Download Preventing Infection in Indwelling Urinary Catheters

Infection Prevention and Control Assurance - Standard Operating
Procedure 17 (IPC SOP 17)
Preventing Infection in Indwelling Urinary Catheters
Why we have a procedure?
To ensure employees of the Black Country Partnership NHS Foundation Trust have a
standard procedure to follow when caring for patients with indwelling urinary catheters.
The Health and Social Care Act 2008: Code of Practice for the NHS for the Prevention and
Control of Healthcare Associated Infections (revised January 2015) stipulates that NHS bodies
must, in relation to preventing and controlling the risk of Health Care Associated Infections
(HCAI), have in place appropriate core policies/procedures. Implementation of this procedure
will contribute to the achievement and compliance with the Act, the NICE and EPIC quality
guidelines in relation to the prevention of Catheter Associated Urinary Tract Infections
(CAUTI).
What overarching policy the procedure links to?

This procedure is supported by the Infection Prevention and Control Assurance Policy
Which services of the trust does this apply to? Where is it in operation?
Group
Mental Health Services
Learning Disabilities Services
Children and Young People Services
Inpatients



Community



Locations
all
all
all
Who does the procedure apply to?
This document applies to all clinical staff employed by or working on behalf of the Black
Country Partnership NHS Foundation Trust caring for patients as part of their role and job
description.
When should the procedure be applied?
Effective prevention and control of healthcare associated infection (HCAI) must be embedded
into everyday practice and applied consistently. Crucial to this are the identification of risk and
the adoption of measures to remove or control such risks for patients who require urinary
catheter devices.
Additional Information/ Associated Documents

Infection Prevention and Control Assurance Policy

Hand Hygiene Policy

Infection Prevention and Control Assurance - Standard Operating Procedure 1 (IPC SOP
1) - Standard Infection Control Precautions
Preventing Infection in Indwelling Urinary Catheters
Page 1 of 15
Version 1.0 April 2016






Infection Prevention and Control Assurance - Standard Operating Procedure 3 (IPC SOP
3) - Surveillance of Infection and Data Collection
Infection Prevention and Control Assurance - Standard Operating Procedure 10 (IPC
SOP 10) - Aseptic Procedures
Epic 3: National evidence based guidelines for preventing healthcare associated
infections in NHS hospitals in England (2014) (section UC1 – UC24)
NICE Quality Standard QS61: Infection Prevention and Control (April 2014)
The Royal Marsden Manual of Clinical Nursing Procedures 9th Edition (Section 5.7 – 5.12
and 10.25)
*NPSA/2009/RRR02 – Rapid Response Report - Female urinary catheters causing
trauma to adult males
Aims
People who need a urinary catheter device will have their risk of infection minimised by the
completion of these specified procedures necessary for the safe insertion and maintenance of
the catheter and its removal as soon as it is no longer needed.
Definitions
Aseptic technique
A method developed to ensure that only uncontaminated
objects/fluids make contact with sterile/susceptible sites. It should
be used during any procedure that by-passes the body’s natural
defences
Catheterisation
A procedure used to insert a urinary catheter into the bladder to
drain and collect the urine
CAUTI
Catheter associated urinary tract infection
Foley catheter
All indwelling urinary catheters are Foley catheters; this simply
means that the catheter has a balloon
French/Charrier size
Catheter diameter is measured in French (Fr) or Charrier (Ch)
units ranging from 6 Fr for children to a 22 Fr for adults
Healthcare Acquired
Infection (HCAI)
Healthcare associated infection (HCAI) refers to infections that
occur as a result of contact with the healthcare system in its widest
sense – from care provided in the patient’s own home, to general
practice, hospital and nursing home care
Insitu
A Latin phrase meaning in place or in position
IPCT
Infection Prevention and Control Team
Risk Assessment
A process used to identify and potential hazards and analyse what
could happen and to identify steps to be taken to reduce or
minimise the risk
Urinary Catheter
A tube which is inserted into the urethra and into the bladder and
remains in place until it is no longer needed
UTI
A urinary tract infection
Long-term urinary
catheter
A urinary catheter designed to stay in the bladder for up to 90 days
Preventing Infection in Indwelling Urinary Catheters
Page 2 of 15
Version 1.0 April 2016
Medium-term urinary
catheters
A urinary catheter designed to stay in the bladder for less than 28
days
Short-term urinary
catheter
A urinary catheter designed to stay in the bladder for up to 7 days
TWOC
Trial without catheter to assess if the patient can pass urine
without the need for a catheter
STATLOCK®
Simpla® Strap
A stabilization device used for securing a urinary
catheter to enhance patient comfort
A stabilization device used for securing a urinary
catheter to enhance patient comfort
Key Principles for Preventing Infections Associated with the use of Urethral Catheters
Consent must be obtained from the individual prior to the procedure of catheterisation, the
nurse must have working knowledge` of how to obtain valid consent and how to confirm that
sufficient information has been provided on which to base this judgment.
Six distinct interventions need to be considered to reduce the risk of infection for patients with
an indwelling urethral catheter insitu:
Intervention 1
Assessing the need for catheterisation - catheterisation should only be used after considering
alternative methods of management. The patient’s clinical need for catheterisation should be
reviewed regularly by the multidisciplinary team (at least weekly) and the urinary catheter
removed as soon as possible. Where necessary the ongoing assessment for the need of the
catheter may require input from a specialist urologist.
The need/reason for catheterisation, as well as details about the insertion, changes and
ongoing care/management must be documented using the standard documentation seen in
Appendix 1.
There is strong association between the duration of catheterisation and the risk of infection –
the longer the catheter is in place the higher the incidence of Catheter Associated Urinary
Tract Infection (CAUTI) and the risk increases 5% for each day of catheterisation.



