References

Afinogenova AG, Grabovskaya KB, Kuleshevich EV, Suvorov AN, Afinogenova AG. Effects of biguanides on the formation of streptococcal biofilms using a human embryo skin fibroblast cell culture. Infections in Surgery.. 2011; 1:5-13

Amuthamani R, Subramaniyan A, Kanungo R. Biofilm producing uropathogens and drug resistance: dual foe for patients on urinary catheter. Int J Curr Microbiol Appl Sci.. 2017; 6:(5)326-330 https://doi.org/10.20546/ijcmas.2017.605.036

Ansell T, Harari D. Urinary catheter-related visits to the emergency department and implications for community services. Br J Nurs.. 2017; 26:(9)S4-S11 https://doi.org/10.12968/bjon.2017.26.9.S4

Brill FHH, Gabriel H, Brill H, Klock J-H, Steinmann J, Arndt A. Decolonization potential of 0.02% polyhexanide irrigation solution in urethral catheters under practice-like in vitro conditions. BMC Urology.. 2018; 18:(1) https://doi.org/10.1186/s12894-018-0362-3

Catheter-related urinary tract infection: transmission and pathogens. 2017. https://tinyurl.com/y5h2cr45 (accessed 24 September)

Bou-Antoun S, Davies J, Guy R, Johnson AP, Sheridan EA, Hope RJ. Descriptive epidemiology of Escherichia coli bacteraemia in England, April 2012 to March 2014. Euro Surveill. 2016; 21

Buehlmann M, Bruderer T, Frei R, Widmer AF. Effectiveness of a new decolonisation regimen for eradication of extended-spectrum β-lactamase-producing Enterobacteriaceae. J Hosp Infect.. 2011; 77:(2)113-117 https://doi.org/10.1016/j.jhin.2010.09.022

Cooper FP, Alexander CE, Sinha S, Omar MI. Policies for replacing long-term indwelling urinary catheters in adults. Cochrane Database Syst Rev.. 2016; 7:(7) https://doi.org/10.1002/14651858.CD011115.pub2

Cheshire & Wirral Partnership NHS Foundation Trust. Clinical guideline for the use of a catheter maintenance solution. Clinical service unit: code CC4. 2012. https://tinyurl.com/y67r78wh (accessed 24 September 2020)

Dalton P, Maute C. Odours and incontinence: what does the nose know?. Proc Inst Mech Eng H.. 2019; 233:(1)127-134 https://doi.org/10.1177/0954411918781409

Fortin E, Rocher I, Frenette C, Tremblay C, Quach C. Healthcare-associated bloodstream infections secondary to a urinary focus: the Québec provincial surveillance results. Infect Control Hosp Epidemiol.. 2012; 33:(5)456-462 https://doi.org/10.1086/665323

Evidence-based guidelines for best practice in urological health care. Catheterisation. Indwelling catheters in adults. 2012. https://tinyurl.com/yahxajs7 (accessed 24 September 2020)

Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol.. 2010; 31:(4)319-326 https://doi.org/10.1086/651091

Hooton TM, Bradley SF, Cardenas DD Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America. Clin Infect Dis.. 2010; 50:(5)625-663 https://doi.org/10.1086/650482

Kamaruzzaman NF, Chong SQY, Edmondson-Brown KM, Ntow-Boahene W, Bardiau M, Good l. Bactericidal and anti-biofilm effects of polyhexamethylene biguanide in models of intracellular and biofilm of Staphylococcus aureus isolated from bovine mastitis. Front Microbiol.. 2017; 8 https://doi.org/10.3389/fmicb.2017.01518

Milligan F. Male sexuality and urethral catheterisation: a review of the literature. Nurs Stand.. 1999; 13:(38)43-47 https://doi.org/10.7748/ns1999.06.13.38.43.c2618

Moore K, Gray D. Using PHMB antimicrobial to prevent wound infection. Wounds UK.. 2007; 3:(2)96-102

Nguyen A, Werneburg G, Kim J, Rohan A, Thanassi D. The characteristics and progression of bacterial biofilms on urinary catheters. J Urol.. 2017; 197 https://doi.org/10.1016/j.juro.2017.02.745

National Institute for Health and Care Excellence. Healthcare-associated infections: prevention and control in primary and community care. Clinical guideline CG139. 2017. https://www.nice.org.uk/guidance/cg139 (accessed 24 September 2020)

Nicolle LE. Urinary tract infections in the elderly. Clin Geriatr Med.. 2009; 25:(3)423-436 https://doi.org/10.1016/j.cger.2009.04.005

Nicolle LE. Catheter associated urinary tract infection. Antimicrob Resist Infect Control.. 2014; 3:23-30 https://doi.org/10.1186/2047-2994-3-23

Oleksy-Wawrzyniak M, Dydak K, Król G, Bartoszewicz M. Non-antibiotic methods of reducing catheter-associated urinary tract infections (UTI). Forum Zakaz‘en’.. 2018; 9:(4)181-188

Pannek J, Everaert K, Möhr S, Vance W, Van der Aa F, Kesselring J. Tolerability and safety of Urotainer® Polihexanide 0.02% in catheterized patients: a prospective cohort study. BMJ Urol.. 2020; 20:(1) https://doi.org/10.1186/s12894-020-00650-1

