Addressing the problems of long-term urethral catheterization: part 1

This is that first of a two-part article looking at the indications for long-term urethral catheterization and good practice, including the use of aseptic non-touch technique used in insertion, and the choice of catheter length and Charrière size. The various routes that bacteria can take to the bladder are discussed, and the reduction in catheter-associated urinary tract infection (CAUTI) through the use of the closed drainage system is considered. It is essential that adequate information is kept relating to catheter care and catheter insertion; documentation, and what should be recorded in the casenotes is discussed. The article then examines the series of Department of Health initiatives aimed at reducing CAUTIs. Recent safety driving programmes related to the Quality, Innovation, Productivity and Prevention programme, Safety Express, quality indicators, nurse-sensitive outcome measures, high impact actions and Energise for Excellence in Care are more fully discussed. Case studies of areas displaying how their High Impact Actions have made marked improvements in catheter care and the reduction in CAUTI are reported.