Maintaining sterility of instruments disposable items during a procedure

Policies and Procedures on Infection Control Ministry of Health Malaysia 45

6. Irrigation

Irrigation should be avoided unless obstruction is anticipated, as might occur with bleeding with prostatic or bladder surgery, closed continuous irrigation may be use to prevent obstruction. To relieve obstruction due to clots, mucous or other causes, an intermittent method of flushing may be use. Continuous irrigation of the bladder with antimicrobials has not proven to be useful and should not be perform as a routine infection prevention measures. The catheter tubing junction should be disinfected before disconnection. A large volume and a sterile syringe and sterile irrigant should be used and then discarded. The person performing irrigation should use aseptic technique. If the catheter becomes obstructed and can be kept open only by frequent irrigation, the catheter should be changed since it is likely that the catheter itself is contributing to the obstruction.

7. Specimen collection

If small volumes of fresh urine are needed for examination, the distal end of the catheter, or preferably the sampling port if present, should be cleansed with a disinfectant, and urine then aspirated with a sterile needle and syringe. Larger volume of urine for special analyses should be obtained aseptically from the drainage bag.

8. Urinary flow

Unobstructed flow should be maintained. Occasionally, it is necessary to temporarily obstruct the catheter for specimen collection or other medical purposes. To achieve free flow of urine; • The catheter and collecting tube should be kept from kinking. • The collecting bag should be emptied regularly using a separate clean collecting container for each patient. Change glove for each patient. • Poorly functioning or obstructed catheters should be irrigated or if necessary, replaced. • Collecting bag should always be kept below the level of the bladder. Always hang drainage bag at beside below groin level to allow gravity drainage and maintain unobstructed urine flow. Do not allow urine to flow from bag or tube back into bladder as the flow of urine may be contaminated and can cause urinary tract infection.

9. Meatal care

Catheter care should consist of good personal hygiene around the meatal area carried out a regular basis. Wiping after bowel cleaning should be carried out from front to back to avoid infection.

10. Catheter change interval

Do not change catheters at arbitrary fixed intervals. However to prevent encrustation, non silicone catheter may need to be change 2 or 3 weeks. Change only when necessary, such as when tube is obstructed, discolored etc. Policies and Procedures on Infection Control Ministry of Health Malaysia 46 Catheter should be removed from post operative patients as soon as possible. Indwelling catheterization is preferable to intermittent catheterization for some groups of post operative patients in the reduction of complications.

11. Spatial separation of catheterized patients

Spatially separating infected and uninfected patients with indwelling catheters is not necessary.

12. Bacteriologic monitoring

Regular bacteriologic monitoring of catheterized patients as an infection control measure is not recommended.