What are the guidelines for performing Foley irrigation to minimize infection risk?

From the Guidelines

Foley catheter irrigation should not be performed routinely to reduce or eradicate catheter-associated bacteriuria or urinary tract infection in patients with indwelling catheters, as recommended by the Infectious Diseases Society of America 1. When irrigation is necessary, it is crucial to follow strict guidelines to minimize infection risk.

• Always use sterile technique, including washing hands thoroughly and wearing sterile gloves before handling the catheter system.
• Use only sterile normal saline solution for irrigation, unless specifically ordered otherwise, and ensure all irrigation equipment is sterile.
• Maintain a closed drainage system whenever possible, disconnecting the catheter from the collection bag only when absolutely necessary.
• When irrigating, cleanse the connection port with an antiseptic solution before attaching the irrigation syringe.
• Use gentle pressure during irrigation to avoid trauma to the bladder mucosa, and never force fluid if resistance is met.
• The irrigation solution should be at room temperature to prevent patient discomfort.
• Document the procedure, including the amount of fluid instilled and returned, and the character of the drainage. Regular irrigation should be avoided unless specifically indicated, as each break in the closed system increases infection risk, as noted in the guidelines 1. It's also important to consider that catheter irrigation with antimicrobials may be considered in selected patients who undergo surgical procedures and short-term catheterization to reduce catheter-associated bacteriuria, but the evidence for this is not as strong 1. In general, the goal is to minimize breaks in the closed system and avoid introducing bacteria into the urinary tract, thereby reducing the risk of catheter-associated urinary tract infections.

From the Research

Guidelines for Performing Foley Irrigation

To minimize infection risk during Foley irrigation, the following guidelines can be considered:

• Use of sterile or clean solutions for irrigation, as studies have shown that tap water can be a safe and cost-effective alternative to sterile solutions 2
• Daily irrigation with normal saline solution has been shown to decrease the risk of catheter-associated urinary tract infections (CAUTI) in comatose patients 3
• Antibiotic-containing solutions may be beneficial in preventing or treating infections, but more research is needed to provide evidence-based recommendations 4
• Proper technique and maintenance of the catheter and irrigation system are crucial to prevent disconnections and introduction of organisms, which can increase the risk of infection 5

Best Practices for Bladder Irrigation

Best practices for performing bladder irrigation include:

• Using manual or continuous irrigation methods, depending on the patient's needs and the type of catheter used 6
• Ensuring proper catheter maintenance and care to prevent disconnections and introduction of organisms
• Monitoring patients for signs of infection, such as fever, urinary tract symptoms, or changes in urine appearance
• Following proper infection control protocols, including hand hygiene and use of personal protective equipment, to minimize the risk of infection transmission

Solution Options for Irrigation

The choice of solution for irrigation depends on various factors, including the patient's condition, the type of catheter used, and the risk of infection. Options include:

• Sterile sodium chloride (NaCl) 0.9% solution
• Tap water or bottled water, which has been shown to be a safe and cost-effective alternative to sterile solutions 2
• Antibiotic-containing solutions, which may be beneficial in preventing or treating infections, but require further research to provide evidence-based recommendations 4