit 7 Discharge and transfer of patient/clients with urinary catheters

The time taken to complete the programme will depend on your prior experience, but it is estimated that each unit will take a minimum of one hour.



Target Audience

This programme is suitable for any practitioners working in NHSScotland and Non NHS settings to learn about urinary catheterisation in the context of their own practice.

How to access the programme

Further information on these courses can be found on our HAI website at:

http://www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/healthcare-associated-infections/online-short-courses/urinary-catheterisation.aspx

The course is provided via Learnpro NHS http://nhs.learnprouk.com. If you do not have an account for Learnpro then you will need to register.

Please follow the instructions on the link above. If you have any problems, please consult the Learnpro Registration Process Tip Sheet:

http://www.nes.scot.nhs.uk/education-and-training/by-theme-initiative/healthcare-associated-infections/learnpro.aspx

It is important that you input the correct details and email address.

Once you have entered Learnpro you can find the course you are looking for by clicking on “Learning” and then click “Get More Learning”. The course title in the list is Urinary Catheterisation: Management Care and Prevention of Infection. Simply select the course and click “Save” to add the course to your list.

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Introduction to the Workbook

The purpose of this workbook is to support your learning around Urinary Catheterisation: management, care and prevention of infection. It is a resource where you and your Line Manager/Mentor can assess your current level of knowledge of urinary catheterisation, care management and prevention of infection and from this, agree with your Line Manager/Mentor your developmental needs. This workbook can form part of your personal development plan.

The learning objectives for this e-learning programme are listed below and each of these link to the workbook

• Demonstrate an awareness of legal aspects of urinary catheterisation

• Demonstrate knowledge of anatomy and physiology of male and female urinary systems.

• Identify the reasons for urinary catheterisation

• List complications associated with urinary catheterisation

• Describe the reasons why catheterised patients develop urinary tract infection including host risk factors

• Acknowledge the rationale for the types and size of urinary catheters to be used

• Describe the principles and practice of safe urinary catheter insertion including principles of asepsis

• Understand how to take urine samples and the basic principle of antibiotic prescribing

• Describe the importance of safe and effective discharge



Your details

Complete the spaces below

Name

Designation

Line Manager/Mentor

Organisation

Department

Date Workbook commenced

Date Workbook completed

Your role

(You can use this space to describe the main duties of your job.)

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Completing the Workbook

When all of the relevant sections have been signed by your Line Manager/Mentor you will have completed the Workbook. Your Line Manager/Mentor will complete the course by signing the Statement of Completion to record your achievement. Use this in your Personal Development Plan (PDP) to demonstrate that you have achieved the recognised knowledge and learning outcomes.


How to use this Workbook

The workbook follows each unit in the e-learning programme. In the workbook you will be presented with a case study, clinical scenario or questions which you are required to answer. At the end of the unit is an opportunity for the you to record any learning “ the learner’s reflective account” you feel took place as a result of the content of the e-learning programme and workbook.

There maybe Units in this programme not relevant to your practice/ role in your organisation. This should be discussed with your Line Manager/Mentor and the agreed relevant Units completed.

Your Line Manager/Mentor will help you to work through this workbook and identify areas in which you require further training. Before you start:

1. Consider your current learning needs.

2. Consider the training you have received already.

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Your Line Manager/Mentor will help you to decide how this applies to the knowledge and skills required in this workbook for your current role. The following questions may help you identify the training you have already undertaken in relation to urinary catheterisation and should focus your thoughts on what are your extra needs.

What training courses have you attended?

In the past year?

In the past 5 years?

What qualifications do you have that relate to your role?



Unit 1 Legislation, policy and good practice

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Unit 1 - Legislation, policy and good practice

Learning objectiveDemonstrate an awareness of legal aspects of urinary catheterisation

Why is it important to obtain patient consent prior to catheterisation and could you explain how you would do this?


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2 The Nursing and Midwifery Council provided guidance on record keeping. There are 7 principles of record keeping that must be followed when writing clinical notes. Can you list them below?

Unit 111


All practitioners have a responsibility to keep up to date and prevent skills fade. Explain what actions you can take to keep up to date and prevent skill fade.3

Learner’s reflective account of Unit 1

Signature (learner)

Line Manager/ Mentor

Date / /

Date / /

Unit 112


Unit 2 Anatomy and Physiology of the Urinary System

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Unit 2

Unit 2 - Anatomy and Physiology of the Urinary System

Learning objectiveDemonstrate knowledge of anatomy, physiology of the male and female urinary system.

