10. INFECTION PREVENTION
10.1 Fluid intake
Drinking sufficient fluid dilutes the urine and helps reduce the risk of catheter encrustation and blockage. Good fluid intake also ensures a constant downward drainage and flushing effect. There is no recommended standard amount of fluid intake and the type of fluid consumed is not important as long as the volume is sufficient to prevent concentration of urine. The amount of fluid needed varies and depends on the patient’s weight (25–35 ml/kg/day), amount of fluid loss, food intake and circulatory and renal status. Regular fluid intake maintains the urinary flow and reduces the risk of infection and catheter blockage. Patients should be given sufficient fluid to maintain an output of 50–100 ml/h. [18, 122, 123, 205] However, one study by Wilde in 2016 showed that fluid intake self-management was not significantly correlated with the frequency and presence of catheter-associated urinary tract infection (UTI). [169]
| Recommendations | LE | GR |
| Advise good fluid intake to all catheter users to maintain a urine output of 50-100 ml/h [18, 122, 123, 205] | 4 | C |
| Advise good fluid intake to prevent blockage of the catheter [169] | 2b | A |
10.2 Cranberries
Cranberries have been used for several decades for the prevention and treatment of UTIs. An in-vitro study by De Llano et al. in 2015 proved the anti-adhesive activity of some cranberry-derived phenolic metabolites against uropathogenic Escherichia coli, suggesting that their presence in the urine could reduce bacterial colonisation and progression of UTI. [206]
The preventive use of cranberry preparations may be useful in women with uncomplicated recurrent cystitis. This is because a comparison with placebo treatment based on several randomized controlled trials indicates that the infection then does not recur or recurs only later, but these women had no indwelling catheter. [207]
The Cochrane review by Jepson et al. studied participants needing catheterisation (intermittent or indwelling). No studies assessing cranberries for the treatment of UTIs which met the inclusion criteria were found. Based on this review this is an unsolved issue. [208]
Further properly designed studies with relevant outcomes are needed.
Attention should be paid to the interaction between cranberries and warfarin. Cranberries may potentiate the effect of warfarin (anticoagulant medication). [209]
| Recommendation | LE | GR |
| Cranberry products are not effective in preventing UTIs in people with indwelling catheters [208] | 1a | B |
10.3 Hand hygiene
Hand-mediated transmission is a major factor in increasing the risk of infection in patients, which emphasises the vital importance of hand hygiene and use of personal protective equipment such as aprons and gloves. [101]
| Recommendations | LE | GR |
| Perform hand hygiene immediately before and after insertion or any manipulation of the catheter device or site [24] | 1b | A |
| Carers and patients managing their own catheters must wash their hands before and after manipulation of the catheter [12] | 1b | A |
| Healthcare professionals should observe protocols on hand washing and the need to use disposable gloves between catheterised patients [14, 18] | 1b | B |