PROCEDURE FOR URINARY CATHETERISATION

Transcription

1 PROCEDURE FOR URINARY CATHETERISATION First Issued Issue Version One Purpose of Issue/Description of Change Planned Review Date To promote safe and effective urinary catheterisation for patients in a community setting 2013 Named Responsible Officer:- Approved by:- Date Continence Nurse Specialist Nursing Policy Group March 2010 Section :- Continence C N o 02 Impact Assessment Screening Complete Date: March 2010 Full Impact Assessment Required Y/N UNLESS THIS VERSION HAS BEEN TAKEN DIRECTLY FROM THE NHS WEBSITE THERE IS NO ASSURANCE THIS IS THE CORRECT VERSION

2 PROCEDURE FOR URINARY CATHETERISATION INDEX Contents Page Number Introduction 3 Procedure Aim 3 Target Group 3 Training 3 Related Policies 4 Risk Factors 4 Product Selection 5-6 Equipment 6 Indications and Catheter selection 7-8 Procedure for Female Catheterisation 9-11 Procedure for Male Catheterisation 11 Procedure for Supra - Pubic Catheterisation 14 References 17 Appendix One ( NPSA Alert Poster) Female Urinary Catheters 18 2/16

3 PROCEDURE FOR URINARY CATHETERISATION INTRODUCTION An indwelling catheter is a hollow tube that is inserted into the bladder to facilitate emptying of the bladder or instillation of fluids (Association of Continence Advice [ACA] 2007). Indwelling catheters are retained by inflating an integral balloon within the bladder; they may be inserted urethrally or supra-pubically (Pomfret 2007). Intermittent catheters are designed to be inserted then removed after draining the bladder (National Institute for Health and Clinical Excellence [NICE] 2003) and therefore do not have a self retaining balloon. Intermittent Catheterisation should always be considered the first option (Evidence Based Practice in Infection Control [Epic] 2003). When considering catheterisation for intractable incontinence, this intervention should only be considered after all other non-invasive management options have been explored and found to be unsatisfactory (NICE 2003). Catheter insertion is an aseptic technique which requires full clinical assessment and should only be performed where there is an identified clinical need or to improve the patients quality of life. This is important because patients having a catheter inserted as part of their clinical care are in significant danger of acquiring a urinary tract infection (UTI). The risk of UTI is associated with the method and duration of catheterisation, the quality of catheter care and host susceptibility (EPIC 2003). PROCEDURE AIM NHS Wirral is committed to providing high quality nursing services to all patients. This procedure outlines the standards of safe and timely healthcare for patients in the community setting who require catheterisation of the urinary bladder. TARGET GROUP This policy applies to all clinical staff directly employed by NHS Wirral, who are required to carry out this role. TRAINING All nurses will comply with the current NHS Wirral Core Clinical Training Programme, which includes a mandatory two day Continence Course covering catheterisation and catheter care, to be attended every three years Managers will monitor attendance as part of performance reviews and management supervision. NHS Wirral Continence Service provides training throughout the year, attendance is also mandatory if practitioner has:- Been on long term sickness absence e.g. over 6 months Identified the need for an update as part of own continuing professional development Not attended an update within the last three years and if:- Manager has identified topic as development need 3/16