Please label the diagrams correctly by entering the relevant number

1 Lower Male Urinary Tract System 1 Urethral openings

2 Erectile tissue of penis

3 Trigone

4 Bladder neck

5 Detrusor muscle

6 Internal urethral sphinter

7 Ureter

8 Prostate gland

9 Urogenital diaphragm

10 Membranous urethra

11 Prostate urethra

12 External urethral sphincter

13 External urethral orifice

14 Spongy (penile) urethra

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Unit 2

2 Lower Female Urinary Tract System 1 Parietal peritoneum

2 Urethral openings

3 Internal urethral sphinter

4 Trigone

5 Bladder neck

6 Urogenital diaphragm

7 Detrusor muscle

8 Urethra

9 External urethral orifice

10 Ureter

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Discuss with your Line Manager/ Mentor how you would deal with this when considering urinary catheterisation.4


Signature (learner)


Date / /

Date / /

Unit 216


Unit 3 Indication for Catheterisation

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Unit 3 - Indication for Catheterisation

Learning objectives• The reasons for urinary catheterisation

• List complications associated with urinary catheterisation

• Describe the reasons why catheterised patients develop urinary tract infection including host risk factors


Consider the common indications for urinary catheterisation in your clinical area. Discuss your answer with your Line Manager/Mentor.1

Unit 318


Discuss the factors you would consider when assessing Mrs Niven’s continence difficulties.2a

Unit 3

Case Study

Mrs Niven, 45 years old, has been diagnosed with Multiple Sclerosis. She lives at home with her husband and two teenage children. Mrs Niven is complaining of a feeling of being unable to empty her bladder properly and she often cannot get to the toilet on time due to her limited mobility. She feels these symptoms are having a negative impact on her quality of life.

2

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Following assessment and discussion between practitioner and patient and due to dexterity problems, Mrs Niven decides that she would like to try an indwelling urinary catheter to manage her continence difficulties. Make notes on the information you would give Mrs Niven in order for you to obtain informed consent.

If, when attempting to catheterise Mrs Niven, you are unable to pass the urinary catheter, what action would you take?

2b

2c

Unit 320


Make notes on how you would assess the patient’s suitability for urinary catheterisation3

Unit 3

Case Study

One of your patients is complaining of abdominal pain and an inability to pass urine. The patient is 12 hours post operative.

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Signature (learner)


Date / /

Date / /

Unit 322


Unit 4 Urinary Catheterisation

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Unit 4 - Urinary Catheterisation

Learning objectives• Acknowledge the rationale for the types and size of urinary catheters to be used

• Describe the principles and practice of safe insertion including the principles of asepsis


You have a frail 70 year old patient is suffering from urinary retention requiring long term urinary catheter use. Explain your decision for catheter selection, providing a rationale for your choice? 1

Unit 424


The catheter must be inserted using an aseptic technique to prevent infection. Explain what an aseptic technique entails and what equipment is required to carry out this procedure?

There are a number of contraindications for the insertion of indwelling urinary catheterisation. Can you list five contraindications?

2

3

Unit 425


When selecting a urinary catheter for urethral catheterisation what points should you consider?4


Signature (learner)


Date / /

Date / /

Unit 426


Unit 5 Catheter Care and Management

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Unit 5 - Catheter Care and Management

Learning objective• Demonstrate an understanding of infection control guidance to help prevent urinary tract infections associated

with urinary catheters


Explain the purpose of a trail without catheter procedure and discuss your local procedures for trial without catheters. Please list your answers below:2

Unit 5

Micro-organisms can enter the bladder through four entry points. List the four entry points below?1

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You have been asked to train a new member of staff to empty a urinary drainage bag. List below the procedure you would expect them to follow?3

Unit 529


List the five moments of hand hygiene as devised by the World Health Organisation?4


Signature (learner)


Date / /

Date / /

Unit 530


Unit 6 Collecting a Urine Sample and Antibiotic Prescribing

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Unit 6 - Urine Sampling and Antimicrobial therapy

Learning objective• Understand how to take urine samples and the basic principle of antimicrobial prescribing


Mrs Niven is complaining of feeling “unwell”. Explain the signs and symptoms of a catheter associated urinary tract infection?1

Unit 632


When would you consider it appropriate to obtain a sample of urine ?

Describe the procedure for obtaining a catheter specimen of urine?

2

3

Unit 633


Mrs Niven has been prescribed antibiotics for CAUTI. You are aware that inappropriate prescribing of antibiotic is everybody’s responsibility and this can lead to the development of multi resistant bacteria. Can you list three errors carried out when prescribing antibiotics?

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Signature (learner)


Date / /

Date / /

Unit 634


Unit 7 Discharge and transfer

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Unit 7 - Discharge and transfer

Learning objective• Describe the importance of safe and effective discharge


Explain what information should be completed in Mrs Niven@s Urinary Catheter Care Passport?1

Unit 7

Case Scenario 1

Mrs Niven is ready to be discharged home with an indwelling urethral catheter.

