The role of antiseptics in the management of patients undergoing short-term indwelling bladder catheterization

Abstract

The significance of the indwelling bladder catheter as the major source of hospital-acquired infections is well documented (Meers et al., 1981; Thompson et al., 1984). Many ingenious attempts have been made over the years to try and prevent these infections and it is clear that the degree of success of the various catheter management procedures and techniques varies in different patient populations (Kunin, 1987). The committee set up by the U.S. Center for Disease Control to produce guidelines for the prevention of catheter-associated urinary tract infections made it clear that they felt that the optimal conditions for catheter care will vary with the duration of catheterization (Wong & Hooton, 1981). Slade & Gillespie (1985) classified continuous catheterization into three groups: (1) short term (l-7 days), covering the normal perioperative period in urological and gynaecological surgery; (2) mid term (7-28 days), used for example in urological patients who are sent home for a few weeks for preoperative preparation, or after orthopa.edic operations in the elderly; (3) long term (over 28 days), necessary for the long-term management of the neuropathic bladders of patients with spinal injuries or other neurological conditions. The management of the bladder catheter has been the subject of much discussion (Simpson, 1986; Kunin, 1987; Seal & Holliman, 1988; Stickler & Chawla, 1988). Stickler & Chawla (1987) considered the nature of the infections and the management of patients with long-term indwelling catheters; the purpose of this article is to examine these issues in short-term catheterization as defined by Slade & Gillespie (1985). The recent study by Mulhall, Chapman & Crowe (1988) h s owed that in England and Wales, the average SOO-bed district general hospital will catheterize up to 2500 patients