/ Indwelling Urinary Catheter Care
Maintenance Bundle for use in the Community /

Version 2

Urinary Catheter Care Maintenance Bundle

Care for catheters individually and aseptically

Urinary Catheter (UC) Care Maintenance Bundle – Standard Operating Procedure
Statement / UCs are used frequently in healthcare delivered in the community, however, their use can lead to serious life-threatening complications. UCs give rise to urinary tract infections and are the second leading cause of blood stream infections. Complications arise directly from their use and in particular if the care is sub-optimal. The risk of infectious complications increases the longer they are in use.
We have a duty to our patients to optimise UC care and to ensure that our UC care does not cause the patients harm. Monitoring our UC care will assist us to optimise procedures, reduce the risk to patients and demonstrate the quality of care we provide.
Objectives / Objectives:
  1. To optimise Urinary Catheter Maintenance procedures in our caseload and thereby minimise the risk of catheter associated urinary tract infections and secondary bacteraemias.
  2. To be able to demonstrate quality UC care in our caseload.

Requirements / Before the UC Bundle Procedure can be Considered
Commitment from the clinical team: Team leader and nurse team to optimising UC care.
Agreement from all Senior Nurses or Clinical Team Leads that named individuals on a weekly/named basis will undertake a UC maintenance bundle, including agreement from the clinical team for the actions within the bundle.
Named individuals competent in performing the bundle as written.
The procedure to complete the bundle is shown overleaf
Procedure /
  1. Perform hand hygiene.
  2. Collect a bundle sheet and complete the top boxes: name, location, etc.
  3. Identify all patients in the case load who have a urinary catheter
  4. Take a bundle form to each patient’s home.
  5. Proceed to the first patient with a urinary catheter (if possible be accompanied by the patient’s nurse).
  6. Introduce yourself to the patient and explain that you are checking all patients with urinary catheters to see if any catheters require to be removed or changed.
  7. To get the bundle data
  8. Confirm from the patient’s documentation that the review date for urinary catheter change has not passed. If no documentation check with the patient’s nurse/doctor whether the urinary catheter requires changing.
  9. Confirm from the patient/carer that the urinary catheter bag has been emptied as required.
  10. Perform hand hygiene
  11. Maintaining the patient’s privacy, ask to see the urinary catheter. Check to see that: the bag is not over full.
  12. Ask the patient if they know what they can do to minimise the risk of infection – if they do not provide the patient with the appropriate information.
  13. Ask the patient/carer/nurse whether the catheter has been disconnected – find out whether the disconnection was appropriate.
  14. Ask the patient/carer/nurse to confirm that all procedures have been performed appropriately. For nurses, confirm that all procedures have been performed aseptically by nurses wearing appropriate PPE.
  15. Confirm with nurses that asepsis has been practiced in all urinary catheter procedures.
  16. Perform hand hygiene.
  17. Record actions in the bundle against the date – make arrangements for removal/renewal of urinary catheter if necessary.
  18. Go to the next patient with a urinary catheter perform hand hygiene and repeat steps 5-9 until all patients with a urinary catheter have been visited..

After care / Complete form and give it to:
Discuss and display the data when it has been returned.
Keep Bundle forms for XX time
Bundle Criteria / Use a single column for each day catheterised patient is assessed. Put a tick  if achieved, or ‘x’ if not achieved, in each box.
Date:
Initials
Review date for urinary catheter change has not passed / 
The UC has been continuously connected to the drainage system and the tap remains closed following emptying, connecting and reconnecting / 
The patient/carer is aware of his/her role in daily personal hygiene to minimise the risk of developing a urinary tract infection, or daily meatal hygiene has been performed by nurses/carer / 
The UC bag is emptied as required into a clean container/ WC / X
Hand hygiene performed before & after procedure / 
Total

Summary Table of UC Maintenance Bundle Findings

/ Total / Comment (if required)
Total number of UCs in situ at start of the Bundle
Total number of UCs removed because they were no longer required.
Total number of UCs which were continuously connected
Total number of patients aware of their role in minimising urinary tract infection
Total number of UCs which have been emptied regularly
Total number of UCs for which all procedures were performed aseptically & individually

All or None Table – Was UC Care Today Optimal

/
Tick if achieved
100% of UCs in situ have not passed their review date
100% of UCs were continuously connected to the drainage system and the tap remained closed following emptying, connection and reconnecting
100% of patients were aware of their role in minimising urinary tract infection
100% of UCs drainage bags were emptied as required
100% of UC procedures were performed aseptically and individually
If all the above were achieved the UC care was optimal

Signature of person completing the UC bundle:

Date bundle completed

Improving process to improve outcome:

Assumes ongoing checks for obstruction or infection of: urine flow; urine clarity, patient discomfort or fever. And the referring of abnormal findings to the medical team. Review date: November 2010