4 Manager has identified topic as a development need following a clinical incident investigation. DEFINITION OF ADULT For the purpose of this document an adult is deemed to be a person over the age of 16 years with the capacity of consent. RELATED POLICIES NHS Wirral Health Records Policy Record Keeping Procedure for Community Nursing NMC (July 2007) Record Keeping NMC (2008) The Code: standards of conduct, performance, and Ethics for Nurses and Midwives Infection Control Policies Incident Reporting Policy Medical Devices Policy Consent Policy Chaperone Policy Continence Procedures Vulnerable Adults Policy Clinical Waste Policy Continence Appliance Formulary NB Always use most current versions of NHS Wirral and NMC policies as may be superseded at any time. PATIENTS WHO HAVE ADDITIONAL RISK FACTORS RISK FACTOR Clients with a history of sexual abuse Heart defects for example heart valve lesion, septal defect, patent ductus or prosthetic valve CONSIDERATION Clients falling into this category may find the procedure too distressing and consent in all cases can be withdrawn at any stage. Wherever possible under these circumstances offer staff of the same gender of patients choosing to undertake this procedure Antibiotic prophylaxis may be required when inserting or changing a urinary catheter (NICE 2003) discuss with general practitioner or medical practitioner in Out of Hours Service DECISIONS TO CATHETERISE 1. Patients must be provided with adequate information in relation to the need, insertion, maintenance, and removal of their catheter by the practitioner planning their care (EPIC 2003). 2. When Catheterisation is being discussed as a treatment option, intermittent catheterisation should always be considered for incomplete emptying as the first option rather than indwelling catheterisation, providing this is a safe acceptable alternative for the individual and carer(s) (NICE 2003). 4/16

5 3. A full assessment of the individual and their needs should be carried out before catheterisation, to ensure benefits outweigh disadvantages (Royal College of Nursing [RCN] 2008). 4. Assessment of the patient must include exploration of factors that may impact on the decision to catheterise these include: Mental health or cognitive status of the patient, catheterisation of patients who are cognitively impaired should be avoided wherever possible (RCN 2008). Patient s ability to manage the catheter independently Carer availability in order to manage/undertake catheter care. INDICATIONS FOR CATHETERISATION Patients with a neurological condition or injury who have difficulty in completely emptying the bladder. Patients with outlet obstruction who may be unfit for surgical repair Patients who have intractable incontinence, or where other methods are inappropriate or unsuccessful. Palliative care patients, where catheterisation promotes comfort and dignity. Chronic urinary retention Tissue viability and preserving skin integrity EXCLUSIONS FOR FIRST CATHETERISATION A history of complicated catheterisation or unsuccessful attempts at catheterisation Advanced prostate cancer Advanced bladder cancer Post Urological Surgery Lymphoedema Known urethral Congenital Abnormalities/False Passages Urethral Obstruction A history of urethral bleeding or undiagnosed Haematuria Acute Retention PRODUCT SELECTION When selecting the correct catheter it is important to consider the following: duration of catheterisation, catheter material, size, length, balloon volume and drainage system (ACA 2007). THE DURATION The duration of catheterisation can be variable and is often related to the reason for catheterisation. For example, it can be short term (1-28 days) or long term (more than 28 days). CATHETER MATERIAL The choice of catheter material will be dependant on the duration of catheterisation (Pellowe 2009). Short Term Catheters (1-28days) 5/16

6 PTFE (Poly tetrafluorethylene) coated latex catheter This includes those long term catheterised patients requiring catheter change more frequently than 4 weekly Long Term Catheters (more than 28 days) Hydrogel coated latex catheter Hydrogel coated silicone catheter All Silicone catheter See Continence Appliance Formulary for 1 st & 2 nd choice For patients with a latex allergy, only 100% silicone catheters contain no latex (ACA 2007). CATHETER SIZE The system of measurement to express catheter diameter is the Charriere (ch). For routine drainage in an adult select the smallest charriere size that will ensure adequate drainage, to minimise urethral trauma and irritation of the bladder mucosa (Pellowe 2009). Female: Male: Supra pubic: 10ch 14ch 12ch - 16ch 14ch 16ch (size is determined by surgeon on insertion) CATHETER LENGTH A standard length catheter is first choice for all patients A standard length catheter should always be first choice; a female length catheter should never be used to catheterise a male patient as there is not enough length to allow the balloon to clear the urethra, therefore when inflating severe trauma will occur (National Patient Safety Agency [NPSA] 2009). Female length catheters must be stored separately from other catheter equipment. BALLOON VOLUME Indwelling catheters require the addition of sterile water to inflate the self- retaining balloon. A 10ml balloon should be used in routine catheterisation (NICE 2003 & ACA 2007). The use of a 30ml balloon in routine catheterisation should always be questioned (ACA 2007) When selecting the catheter pre-filled balloons are preferable for urethral catheterisation, the exact amount stated by the manufacturer should be instilled, do not over or under inflate as this could lead to misshaping of the balloon (ACA 2007). SELECTING THE DRAINAGE SYSTEM The catheter should always be connected to a sterile closed drainage system or valve (DH 2006). It should be well supported to prevent trauma and kept below the level of the waist. The closed drainage system should only be broken for valid clinical reasons and a link system used for overnight drainage if required (DH 2006). There are a range of drainage bags available; they should be selected on an individual patient basis to ensure the capacity of the drainage bag and tubing length meets the individual needs of the patient and avoids complications such as kinking and dragging of the tubing or overfilling of the bag (ACA 2007). SELECTING THE DRAINAGE SYSTEM ADVICE 6/16