Only use a short-term indwelling urethral Foley catheter in patients for whom it is
clinically indicated, following assessment of alternative methods and discussion with the
patient
Document the clinical indication(s) for catheterisation, date of insertion, expected
duration, type of catheter and drainage system and planned date of removal
Assess and record reasons for catheterisation every day
Preventing Infection in Indwelling Urinary Catheters
Page 3 of 15
Version 1.0 April 2016

Remove the catheter when no longer clinically indicated and record date/time and reason
for removal (catheter removal procedure see the Royal Marsden Manual of Clinical
Nursing Procedures)
N.B. for patients admitted to an in-patient unit with a urinary catheter already insitu the
assessing nurse must establish the reason the catheter was inserted, when it was inserted
and when it is due to be removed or replaced. This must be documented in the patients care
records using the standard documentation in Appendix 1.
Intervention 2
Selection of catheter type and system - Smaller gauge catheters with a 10ml balloon minimise
urethral trauma, mucosal irritation and residual urine in the bladder – all factors which
predispose to CAUTI. Note there is also a risk of urethral trauma associated with using a
female length catheter in a male patient – this is a never event (see the alert*).






Assess patients’ needs prior to catheterisation in terms of latex allergy, length of catheter
and the French/Charrier size. Short length catheters are generally used for ambulatory
female patients (unless obese or wheelchair bound), which allows for a leg bag to be
worn
A short length catheter must never be used in male patients as this can cause severe
trauma to the prostatic urethra
Select the type of sterile drainage bag and sampling port e.g. urometer, 2L bag, leg bag
etc.
Ensure the patients comfort and dignity is not compromised
Select a catheter that minimises urethral trauma, irritation and patient discomfort and is
appropriate for the anticipated duration of catheterisation e.g. short, medium or long-term
Choose the smallest French/Charrier size catheter that with a 10ml retention balloon in
adults that will drain adequately for its intended use ), e.g. Female 12/14 Fr/Ch, Male
12/14/16 Fr/Ch. (Follow manufacturer’s instructions for paediatric catheters usually 5ml
balloon)
Female
Male
Paediatric
Catheter Size
12/14 Fr/Ch
12/14/16 Fr/Ch
6/8/10/12 Fr/Ch
Catheter Length
Short 23-26cm
Standard 40-44cm
30cm
Balloon Size
10ml
10ml
5ml
Intervention 3
Catheter insertion – urinary catheters must be inserted using sterile equipment and the aseptic
technique.





