Urinary tract infection is one of the biggest concerns for those of us with long-term indwelling catheters (both urethral and suprapubic). And sadly, there is a bunch of misinformation out there about how to help prevent a UTI.
I’m a huge fan of scientifically gathered evidence. I’m also a fan of not wasting time and effort. If there is no scientific foundation for doing something – like drinking cranberry juice to treat a urinary tract infection – then I don’t waste time and hope on it. One of my favorite questions about anything is: “is there any evidence to support that?”
My urologist told me there isn’t any evidence to support a lot of the things things people do prevent UTI once a long-term indwelling catheter is placed, things like sterilizing and washing every little thing, avoiding detaching an SP catheter for showering, etc. But because I am also a fan of “trust, but verify,”I’m much happier when I have read the results of a study myself.
I don’t actually have all my questions answered yet, but the report I read this morning was extremely enlightening. It was Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America from the Oxford Journal, Clinical Infectious Diseases. It’s pretty long and involved, and like I said, it didn’t answer all of my questions. But here is a summary (though I recommend you read it for yourself). The following refer to catheter associated bacteria and UTI specifically, as opposed to the lucky folks who live catheter-free. Also, keep in mind that folks with indwelling catheters are going to have bacteria in the urinary tract. The difference is whether they just colonized (not causing symptoms), or if they invade your tissues (UTI).
- There is no evidence that Antimicrobial coated catheters reduce the amount of bacteria or the likelihood of UTI.
- There is no evidence that cranberry products reduce catheter associated bacteria or the liklihood of UTI.
- There is no evidence that daily meatal (opening of the urethra) cleansing reduces the risk of UTI.
- There is no evidence that catheter irrigation with either antimicrobials or normal saline reduces risk of UTI.
- There is no evidence that adding antimicrobials or antiseptics to the drainage bag reduces the amount of bacteria or risk of UTI.
- There is no evidence that routine catheter change (like every 2-4 weeks) reduces the risk of bacteria or UTI.
I would still like some actual evidence to support (or not) other things I’ve heard, like never letting your bag touch the floor, wiping drainage bag connection points with alcohol swabs when you change bags (like from nighttime bedside bag to daytime leg bag), washing drainage bags with vinegar and/or soap after disconnecting them, letting bags dry out by making sure both ends are open (I’ve actually heard doing the opposite of this!), plugging (or otherwise blocking) the end of your catheter when showering (this may actually be really bad for you – potentially causing colonized urine to back-flow into your ureters or kidneys), pinching the end of your catheter when changing bags to limit exposure to the air, and a few others.
If you come across any valid studies with results in those areas, please – please – please let me know, either by leaving a comment below or contacting me through the contact page. I’ll update this post as I get that information.
Some of the countermeasures I listed above (the ones I can’t find evidence for) I will continue to do just hedge my bets; things like washing my hands and using alcohol swabs.
Things We KNOW You Should Do To Prevent Urinary Tract Infection
Certain things are proven to increase risk of UTI and should always be done. These include:
- Keeping the drainage bag below the level of your bladder to prevent back-flow of already-drained urine back into your bladder
- Changing indwelling catheters once every month
- Drinking lots and lots of water – early and often – to help keep everything moving
I hope this helps keep our knowledge current and correct to the greatest extent possible. Like I said earlier, I am a big fan of the scientific process, which includes replacing old knowledge with new. So if you find good, solid information on preventing urinary tract infections in folks wearing long term indwelling catheters (either urethral or suprapubic), please help me keep this page current.