7 Urine drainage bags For overnight drainage use a link system For patients who are non-ambulatory, confined to bed Will normally be leg bags for people who are ambulant to use in the day. Follow manufacturer s instructions that indicate that the bag will normally be changed every 5 7 days. A 2-litre single use non-drainable night bag is attached to the leg bag. A sterile 2 litre, drainable bag is only used where the person is non-ambulatory. If this system is used, the bag will remain attached for 5 7 days with the catheter bag junction unbroken (as manufacturer s instructions) Advise patient or carer to label bag with date bag has been attached and date due for changing and document advice given in the patient s health records Catheter valves (Please see Continence Appliance Formulary) Anaesthetic gels (prescribed on community medicines administration chart) Will be used following guidance in relation to manufacturers instructions and following clinical assessment. Should be used in Female catheterisation (6mls). Male catheterisation (11mls) and supra-pubic catheterisation This is contraindicated in patients with known sensitivities to the ingredients Lidocaine or Chlorhexadine EQUIPMENT Single use disposable apron Catheter : Sterile dressing pack Additional pair of single use disposable sterile gloves One pair of single use disposable non-sterile gloves Prescribed single use anaesthetic gel/ lubricant gel - written on Patients Medication Administration Chart Drainage bag 10 ml Syringe x 2 single use sachet normal saline 0.9% If catheter is not prefilled - 10mls sterile water for injection and green needle. Disposable Non-sterile Kidney dish PROCEDURE FOR FEMALE URINARY CATHETERISATION PROCEDURE Introduce yourself and any colleagues involved at the contact. Verbally confirm the identity of the patient by asking for their full name and date of birth. If patient unable to confirm, check identity with family/ carer Explain procedure to patient including risks and benefits and gain informed consent. If patient unable to give consent, act in patients best interests by following Consent Policy RATIONALE To gain co-operation To avoid mistaken identity To ensure client understands procedure Use consent form 4 if appropriate 7/16