Catheterisation should only be undertaken by healthcare workers trained and competent
in the procedure – it is usually performed by nurses and doctors following the Royal
Marsden Manual of Clinical Nursing Procedures – Urinary Catheterisation
The urethral meatus should be cleaned with sterile normal saline prior to insertion of the
catheter
An approved lubricant from a sterile single use container must be used to minimise
urethral discomfort, trauma and the risk of infection and should be inserted/retained for 5
minutes before catheter insertion
Only sterile water to be used to inflate the balloon
The catheter must be secured comfortably to reduce risk of further trauma using a
STATLOCK® device or Simpla® Strap. Staff must record on the catheter documentation
the date/time of insertion and type of catheter, procedure used and date due for
review/removal (Appendix 1)
Preventing Infection in Indwelling Urinary Catheters
Page 4 of 15
Version 1.0 April 2016
Intervention 4
Catheter maintenance – maintaining a sterile, continuously closed urinary drainage system is
central to the prevention of CAUTI. The risk reduces from 97% with an open system to 8-15%
when a sterile closed system is used. Breaches in closed system such as unnecessary
emptying, changing of the urinary drainage bag or taking a urine sample, will increase the risk
of CAUTI.

Connect the catheter to a sterile closed urinary drainage bag system with a sampling port

Do not break the connection between the catheter and the urinary drainage bag system
unless clinically indicated

Hands must be decontaminated and clean non-sterile gloves must be worn before
manipulation of the catheter or closed system, including drainage taps. Decontaminate
hands immediately following the removal of gloves

Drainage bags should be changed when necessary according to the manufacturer’s
instructions or the patient’s clinical need

Position the urinary drainage bag below the level of the bladder to prevent back-flow (i.e.
positioned below the level of the bladder)

Drainage bags should be hung on a catheter stand to prevent contact with the floor

Use the sampling port and the aseptic technique to obtain a catheter specimen of urine

Do not allow the urinary drainage bag to fill beyond three-quarters full

Use a separate, clean disposable container for each patient and avoid contact between
the urinary drainage tap and the container when emptying the drainage bag

Do not add antiseptic or antimicrobial solutions to urinary drainage bags or use bladder
maintenance solutions to prevent CAUTIs

Daily routine personal genital hygiene is all that is required for meatal cleansing
Intervention 5
Education of patients, relatives and healthcare workers – it is important that patients, their
relatives and healthcare workers responsible for catheter insertion and management are
educated about infection prevention, signs and symptoms of UTI and how to access expert
help when difficulties arise.


Healthcare workers must be trained and competent in the appropriate use, selection,
insertion, maintenance and removal of indwelling urethral catheters
Ensure patients, relatives and carers are given information regarding the reason for the
catheter and the plan for review and removal
Preventing Infection in Indwelling Urinary Catheters
Page 5 of 15
Version 1.0 April 2016

If discharged with a catheter the patient should be given written information and shown
how to:
- Manage the catheter and drainage system
- Minimise the risk of UTI
- Obtain additional supplies suitable for the individuals needs
- Be referred to GP/community services as required for review and follow up
ideally with a catheter passport which provides all the essential information
(see Appendix 2)
Intervention 6
System interventions for reducing the risk of infection – Catheterised patients should be
encouraged to have a good fluid intake of at least 2 litres per day to discourage infection.
For surveillance, monitoring and audit purposes, all patients with an indwelling urinary catheter
insitu should be notified to the Infection Prevention and Control Team. This will enable the
team to monitor and advise on individual patient management in order to reduce the risks of
CAUTI and ensure:

Audit and feedback of compliance with practice guidelines

Audit and feedback of compliance with catheter insertion and maintenance
documentation

Continuing professional education
Other Considerations
Removal/Changing

All indwelling urinary catheters must have the balloon deflated prior to removal. The
water is removed from the balloon using a syringe fitted into the catheter valve. Care
needs to be taken to avoid violent suction, which will collapse the inflation channel
making deflation of the balloon difficult. (See the Royal Marsden Manual of Clinical
Nursing Procedures section 5.12)

The catheter must be removed slowly to minimise trauma

Catheters should only be changed when clinically necessary, not exceeding the
manufacturers recommendations

