A study carried out by Okamoto et al (2017) found that there is uncertainty among intermittent self-catherisation (ISC) users regarding the signs and symptoms of urinary tract infection (UTI) and at what point they should seek help. The researchers suggested that a self-help tool would be ideal for this patient cohort, which could assist with the identification of infection, as well as improve communication between patients and health professionals. The tool could also prevent excessive or unnecessary contact with practitioners by ensuring that patients have the tools and abilities to self-manage, while still providing the knowledge for patients to know when it is time to seek help.
A tool has since been developed, though with a slightly different focus, as it requires that a health professional carry out the assessment. The tool was published in BMC Nursing by Lauridsen et al (2022). A UTI risk factors model was used as the basis to inform the content included in the tool and the authors used the Design Thinking Process to guide its development, in terms of both its content and format.
In total, 22 articles in the literature search met the criteria for informing the tool development, and the team conducted three rounds of meetings with approximately 90 nurses throughout Europe from the Nurse Advisory Boards. The researchers also looked at insights generated from the Coloplast Nurse Advisory Boards, and explored user perspectives and practices in relation to infection by conducting qualitative evidence synthesis.
From their research, Lauridsen et al (2022) then developed a UTI assessment tool for intermittent catheter users, made of the following three parts:
- A guide for health professionals
- A dialogue board
- A notepad.
The dialogue board contains six sections to help individuals to confirm if they have a urinary tract infection. It also has various other informative sections that help to pinpoint the knowledge that the patient requires surrounding other aspects of the process and procedures surrounding infection and catheter usage management. The tool consists of questions that focus on health, adherence, technique, and the catheter, as well as a section for cases in which a patient needs further support.
The most recent guidance from the National Institute for Health and Care Excellence (NICE) that covers ISC was published more than 10 years ago now in 2012. The guidance notes that long-term (over 28 days) urinary catheterisation is most often used in patients who are older or with a neurological condition. The prevalence of use of long-term catheterisation is 0.5% in people over the age of 75 and 4% in people receiving care at home. Long-term catheterisation could involve a continuous-flow catheter or suprapubic catheter, or ISC, which provides a more independent method of catheterisation, for those patients who are able to understand and comply well with the clean technique required.
Hydrophilic or coated catheters have been reported to increase comfort, reduce trauma, and contribute to overall higher levels of satisfaction when compared with traditional non-coated catheters (Shamout et al, 2017). The coated catheters also have a slightly lower incidence of infection. Usually, self-lubricating/hydrophilic coatings are used for ISC, but a lubricant is required where this is not the case.
Most often, however, despite how common long-term catheterisation is among patients, it is in fact a last resort. While more and more people are living with chronic conditions, catheterisation is costly in the long term due to the amount of catheter devices and associated products required, and can also serve to take some independence away from the person. Other alternatives should thus be explored first but, for some patients, this will be the necessary option (NICE, 2012).
Usually when considering the type of long-term catheterisation, this will be an individualised choice regarding what best suits the needs and preferences of the patient. There will be a risk of complications that comes with this treatment choice, infection being one, and others involving structural or physiological damage, urological cancer or psychosocial issues (NICE, 2012). The issue of infection is caused primarily by encrustation and blockage, which need to be accounted for in the management of the catheter device the patient receives in their treatment.
Self-catheterisation was not linked to a higher rate of infection where the technique to insert was clean rather than sterile; however, it increases the ease and confidence of the patient in inserting this type of catheter option. Further, NICE (2012) reported clean intermittent catheterisation to be unlikely to lead to additional infections, with the additional cost of a sterile technique therefore being unjustified.
The Royal College of General Practitioners (2021) includes leaflets on its website, which can be printed by the patient or by health professionals who can then hand them out to patients to self-manage their catheters and to prevent urinary tract infections.