8 Offer patient a chaperone and document decision in health records Ensure all equipment is gathered before commencing the procedure Check the catheter size and type against the written instructions in the patient s health records If not first catheterisation ask the patient to empty their drainage bag. Check for any allergies e.g. latex or anaesthetic gels It is the patients choice to have a chaperone if wanted. Discuss with line manger if nurse considers a chaperone is needed as part of risk assessment To prevent contamination of sterile equipment and to ensure the procedure is not commenced without all necessary equipment To reduce risk of using the incorrect device To avoid spillages of urine during procedure To reduce risk of anaphylaxis Decontaminate hands prior to procedure To reduce the risk of transfer of transient micro - organisms on the health care workers hands Open sterile dressing pack onto a clean field and To maintain asepsis and prevent contamination place all sterile single use equipment required of sterile equipment within sterile field Use aseptic principle to ensure that only sterile single use items are used to keep exposure of the susceptible site to a minimum In the event the patient requires assistance with personal hygiene apply single use disposable non-sterile apron and gloves To prevent contamination of a susceptible site by organisms that could cause infection To prevent cross infection Ask or assist the patient to position themselves in To maintain dignity and comfort a supine position, with knees bent and hips flexed and feet comfortably apart.(if able) Decontaminate hands prior to procedure To reduce the risk of transfer of transient micro - organisms on the health care workers hands Apply single use disposable apron and gloves To prevent cross infection and environmental contamination. If not first catheterisation remove existing catheter To avoid vacuuming of the bladder mucosa attach empty syringe to catheter port. Do not draw back on the syringe; allow the catheter balloon to deflate using gravity. Place a piece of gauze around the catheter and slowly withdraw the catheter Using sterile gauze, separate the labia and identify urethral meatus, clean around the urethral orifice with normal saline 0.9% using downward strokes Insert prescribed single use anaesthetic / lubricating gel with dominant hand to urethra and leave for recommended manufacturer s time/ 5 minutes Remove and dispose of PPE to comply with waste management policy Inadequate preparation of the urethral orifice is a major cause of infection following catheterisation. To reduce risk of cross infection (DH 2005) To ensure full effectiveness of anaesthetic/lubricant gel, to minimise discomfort and help prevent urethral trauma (Woodward 2005) To prevent cross infection and environmental contamination Arrange sterile towel to cover the surrounding area and maintain dignity To create sterile field and help prevent contamination 8/16

9 Apply single use disposable sterile apron and gloves in a manner which prevents the outer surface of the sterile glove being touched by a non-sterile item Insert the catheter approximately 5-6cms. Once urine has started draining insert a further 3-5cms. If at any time the patient experiences any undue pain or there is resistance when passing the catheter, stop and seek advice. If Prefilled balloon: Release clamp of balloon and allow slow release of water. If not prefilled balloon: Slowly inflate the balloon with 10mls of sterile water according to manufacture s instructions. Balloon inflation should be pain free. If the patient is experiencing any pain or discomfort during balloon inflation, the balloon might be positioned in the urethra. Deflate the balloon and advance the catheter a few more centimetres before trying again. Attach the catheter to a previously selected drainage system or catheter valve. To maintain asepsis, reduce the risk of microbial contamination and prevent the spread of infection To ensure the balloon is in the bladder To retain catheter in bladder (Over inflation of the balloon may cause irritation of the bladder trigone inducing bladder spasm which in turn causes by passing of urine around the urethral orifice) Attach sterile drainage bag. Measure the amount of urine Ensure the patient is comfortable and the genital area is dry On completion of procedure remove and dispose of PPE to comply with waste management policy To maintain closed circuit system To be aware of bladder capacity for patients who have presented with urinary retention. To monitor renal function and fluid balance If the area is left wet or moist, secondary infection and skin irritation may occur To prevent cross infection and environmental contamination Decontaminate hands following removal of PPE Record information in patients health records Catheter material/ expiry date Charrière size and length Balloon size Batch number Cleansing and anaesthetic agents Urine drainage system Planned date for the next catheter change Reinforce management of catheter and ongoing care, document patient catheter booklet explained and given to patient/carer contact details given To remove any accumulation of transient skin flora that may have built up under gloves and possible contamination following removal of PPE To document event and have a permanent record for reference and monitoring of future care planning. Date of catheter change essential for safety of patient Promotes independence and reduces incidence of problems/infections Promoting self-care 9/16