No patient should be discharged or transferred to/from any in-patient unit with a catheter
insitu without a management plan and catheter passport/documentation (see Appendix
1 and 2)
Choice of Drainage Systems
The choice of drainage system must be dictated by the intended duration, patient mobility and
dexterity and patient choice.
Closed System Drainage
In order to prevent infection, the connection between the catheter and urinary drainage system
is not broken except for good clinical reasons e.g. changing the bag in line with the
manufacturer’s recommendations. Changing the drainage bag is usually recommended every
7 days according to the manufacturer’s instructions or sooner if clinically indicated.
When a leg bag is not suitable for use e.g. end of life care, a large drainable bag should be
used to create a continual circuit and increase collection capacity.
Preventing Infection in Indwelling Urinary Catheters
Page 6 of 15
Version 1.0 April 2016
Leg Bags
Together, the catheter, leg bag and night bags form a continuous circuit known as a total
‘closed link’ drainage system. This not only facilitates overnight drainage but also keeps the
original system in tact thereby preventing bacteria getting into the system. The night drainage
bag should always be positioned below the level of the bladder and be attached to a
supporting stand to avoid contact with the floor.







Ambulant patients will probably prefer leg bags. These are available in 350, 500 and
750ml volumes with short, medium or long tubing
Leg bags are usually worn by women on the thigh and by men on the calf so selecting
the correct type of equipment is essential
Choose a length that will prevent kinking or dragging of the catheter and tubing
Attachment of leg bags may be either with straps or a leg bag sleeve. The bags should
have a drainage tap (lever type) to facilitate emptying
At night a night bag will be required, when in hospital a single use disposable night bag
must be used. The leg bag is not disconnected from the catheter unless it is due for
change (usually every 7days in accordance with the manufacturer’s instruction)
It is important that the night bag is attached using the ‘closed system’ technique e.g.
attached to the leg bag and the valve on the leg bag opened to allow free drainage
The night bag is removed and discarded in the morning ensuring the leg bag valve is
closed
See Appendix 3 for details of the procedure.
Discharge of Patients with an Indwelling Urinary Catheter

No patient should be discharged or transferred with an indwelling urethral catheter
without a plan documenting their:
- Reason for a catheter
- Clinical reasons for continuing catheterisation
- Date of removal or review by an appropriate professional overseeing their
care
See Appendix 2
Obtaining a Catheter Specimen of Urine (CSU)
Patients with an indwelling urinary catheter insitu have an increased risk of developing a
urinary tract infection. The process of obtaining a sample of urine from a patient with an
indwelling urinary catheter must be obtained from a sampling port. The sampling port is
usually situated in the drainage tubing proximal to the collection bag which ensures the
freshest sample possible. The use of drainage systems without a sampling port should be
avoided.
Preventing Infection in Indwelling Urinary Catheters
Page 7 of 15
Version 1.0 April 2016
The procedure for obtaining a CSU can be found in the Royal Marsden Manual of Clinical
Nursing Procedures section 10.25.
Where do I go for further advice or information?




