12. INFECTION PREVENTION
Urinary tract infection (UTI) has an impact on quality of life in terms of patients refraining from social activities, duration of illness, and number of days lost from work. [48] Bacteriuria is acquired at the rate of 1–3% per catheterisation. Therefore, almost all patients are positive for bacteriuria by the end of the third week. [38] Asymptomatic bacteriuria does not require treatment, only UTI (definition see Section 4.3).
12.1 Urinalysis
Patients performing intermittent catheterisation (IC) routinely have abnormal urinalysis. The majority of patients have chronic or recurring bacteria present in their urine. [39, 61] Dipstick testing alone has limited value to rule out infection because of uncertainty in the performance of urinalysis. [166]
| Recommendation | LE | GR |
| Undertake urinalysis or collect a specimen of urine for culture if an IC user has symptoms suggesting a UTI [26, 53] | 1a | A |
12.2 Fluid intake
Drinking sufficient fluid dilutes the urine and ensures a constant downward drainage and flushing effect. The amount of fluid needed varies and depends on patient size (25–35 ml/kg/day), fluid loss, food intake, and circulatory and renal status. Inadequate fluid intake is a companion problem to inadequate frequency of bladder emptying. When < 1200 ml of urine per day is produced, patients are less inclined to micturate at desired intervals, producing stagnation and distension, which can lead to an increase in infection rate. [113] Excessive fluid intake increases the risk of over-distension of the bladder and overflow incontinence. [113]
| Recommendations | LE | GR |
| Advise users how much fluid they need based on their weight (25–35 ml/kg/day), fluid loss, food intake, and circulatory and renal status | 4 | B |
| Encourage IC users to drink enough fluid to maintain a urine output of at least 1200 ml per day [113] | 4 | C |
12.3 Cranberries
There is no evidence that the prophylactic administration of cranberry supplementation affects the incidence or risk of catheter-associated UTI as a result of IC. [167, 168] Patients should be informed that the quality of evidence underpinning the use of cranberries is low with contradictory findings.
| Recommendation | LE | GR |
| Do not recommend cranberry supplementation routinely to prevent or treat UTI [168-170] | 1b | A |
12.4 Hand hygiene
To minimise the risk of cross-infection, healthcare professionals should constantly be aware of their hand hygiene. Patients who self-catheterise should disinfect or wash their hands thoroughly with water and soap before and after catheterisation [171, 172]
| Recommendations | LE | GR |
| Adhere to protocols on hand hygiene before catheterisation [38, 172, 173] | 1b | A |
| Educate patients and caregivers in techniques of hand hygiene [172] | 4 | B |
12.5 Urinary tract infection assessment tool
The UTI assessment tool for intermittent catheter users is designed to help healthcare professionals assess UTI risk factors in a systematic way, while engaging users and taking their perspective into account. [114]