10 Fully document all intervention and any follow up care required in the patients care plan Record patients/carers comments or any concerns following the procedure To comply with NHS Wirral record keeping policies. To record patients perspective. To provide safe and effective continuity of care PROCEDURE FOR MALE URINARY CATHETERISATION PROCEDURE Introduce yourself and any colleagues involved at the contact. Verbally confirm the identity of the patient by asking for their full name and date of birth. If patient unable to confirm, check identity with family/ carer Explain procedure to patient, including risks and benefits and gain informed consent. If patient unable to give consent, act in patients best interests by following Consent Policy Offer patient a chaperone and document decision in health records Ensure all equipment is gathered before commencing the procedure Check the catheter size and type against the written instructions in the patient s health records RATIONALE To gain co-operation To avoid mistaken identity To ensure client understands procedure and enable patient to make informed decisions Use consent form 4 if appropriate It is the patients choice to have a chaperone if wanted. Discuss with line manger if nurse considers a chaperone is needed as part of risk assessment To prevent contamination of sterile equipment and to ensure the procedure is not commenced without all necessary equipment To reduce risk of using the incorrect device. Check for any allergies e.g. latex or anaesthetic To reduce risk of anaphylaxis gels If not first catheterisation ask the patient to empty To avoid spillages of urine during procedure their drainage bag. Decontaminate hands prior to procedure To reduce the risk of transfer of transient micro - organisms on the health care workers hands Open sterile dressing pack onto a clean field and place all sterile single use equipment required within sterile field including catheter and drainage system Use aseptic principle to ensure that only sterile single use items are used to keep exposure of the susceptible site to a minimum In the event the patient requires assistance with personal hygiene apply single use disposable non-sterile apron and gloves Ask or assist the patient into a supine position To maintain asepsis and prevent contamination of sterile equipment To prevent contamination of a susceptible site by organisms that could cause infection To prevent cross infection To ensure abdominal muscles relaxed 10/16

11 Decontaminate hands To reduce the risk of transfer of transient micro - organisms on the health care workers hands Apply sterile single use disposable apron and gloves To prevent cross infection and environmental contamination. If not first catheterisation, remove existing catheter attach empty syringe to catheter port. Do not draw back on the syringe; allow the catheter balloon to deflate using gravity. Place a piece of sterile gauze around the catheter and slowly withdraw the catheter, whilst supporting the penis Retract foreskin (if not circumcised), clean around the Glans and urethral orifice with normal saline 0.9% Insert prescribed single use anaesthetic / lubricating gel slowly into urethra and leave for recommended manufacturer s time/ 5 minutes Remove and dispose of PPE to comply with waste management policy Decontaminate hands and apply new sterile single use disposable apron and gloves Arrange sterile towel to cover the surrounding area and maintain dignity Wrap sterile folded gauze around the penis and use to support the penis at a 90 degree angle To avoid vacuuming of bladder mucosa Inadequate preparation of the urethral orifice is a major cause of infection following catheterisation. To reduce risk of cross infection (DH 2005) To ensure full effectiveness of anaesthetic/lubricant gel, to minimise discomfort and help prevent urethral trauma (Woodward 2005) To prevent cross infection and environment contamination To reduce the risk of transfer of transient micro - organisms on the health care workers hands To create sterile field and help prevent contamination This straightens out the first curve of the urethra; the gauze will contain any excess gel. Whilst maintaining an angle of 90 degrees, insert the catheter slowly into urethra. There may be a slight resistance at the external sphincter, ask the patient to cough or try to pass water and the catheter should pass easily. If resistance felt and unable to progress the catheter, stop and seek help, do not force. Insert catheter until urine has started to drain, then insert a further 5cm or almost up to the bifurcation. If Prefilled balloon: Release clamp of balloon and allow slow release of water. If not prefilled balloon: Slowly inflate the balloon with 10mls of sterile water according to manufacture s instructions. Balloon inflation should be pain free. If the patient is experiencing any pain or discomfort during balloon inflation, the balloon might be positioned in the urethra. Deflate the balloon and advance the catheter a few more centimetres before trying again. Attach the catheter to a previously selected sterile drainage system or catheter valve. To aid insertion This will help relax the pelvic floor and sphincters to aid insertion of the catheter. To prevent trauma as there could be an obstruction. Ensures the catheter is within the bladder. To retain catheter in bladder (Over inflation of the balloon may cause irritation of the bladder trigone inducing bladder spasm which in turn causes by passing of urine around the urethral orifice) 10ml balloon catheters are now recommended for urine routine use. 11/16