Infection Prevention and Control Team
Physical Health Matron
Your Service Manager, Matron, General Manager, Head of Nursing, Group Director
Your Group Governance Staff
Training
Staff may receive training in relation to this procedure, where it is identified in their appraisal
as part of the specific development needs for their role and responsibilities. Please refer to the
Trust’s Mandatory and Risk Management Training Needs Analysis for further details on
training requirements, target audiences and update frequencies.
Monitoring / Review of this Procedure
In the event of planned change in the process(es) described within this document or an
incident involving the described process(es) within the review cycle, this SOP will be reviewed
and revised as necessary to maintain its accuracy and effectiveness.
Equality Impact Assessment
Please refer to overarching policy
Data Protection Act and Freedom of Information Act
Please refer to overarching policy.
Preventing Infection in Indwelling Urinary Catheters
Page 8 of 15
Version 1.0 April 2016
Appendix 1
Urinary Catheter Care Pathway
(3 pages)
To be completed for all patients/clients with a urinary catheter insitu and retained in the patients records.
Short-term catheters = up to 7 days
Medium-term catheters = up to 28 days
Patient details: affix documentation identification
Long-term catheters = up to 90 days
1. Admitted with a catheter YES/NO
2. Insertion Date:
Reason for catheterisation: (please circle below):
label
Name:
Retention of
Fluid
urine
monitoring
Other reason please specify:
Address:
NHS Number:
Residual urine in mls:
DOB:
Dipstick test:
Pressure sore
management
Urologists
decision
Latex or other allergy (detail below):
(if latex suggest silicone catheter)
3. CATHETER CHOICE (please detail below):
Brand: e.g. Bard
Type:
e.g. latex,
silicone, silver etc.
Size:
e.g. 14Fg
Male/Female/
Paed:
Catalogue No:
Other:
4. INSERTION TECHNIQUE (please detail each of the 9 steps below  box): NB all 9 steps recommended
Procedure
Yes
No
1. Hand Hygiene
2. Explain procedure to patient
3. Facial protection (only if risk of
splash injury)
Procedure
Yes
No
1. Sterile gloves
2. Urethral meatus clean (use
0.9% normal saline)
3. Instillagel used
Catheter Sticker
(Found on packaging)
Batch No:
4. Disposable apron
4. Aseptic technique followed
5. Sterile field
5. Number of mls of sterile water used to inflate balloon ………………..
Batch No:
Signed:
Print Name:
Who inserted catheter? (circle one) RGN/RMN/HO/SHO/Registrar/Consultant/Student Nurse/Med Student/other:
5. CATHETER DUE DATE CHANGE/REMOVAL (this will depend on type of catheter used see manufacturer guide):
Give details:
6. PATIENT EDUCATION RE: CATHETER CARE
YES
NO
1. Hand Hygiene – how and the importance prior to handling catheter/equipment
2. Daily catheter hygiene - how and the importance
3. Correct position for catheter bag drainage and avoiding kinks to tubing (below hip/bladder)
4. How to attach a leg bag and secure to leg to prevent pulling (STATLOCK® or Simpla® strap)
5.
6.
7.
8.
Male Catheter
Female Catheter
How to attach a catheter drainage bag
How to clean the spout before and after emptying
How to empty without contaminating the drainage spout
Signs of infection what to look for (offensive smell and/or cloudy urine, pain, temperature,
increasing confusion)
9. How much to drink – importance of fluid intake
10. How and when – the frequency for changing the drainage bag and when the catheter is
due for review – using the catheter passport
Patient Sign:
Nurse sign/print
7. Give details of catheter equipment in use e.g. name/make and order codes
Preventing Infection in Indwelling Urinary Catheters
Page 9 of 15
Version 1.0 April 2016
o
Catheter type
o
Leg bag
o
Closed circuit drainage bag
o
Catheter stand
o
Leg straps (STATLOCK® or Simpla® strap)
o
Other (specify)
8. CATHETER SPECIMEN OF URINE (CSU) send CSU on insertion if leucocytes present
Generally CSU’s are ONLY to be taken if there are signs of infection – use red top universal container
Date
UTI
suspected
Yes
If YES please state
symptoms
No
Sample taken
aseptically from
catheter sample
port
Yes
Lab Results
Treatment
No
9. URINARY CATHETER CARE PATHWAY – enter Y for Yes, N for No or NA or V for Variance – for any N or
V please record in section 10 and actions taken to reduce risks
Day/Date
Mon
Tue
Wed Thur
Fri
Sat
Sun
DD/MM/YY
1. Is the catheter still needed?
2. Single use gloves have been worn for all catheter
interventions preceded and followed by hand
hygiene.
3. Urethral meatal hygiene has been included as part
of daily genitalia hygiene care
4. Catheter circuit remains unbroken (except for good
clinical reason)
5. If the patient is mobile a leg bag is used
6. When a leg bag is in use at night a closed circuit
bag is attached and the leg bag valve is opened and
the overnight bag is discarded after each use (inpatients discard after each use, community patients can be
used up to 7 days as per the manufacturer’s instructions)
7. Leg bags when in use are secured to the patient to
reduce trauma.
8. All leg bags and continuous drainage bags are
dated and changed every 7 days (night bags discarded
after each use)
9. Urine drainage bags are emptied at regular intervals
to prevent backflow (at least 4x daily) and recorded
on fluid balance chart
10. The patient is encouraged to drink at least 2L fluid
every 24hrs and input/output recorded of fluid
balance chart
11. Catheter drainage bags are attached to a hanger
and placed 30cms below the bladder and the
drainage bag is off the floor
12. Colour of urine is observed and appropriate action
taken as required e.g. if urine concentrated, cloudy,
offensive, haematuria etc.
13. The patient is involved in caring for their catheter
Initials of Nurse assessing patients care:
N.B. this document is in addition to the individual’s care plan
Preventing Infection in Indwelling Urinary Catheters
Page 10 of 15
Version 1.0 April 2016
Continuation sheet use as required – Urinary Catheter Care Pathway
Date due for removal/change:
Day/Date Mon Tue Wed Thur Fri
Sat Sun Mon Tue
Wed Thur
Fri
Sat
DD/MM/YY
1. Is the catheter still needed?
2. Single use gloves have been worn for all catheter
interventions preceded and followed by hand
hygiene.
3. Urethral meatal hygiene has been included as part
of daily genitalia hygiene care
4. Catheter circuit remains unbroken (except for good
clinical reason)
5. If the patient is mobile a leg bag is used
6. When a leg bag is in use at night a closed circuit
bag is attached and the leg bag valve is opened and
the overnight bag is discarded after each use (inpatients discard after each use, community patients can be
used up to 7 days as per the manufacturer’s instructions)
7. Leg bags when in use are secured to the patient to
reduce trauma.
8. All leg bags and continuous drainage bags are
dated and changed every 7 days (night bags discarded
after each use)
9. Urine drainage bags are emptied at regular intervals
to prevent backflow (at least 4x daily) and recorded
on fluid balance chart
10. The patient is encourage to drink at least 2L fluid
every 24hrs and input recorded of fluid balance
chart
11. Catheter drainage bags are attached to a hanger
and placed 30cms below the bladder and the
drainage bag is off the floor
12. Colour of urine is observed and appropriate action
taken as required e.g. if urine concentrated, cloudy,
offensive, haematuria etc.
13. The patient is involved in caring for their catheter
Initials of Nurse assessing patients care:
Preventing Infection in Indwelling Urinary Catheters
Page 11 of 15
Version 1.0 April 2016
Sun
Appendix 2
Please send 2 copies with the patient (1 for the patient and 1 for the GP/District Nurse) - 2 pages
Transfer/Discharge Plan - Urinary Catheter Care Pathway
Patient details: affix documentation identification
Admitted with a catheter insitu:
YES/NO
label
Name:
Catheter Insertion Date:
Address:
Reason for catheterisation:
Type/size catheter
insitu:
Date catheter due for
removal/TWOC:
NHS Number:
DOB:
1. Copy of page 1 of Urinary Catheter Care Pathway included (detailing full insertion records)
Yes/No
2. Give details of catheter equipment in use e.g. name/make and order codes
o
Catheter type
o
Leg bag
o
Closed circuit drainage bag
o
Catheter stand
o
Leg straps (STATLOCK® or Simpla® strap)
o
Lubricating insertion gel
o
Other (specify)
A one week supply of all catheter equipment has been provided circle below:
Catheter
Y N N
A
Leg Bag
Y N N Leg bag
A straps
Y
N
N
A
2L
drainage
bag
Y
N
N
A
Catheter
stand
Y N
Additional information:
3. Contact Details