Biofilms made easy. 2010. https://tinyurl.com/yxrag4fh (accessed 24 September 2020)

English surveillance programme for anti-microbial utilisation and resistance (ESPAUR).London: PHE; 2017

Renzoni A, von Dach E, Landelle C Impact of exposure of methicillin-resistant Staphylococcus aureus to polyhexanide in vitro and in vivo. Antimicrob Agents Chemother.. 2017; 61:(10)e00272-17 https://doi.org/10.1128/AAC.00272-17

Rew M, Woodward S. Troubleshooting common problems associated with long-term catheters. Br J Nurs.. 2001; 10:(12)764-74 https://doi.org/10.12968/bjon.2001.10.12.5302

Sabir N, Ikram A, Zaman G Bacterial biofilm-based catheter-associated urinary tract infections: causative pathogens and antibiotic resistance. Am J Infect Control.. 2017; 45:(10)1101-1105 https://doi.org/10.1016/j.ajic.2017.05.009

Singha P, Locklin J, Handa H. A review of the recent advances in antimicrobial coatings for urinary catheters. Acta Biomater.. 2017; 50:20-40 https://doi.org/10.1016/j.actbio.2016.11.070

Słojewska-Poznan'ska E, Zuchowski A, Bartoszewicz M. Epidemiologia zakaz‘en’. dróg moczowych u pacjentów cewnikowanych. Forum Zakaz‘en’.. 2017; 8:(1)27-31

Smith DRM, Pouwels KB Epidemiology and health-economic burden of urinarycatheter-associated infection in English NHS hospitals: a probabilistic modelling study. Journal of Hospital Infection.. 2019; 103 https://doi.org/10.1016/j.jhin.2019.04.010

Stamm WE. Urinary tract infections, 4th edn. In: Bennett JV, Brachman PS (eds). Philadelphia (PA): Lippincott-Raven; 1998

Stickler DJ. Bacterial biofilms in patients with indwelling urinary catheters. Nat Clin Pract Urol.. 2008; 5:(11)598-608 https://doi.org/10.1038/ncpuro1231

Thorne S, Reimer Kirkham S, O'Flynn-Magee K. The analytic challenge in interpretive description. Int J Qual Methods.. 2004; 3:(1)1-11 https://doi.org/10.1177/160940690400300101

Waskiewicz A, Alexis O, Cross D. Supporting patients with long-term catheterisation to reduce risk of catheter-associated urinary tract infection. Br J Nurs.. 2019; 28:(9) https://doi.org/10.12968/bjon.2019.28.9.S4

Wilde MH, McDonald MV, Brasch J Long-term urinary catheter users self-care practices and problems. J Clin Nurs.. 2013; 22:(3–4)356-367 https://doi.org/10.1111/jocn.12042

Maintenance of indwelling urinary catheters with a novel polyhexanide-based solution: user experience

08 October 2020
14 min read
Volume 29 · Issue 18

Abstract

Background:

Catheter-associated urinary tract infection (CAUTI) can significantly affect patients' quality of life and increase healthcare costs.

Aims:

This study aimed to capture patients' and nurses' experience of catheter maintenance using a polyhexanide-based solution (PS) in everyday practice.

Methods:

Retrospective analysis of data was collected for a product evaluation. PS was used twice a week for five weeks.

Findings:

The study included 42 patients, 30 (71%) men and 12 women (29%). After five weeks of rinsing catheters with PS, nine patients reported no or decreased frequency of CAUTI, eight a better quality of life, eight reduced blockage, seven a decrease in odour and five fewer catheter changes. Three patients reported no benefit from PS use. Nurses reported that fewer visits were needed and consumption of disposables was lower.

Conclusions:

User experiences suggest that, as a novel means of catheter maintenance, PS has the potential to reduce catheter-associated complications such as CAUTI, improve quality of life and reduce healthcare costs.

Bacteriuria develops rapidly in catheterised patients (3–10% daily incidence rate) and the majority of patients with long-term indwelling catheters are continuously bacteriuric (Stamm, 1998; Hooton et al, 2010; Nicolle, 2014; Brusch, 2017). Even when urinalysis has positive results, the majority of these patients remain asymptomatic (Nicolle, 2014). However, up to 30% of patients with catheter-associated bacteriuria will develop symptoms; the occurrence of both positive culture and symptoms is defined as catheter-associated urinary tract infection (CAUTI) (Stamm, 1998; Nicolle, 2014).

The signs and symptoms of CAUTI, such as foul odour from the urine, fever, malaise and abdominal pain, can be embarrassing, distressing and uncomfortable for the patient (Nicolle, 2014; Dalton and Maute, 2019). If the primary infection is not effectively treated, patients may develop bacteraemia, which can be serious and lead to significant morbidity and mortality (Stamm, 1998; Nicolle, 2014). In community care settings in both residential/care homes and people's own homes, the risk of bacteraemia is much greater than it is in acute settings (Nicolle, 2014). CAUTI has been identified as the source of more than 50% of episodes of bacteraemia in long-term care facilities (Hooton et al, 2010; Fortin et al, 2012). Escherichia coli bacteraemia rates have increased by 24.3% between 2012 and 2016, with three-quarters defined as community onset (Bou-Antoun et al, 2016; Public Health England, 2017).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content