12 Measure the amount of urine Attach sterile drainage bag. Ensure the patient is comfortable and the genital area is dry On completion of procedure remove and dispose of PPE to comply with waste management policy To be aware of bladder capacity for patients who have presented with urinary retention. To monitor renal function and fluid balance To maintain closed circuit system If the area is left wet or moist, secondary infection and skin irritation may occur To prevent cross infection and environmental contamination Decontaminate hands following removal of PPE Record information in patients health records Catheter material/ expiry date Charrière size and length Balloon size Batch number Cleansing and anaesthetic agents Urine drainage system Planned date for the next catheter change Reinforce management and ongoing care of catheter and contact details should any problems arise. Patient catheter booklet explained and updated with date of change To remove any accumulation of transient skin flora that may have built up under gloves and possible contamination following removal of PPE To document event and have a permanent record for reference and monitoring of future care planning. Date of catheter change essential for safety of patient Promotes independence and reduces incidence of problems/infections Promoting self-care Fully document all intervention and any follow up care required in the patients care plan Record patients/carers comments or any concerns following the procedure To comply with NHS Wirral record keeping policies. To record patients perspective. To provide safe and effective continuity of care 12/16

13 PROCEDURE FOR SUPRA - PUBIC URINARY CATHETERISATION PROCEDURE Verbally confirm the identity of the patient by asking for their full name and date of birth. If patient unable to confirm, check identity with family/ carer Introduce yourself and any colleagues involved at the contact. Explain procedure to patient including risks and benefits and gain informed consent. If patient unable to give consent, act in patients best interests by following Consent Policy Offer patient a chaperone and document decision in health records Ensure all equipment is gathered before commencing the procedure Check the catheter size and type against the written instructions in the patient s health records Check for any allergies e.g. latex or anaesthetic gels If not first catheterisation ask the patient to empty their drainage bag. Decontaminate hands prior to procedure Open sterile dressing pack onto a clean field and place all sterile single use equipment required within sterile field including catheter and drainage system Use aseptic principle to ensure that only sterile single use items are used to keep exposure of the susceptible site to a minimum In the event the patient requires assistance with personal hygiene apply single use disposable non-sterile apron and gloves Ask or assist the patient into a supine position Decontaminate hands prior to procedure Apply single use disposable apron and gloves Using dominant hand wrap a piece of sterile gauze around existing catheter at the point it enters the cystostomy To remove existing catheter attach empty syringe to catheter port. Do not draw back on the syringe; allow the catheter balloon to deflate using gravity. Slowly remove, noting length and angle of removed catheter. Place old catheter into non-sterile kidney dish Cleanse around the cystostomy site using normal saline 0.9% Observe the cystostomy site for discharge, inflammation or over granulation RATIONALE To avoid mistaken identity To gain co-operation To ensure client understands procedure and enable patient to make informed decisions Use consent form 4 if appropriate It is the patients choice to have a chaperone if wanted. Discuss with line manger if nurse considers a chaperone is needed as part of risk assessment To prevent contamination of sterile equipment and to ensure the procedure is not commenced without all necessary equipment To reduce risk of using the incorrect device To reduce risk of anaphylaxis To avoid spillages of urine during procedure To reduce the risk of transfer of transient micro - organisms on the health care workers hands To maintain asepsis and prevent contamination of sterile equipment To prevent contamination of a susceptible site by organisms that could cause infection To prevent cross infection To relax abdominal muscles To reduce the risk of transfer of transient micro - organisms on the health care workers hands To prevent cross infection and environmental contamination The gauze will act as a marker to ensure correct length of new catheter inserted To avoid vacuuming of bladder mucosa. For later comparison and inspection of the catheter To reduce risk of cross infection May indicate signs of infection that require intervention