GP notified patient has a
catheter insitu (give details

date/time/name of contact):
District Nurse notified (give
details date/time/name of contact):


Contact Number:
Date of 1st visit:

Other please specify:
4. Patient/carer are aware how to care for catheter:
Preventing Infection in Indwelling Urinary Catheters
Page 12 of 15
Version 1.0 April 2016
N
A
Patient
Carer (Name):
Yes












No
Hand hygiene
Daily genital hygiene care
How to attach leg bag and secure to
leg to prevent pulling
Correct position for catheter bag
drainage (below bladder)
Preventing kinks to catheter and
tubing
How to empty leg and overnight
drainage bags without
contaminating the spout
How to clean the spout before/after
emptying the bags
How to dispose of equipment
How to attach drainage bag to the
catheter stand
How and when to replace the
drainage bag
How much to drink
Signs of infection (offensive cloudy urine,
Yes












pain, high temperature, confusion)

Who to call for help and contact
numbers
No
Hand hygiene
Daily genital hygiene care
How to attach leg bag and secure to
leg to prevent pulling
Correct position for catheter bag
drainage (below bladder)
Preventing kinks to catheter and
tubing
How to empty leg and overnight
drainage bags without contaminating
the spout
How to clean the spout before/after
emptying the bags
How to dispose of equipment
How to attach drainage bag to the
catheter stand
How and when to replace the
drainage bag
How much to drink
Signs of infection (offensive cloudy urine,
pain, high temperature, confusion)

Who to call for help and contact
numbers
5. Do’s and Don’ts
DO…..

