Prevention Strategies - Intermittent Catheters

Adherence to basic daily prevention habits may help avoid UTIs in the higher-risk intermittent catheterization population.  The table below summarizes this information.

The most important prevention measures in preventing a UTI are: 

  • adequate education
  • patient compliance
  • the use of appropriate catheter type and material
  • consistent catheterization technique 

Less frequent catheterization results in higher catheterized urine volumes and places the patient at increased risk for developing a UTI.  More frequent catheterization and the avoidance of bladder overfilling is an extremely important prevention measure.

Catheterization between four and six times a day is recommended for most individuals. More frequent catheterization, however, increases the risk of introducing harmful bacteria.

Another measure that may reduce infection is the acidification of urine with cranberry juice or capsules, foods containing lactobacillus, and vitamin C capsules.

Cranberries inhibit bacterial adherence to the uroepithelial wall and have been primarily studied with Escherichia coli (E. coli). In a community-based survey of patients with a spinal cord injury on intermittent catheterization, it was found that those who ingested cranberry or vitamin C agents decreased their incidence of UTI.

Suggestions for Prevention of UTIs Associated with Intermittent Catheterization

 

Maintenance of hygiene, particularly of the hands and perineum

  1. Hands should be thoroughly washed before attempting catheterization
  2. The genitalia should be washed daily with soap and water and always cleansed from front to back
  3. Preferable to perform catheterization before bowel program to minimize E. coli bacteria contamination of the urethra
  4. Immediate perineal hygiene is recommended after vaginal intercourse  
  5. Avoidance of spermicidal lubricants in sexually active females because these products may lower urethral flora

  2.   Teach male patients the correct positioning of the male urethra during insertion of the catheter to minimize trauma 

  3.   Be careful to avoid touching the tip of the catheter and/or letting it touch other surfaces

  4.   If a postmenopausal female patient has hypoestrogenized perineal tissue, consider transvaginal estrogen medication

  5.   Use a generous amount of lubricant along the length of the catheter, since dry catheters may cause excoriations in the
        urethra, leading to an entry point for bacteria contamination

  6.   Keep the bladder as empty as possible by having patients catheterize at least four to six times a day 
        Keeping the bladder as empty as possible will prevent over-distension of the bladder 

  7.   Encourage use of a new catheter each time performing intermittent catheterization  
        Most catheters are manufactured and packaged for single sterile use

  8.   Acidification of the bladder may prevent bacterial growth 
        In non-catheterizing populations, cranberry capsules and juice have been shown to help prevent the growth of bowel
        bacteria in the urethra and the bladder
        Cranberry ingestion may be contra-indicated in some patients (patients prone to oxalate or uric acid calculi) 
        Cranberry is contraindicated in patients on anticoagulation therapy and should not be recommended to this group
        Lactobacillus in the diet (yogurt) has been shown to prevent E. coli from growing in the urethra
        Hiprex® 1000 mg combined with vitamin C 1000 mg capsules twice daily is thought to acidify urine enough to prevent
        bacterial growth in the bladder and is recommended in patients with recurrent UTIs

References

Hess, M.J., Hess, P.E., Sullivan, M.R., Nee, M., & Yalla, S.V.Evaluation of cranberry tablets for the prevention of urinary tract infections in spinal cord injured patients with neurogenic bladder. Spinal Cord, 2008; 46(9), 622-626. 
Igawa, Y., Wyndaele, J.J., & Nishizawa, O.  Catheterization: Possible complications and their prevention and treatment. International Journal of Urology, 2008; 15(6), 481-485.
Jepson, R.G., & Craig, J.C.  Cranberries for preventing urinary tract infections. Cochrane Database System Review, 2, 2008 CD001321.
Newman, D.K., Fader, M., & Bliss, D.Z. (2004). Managing incontinence using technology, devices and products. Nursing Research, 53(6, Suppl.), S42- S48.
Newman, D.K., & Wein, A.J.  Managing and treating urinary incontinence (2nd ed). 2009 Baltimore: Health Professions Press.
Woodbury M.G., Hayes K.C., & Askes H.K. Intermittent catheterization practices following spinal cord injury: A national survey. Canadian Journal Urology, 2008; 15(3), 4065-4071.
Wyndaele, J.J. Complications of intermittent catheterization: Their prevention and treatment. Spinal Cord, 2002; 40(10), 536-541.
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