14 Insert prescribed single use anaesthetic lubricating gel and wait for three to five minutes remove and dispose of PPE to comply with waste management policy Decontaminate hands prior to procedure and apply new single use disposable sterile apron and gloves Visually compare length of new catheter with length of old catheter (the inner wrapper can be used to mark the length of catheter to be inserted) Gently insert new catheter to same length and angle as previous catheter (this should be done as soon as possible after removal of old catheter to maintain patency of the cystostomy). Wait for urine to appear Inflate balloon slowly with the volume of sterile water recommended for balloon size, observing the patient for signs of pain or discomfort. Attach sterile drainage bag. Apply keyhole dressing if required to catheter site Inspect the removed catheter, checking that it is intact, check for encrustation and its extent. on completion of procedure remove and dispose of PPE to comply with waste management policy Decontaminate hands prior to procedure and apply new single use disposable sterile gloves Record information in patients health records Catheter material/ expiry date Charrière size and length Balloon size Batch number Cleansing and anaesthetic agents Urine drainage system Planned date for the next catheter change Reinforce management and ongoing care of catheter and contact details should any problems arise. Patient catheter booklet explained and updated with date of change To ensure area is lubricated and anaesthetised to prevent cross infection and environmental contamination To reduce the risk of transfer of transient micro - organisms on the health care workers hands To ensure catheter inserted to the correct length Ensures catheter is inserted to client s own requirements Confirms intravesical positioning Ensures intravesical inflation of balloon To maintain closed circuit system Dressings should only be used if discharge present or patient finds it more comfortable with a dressing in place Encrustation is a sign of infection To prevent cross infection and environmental contamination. To reduce the risk of transfer of transient micro - organisms on the health care workers hands To document event and have a permanent record for reference and monitoring of future care planning. Promotes independence and reduces incidence of problems/infections Promoting self-care Fully document all intervention and any follow up care required in the patients care plan Record patients/carers comments or any concerns following the procedure To comply with NHS Wirral record keeping policies. To record patients perspective. To provide safe and effective continuity of care 14/16

15 PATIENT EDUCATION Patient and carers (both formal and informal) should be educated in the following: (NICE 2003, Getcliffe & Dolman 2007). Hand decontamination and meatal hygiene Changing and emptying of leg bags/valves How to attach night bags Possible signs and symptoms of infection Dietary and fluid advice How to order supplies How to access help if difficulties arise CLINICAL INCIDENTS Any related incidents arising from carrying out these procedures which may involve clinical error or near miss must be reported following the NHS Wirral incident reporting policy. REFERENCES / BIBLIOGRAPHY Association for Continence Advice (2007) Notes on good practice Association for Continence Advice. London Department of Health (2005) Saving Lives A Delivery Programme to Reduce HCAI (including MRSA) Retrieved from: Department of Health (2006) Essential Steps to Safe, Clean Care: Reducing Healthcare-Associated Infections. Retrieved from: Evidence Based Practice in Infection Control (2003) Infection control: Prevention of healthcare-associated infection in primary and community care. Retrieved from: Getcliffe, K & M. Dolman (2007) Promoting Continence A Clinical and Research Resource. Bailliere Tindall. London National Institute of Health and Clinical Excellence (2003) Infection Control: Prevention of Health- Care Associated Infections in Primary Care. Retrieved from: National Patient Safety Agency (2009) Female Urinary Catheters Rapid Response Report. Retrieved From: Pellowe, C. (2009) Using Evidence-Based Guidelines to Reduce Catheter Related Urinary Tract Infections in England. Journal of Infection Prevention.10 (2) Pomfret, I. (2007) Urinary Catheterization: Selection and Clinical Management. British Journal of Community Nursing. 12(8) Royal College of Nursing (2008) Catheter Care: RCN Guidance for Nurses. Retrieved From: data/assets/pdf_file/0018/157410/ pdf Woodward, S. (2005) Use of Lubricant in Female Urethral Catheterisation. British Journal of Nursing. 14(19) CONSULTATION Nursing Policy Group Continence Service Infection Control Team 15/16

16 16/16 Appendix One