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Mrs Niven should be able to care for her catheter on discharge. This will reduce her risk of infection and promote independence. What are the core elements of patient education are necessary to ensure safe care?2

Unit 737


What information would you need to establish prior to carrying out the supra-pubic catheter change?3

Unit 7

Case Scenario 2

You are working in the community setting and are required to visit a patient at home to change their supra-pubic catheter.

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Signature (learner)


Date / /

Date / /

Unit 739


Continuing your development

Completion of this Workbook is a demonstration of the knowledge and skills you have gained. However, it is important that you continue to develop these and there are a number of ways to do this.

• Observe the practice of an experienced colleague• Familiarise yourself with local and national guidelines;• Explore printed or online sources of information;• Undertake courses such as the ‘Promoting Hand Hygiene in

Healthcare Programme’, to keep update to date with newresearch and evidence in this field

The foundation layer of the Scottish Infection Prevention and Control Education Pathway comprises e-learning modules, printable learning resources, pocket guides, videos, animations, DVDs etc. covering all 10 Standard infection Control Precautions and other introductory IPC topics”. In the second sentence change the word “ course” with “learning resources”. These essential learning resources are aimed at staff and students new to health and social care, but are also suitable for more experienced staff in any setting who want to refresh their knowledge or update their skills. They are aligned with the National Infection Prevention and Control Manual (NIPCM) and provide the foundation for further learning in infection prevention and control.

The aim of the foundation layer is to enable all staff to contribute to a healthcare culture in which patient safety related to infection prevention and control is of the highest importance.

If you are interested in this course your Line Manager will be able to provide you with more information about this. Use this space to plan and monitor further training with your Line Manager/Mentor and to demonstrate your commitment to ongoing learning.

Completion of the Workbook

When all of the relevant sections have been signed you will have completed the Workbook and your Line Manager/ Mentor will sign the Statement of Completion to record your achievement. Use this in your Personal Development Plan (PDP) to demonstrate that you have completed the workbook successfully.

You may have identified areas where you can further improve your practice and learning. Discuss this with your Line Manager/Mentor and agree any future learning plan.



Statement of CompletionName of Organisation

Name of Participant

Job Title

Ward/Unit/Department

Date Completed

SignatureLine Manager/ Mentor


Appendix 2 Further Reading and Resources


Appendix 2

Epic. 2001 Guidelines for Preventing Infections Associated with Insertion and Maintenance of Short term Indwelling urethral Catheters in Acute Care. Journal of Hospital Infection, 47 (Supp): S239 – 246.

Healthcare Improvement Scotland (2004). Urinary Catheterisation & Catheter Care. Best Practice Statement. Edinburgh.HIS. Available from www.healthcareimprovementscotland.org/previous_resources/best_practice_statement/urinary_catheterisation__care.aspx.

Institute for Healthcare Improvement (2009). Getting started Kit: Prevent Catheter-Associated Urinary Tract Infections. How-to Guide, USA, IHI Available from http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventCatheterAssociatedUrinaryTractInfection.aspx

Mullings, A., Murdoch, F & Reilly, J. (2011). Catheter associated urinary tract infection within care of elderly facilities: results from a Scottish pilot study. Journal of Infection Prevention, 12, pp. 32 -36.

Health Protection Scotland (2017) Healthcare Associated Infection Annual Report. Available from http://www.hps.scot.nhs.uk/resourcedocument.aspx?id=4089 (Accessed 17 May 2017).

Scottish Urinary Tract Infection Network (SUTIN) NewsletterContact – [email protected] Find out more at: http://www.hps.scot.nhs.uk/haiic/sutin.aspx

National Infection Prevention and Control Manual: http://www.nipcm.scot.nhs.uk. (Accessed 17 May 2017).

Scottish Patient Safety Programme (2017) Catheter Associated Urinary Tract Infection (CAUTI 2017).

Improvement Scotland www.scottishpatientsafetyprogramme.scot.nhs.uk/programmes/acute-adult/cauti (Accessed 18 May 2017).

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http://www.healthcareimprovementscotland.org/previous_resources/best_practice_statement/urinary_catheterisation__care.aspx

http://www.healthcareimprovementscotland.org/previous_resources/best_practice_statement/urinary_catheterisation__care.aspx

http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventCatheterAssociatedUrinaryTractInfection.aspx

http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventCatheterAssociatedUrinaryTractInfection.aspx

http://www.hps.scot.nhs.uk/resourcedocument.aspx?id=4089

http://www.hps.scot.nhs.uk/haiic/sutin.aspx

http://www.nipcm.scot.nhs.uk/

http://www.scottishpatientsafetyprogramme.scot.nhs.uk/programmes/acute-adult/cauti


NHS Education for ScotlandWestport 102West PortEdinburgh EH3 9DN

tel: 0131 656 3200

www.nes.scot.nhs.uk

Published June 2017

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