30 JCN 2013, Vol 27, No 5 CONTINENCE M anaging patients in the community involves a number of challenges that differ significantly to those of hospital-based healthcare. This is particularly relevant to infection control. In the hospital environment the patient’s surroundings and personal hygiene can, to a certain extent, be managed. However, in the community, these circumstances are not so easily controlled. For a range of patients, infection control can be a particular challenge, for example those with indwelling catheters, leg ulcers or post-surgical wound sites. Using an antimicrobial skin cleanser before catheterisation Nurses visiting patients’ homes needs a certain skill-set to work in an environment that may be contaminated with household refuse or pets, for example, and where there may be issues around showering and washing. Community nurses’ caseloads can include a large number of catheterised patients with differing issues. For example, blocked urinary catheters are a significant problem for district nurses (Evans and Painter, 2001), and many end of life patients have catheter-related needs (Young and Conway, 2011). Catheter-related infection is a significant problem — between 10–30% of patients who are catheterised for a short period (2–4 days) develop bacteria in the urine (bacteriuria), a figure that rises to 90–100% of those who are catheterised long-term (Brusch, 2013). Similarly, approximately 80% of hospital-related (including post- discharge) urinary tract infections (UTIs) are related to urethral catheterisation (Brusch, 2013). This means that catheter-related infection can take up a significant amount of community nurses’ time and they need to understand the infection risks of catheterisation and how to combat them. This article looks at the microbial risks associated with catheterisation in the community. It examines the findings of a new study, which looked at an antimicrobial cleansing solution (octenilin ® ; Schülke) and whether its properties reduced the infection risk associated with catheterisation. CATHETERISATION Many people transferring from hospital to primary care will have a urinary catheter still in place (Seymour, 2007). Similarly, many patients seen regularly by community nurses, such as elderly patients in nursing homes, will have a long-term catheter in situ. Therefore, community nurses need to understand the basic principles behind this common procedure. The purpose of urinary catheterisation is to drain urine from the bladder into a collection device, such as a catheter bag. The catheter itself comprises a flexible tube, usually manufactured from silicone, which is inserted through the urethra or sometimes via an abdominal incision (suprapubic catheterisation). In order to perform catheterisation, the clinician guides the catheter into the bladder permitting urine to flow into the drainage device (Ghaffary et al, 2013). Urinary catheters can be in place for either a short time or be used as a longer-term measure. Reasons for short-term catheterisation might include:  Post surgery when anaesthetic has interfered with bladder function Tim Sandle, Head of Microbiology, Bio Products Laboratory Limited, Watford Community nurses’ caseloads may include a large number of catheterised patients and catheter-related infection is a signiicant problem, with up to 90–100% of those who are catheterised long- term going on to develop a catheter-associated urinary tract infection (CAUTI). For community nurses, ensuring that their skin and that of the patient has been cleansed before any catheter- related intervention is paramount. This article looks at the use of a new antimicrobial cleansing solution (octenilin ® ; Schülke) and whether its properties reduced the infection risk associated with catheterisation in the community. KEYWORDS: Continence  Catheters  Urinary tract infection  Infection control Tim Sandle © 2013 Wound Care People Ltd