Remember to drink plenty of fluids unless informed
fluids are restricted for medical reasons – ideally drink
2 litres/day

Always wash your hands with soap and water before
touching/emptying your catheter.

Clean the area around the catheter daily with
unperfumed soap/water. Men should be sure to wash
under their foreskin.

Night urine drainage bags should be positioned below
the level of the bladder and not be in contact with the
floor. A catheter stand should be used to support this.

Catheter tubing should be fixed to the leg to avoid
kinking of the tubing and pulling of the bladder neck.

Take regular exercise but avoid anything too vigorous,
ensure your catheter is well supported before any
exercise.
DON’T…….

Don’t disconnect the leg bag unnecessarily or touch
the end of the connector or this can lead to infection.

Don’t use oil based creams or talcum powder around
the catheter area.
6. Call a healthcare professional if:

No urine or very little urine is flowing into the collection
bag and you feel your bladder is full

The insertion site becomes very irritated, swollen, red
or tender

You have new pain in your abdomen, pelvis, legs or
back

Your urine has a foul odour (smell)


Urine is leaking from the insertion site
Your urine has changed colour, is very cloudy, looks
bloody or has large blood clots in it

You have a fever

You develop nausea, vomiting or feel unwell.
Preventing Infection in Indwelling Urinary Catheters
Page 13 of 15
Version 1.0 April 2016
Appendix 3
Attaching and Disconnecting the Night Drainage System
Attaching the Night Drainage Bag
1. Wash your hands thoroughly noting the areas frequently missed and put on gloves. (See
hand hygiene policy). Note: Patients managing their own catheters, and their carers, must be
educated about the need for hand decontamination before and after manipulation of the
catheter and drainage bag
2. Remove protective cap from the disposable, single use, non-drainable/drainable 2 litre night
bag
3. Insert night bag connector firmly into the outlet drainage tube of the leg bag
4. Remove leg bag fixation straps or leg bag support sleeve to allow free drainage of urine.
5. Open leg bag tap or valve tap to allow urine to flow into the 2 litre non-drainable/drainable
collection bag
6. Secure the 2 litre non-drainable/drainable night bag on to a supporting stand and ensure that
it is positioned lower than the bladder to assist free drainage and prevent backflow of urine,
see diagram below
7. Ensure that the catheter is never pulled by any drainage bag
8. Remove gloves and wash hands
Disconnecting the Night Drainage Bag
1. Wash your hands thoroughly and put on gloves. Note: Patients managing their own catheters,
and their carers, must be educated about the need for hand decontamination before and after
manipulation of the catheter and drainage bag.
2. Close the tap on the leg bag or on the catheter valve.
3. Disconnect the non-drainable/drainable urine collection bag from the leg bag or catheter
valve.
4. Empty the urine from the bag and discard as clinical waste.
5. Secure the leg bag on to the thigh or calf using fixation straps or a leg bag support sleeve.
6. Remove gloves and wash hands
Preventing Infection in Indwelling Urinary Catheters
Page 14 of 15
Version 1.0 April 2016
Standard Operating Procedure Details
Unique Identifier for this SOP is
BCPFT-COI-POL-05-17
State if SOP is New or Revised
New
Policy Category
Control of Infection
Executive Director
whose portfolio this SOP comes under
Policy Lead/Author
Job titles only
Executive Director of Nursing, AHPs and
Governance
Infection Prevention and Control Team
Committee/Group Responsible for
Approval of this SOP
Infection Prevention and Control Committee
Month/year consultation process
completed
April 2015
Month/year SOP was approved
April 2016
Next review due
April 2019
Disclosure Status
‘B’ can be disclosed to patients and the public
Review and Amendment History
Version
Date
Description of Change
1.0
Apr
2016
New Procedure established to supplement Infection Control
Assurance Policy
Preventing Infection in Indwelling Urinary Catheters
Page 15 of 15
Version 1.0 April 2016