Infection control strategies are procedures or plans which are aimed in minimizing the risk of obtaining hospital acquired infections, also known as nosocomial infections. Health professionals should always keep up with latest research and findings in order to provide better care for their patients and reduce risk of infections. The case I will be discussing is about urinary catheterizing a thirty five year old woman in labor who had just had an epidural procedure done at the delivery suite.
According to Dougherty and Lister (2015), as stated by Yates (2017), urinary catheterization involves the insertion of a tube into the bladder using aseptic technique. This sterile tube is firstly inserted in the urethra of a patient and then it is moved further along to reach the bladder. Once the tube reaches the bladder, it is held into place by a balloon which is inflated by inserting 10mL sterile water or saline solution through a syringe. Before the procedure is done it is important to assess which catheter is best to use, especially if the patient has any allergies. During catheterization it is important to remain sterile at all times. Since urine itself is sterile, it is important not to introduce bacteria in the urinary tract during the procedure as it could lead to a urinary tract infection (CAUTI). It was the best idea for this woman to be catheterized because she was under epidural analgesia and could not walk. If she wouldn’t have been catheterized she would have had a full bladder, which in turn doesn’t let the baby’s head to descend. In a procedure like this, the Aseptic Non Touch Technique (ANTT) can be followed. The ANTT was developed by Stephen Rowley and has been used as a guideline in aseptic techniques all around the world.
In the case I was assisting in, the patient decided to get an epidural as a pain relief method. The midwife advised her to pass urine before having the procedure done, so not to have a full bladder during the procedure and feel uncomfortable. The epidural procedure was done and afterward the midwife gained consent for catheterization and prepared and gathered everything she needed for the procedure. She used: one pack sterile gloves, sterile gauze swabs, sterile sheet, inco pad, urethral catheter, urinary drainage bag, 0.5% chlorhexidine solution, 10mL saline solution, 10mL syringe and a catheter pack which includes sterile cotton balls, two sterile containers and two sterile forceps. She put everything she was going to use on the bench and then proceeded to wash her hands and dry them well. Following that, the midwife opened the catheter pack carefully on a trolley while making sure not to touch the inner part of the sterile field. The package of the sterile gloves was opened and the gloves that were packaged inside were dropped onto the sterile field and she wore them. 0.5% chlorhexidine solution was poured into one of the sterile containers which contained the sterile cotton balls. An inco pad and sterile sheet were put underneath the buttocks of the patient. On the sterile field she put the catheter, opened a gauze pack and sterile container containing the cotton balls soaked in chlorhexidine. The midwife started cleaning the woman’s vulva with the forceps and the cotton balls soaked in the chlorhexidine solution whilst separating the labia with a gauze swab. She moved the cotton ball in a front to back direction, using each cotton ball only once and then grabbed it with the other forceps and put it in the unused sterile container on the trolley (used as the dirty area). Urethra was located and the lubricated catheter was inserted. The midwife never touched the catheter directly as she kept it in its original package whilst inserting it simultaneously. In the meantime, another midwife assisting her prepared the syringe with 10mL saline solution. When the catheter was inserted and urine was seen flowing, the midwife inserted the catheter an additional 4cm. Following that she inflated the balloon using the 10mL saline solution in the syringe. This is done so that the catheter remains in place. When everything was done the only thing left to do is to connect the catheter to the drainage bag. Lastly, equipment was disposed either in the general waste bag or the yellow bag. Any sharps were disposed in the sharps box.
The midwife did well in preparing and carrying out this procedure. Firstly she gathered all the items she was about to used in order to have everything in one place. This is a key step in such procedure so to have everything ready and gathered. The catheter pack was inspected beforehand making sure it was not opened and was dry, which is a very important step in preventing infection. If it was opened it would have easily been contaminated by infection causing organisms. The package was opened by only touching the outside part of the wrapper and not the sterile field. The sterile gauze swabs and the sterile gloves packet were opened on top of the sterile field so that the sterile gloves and gauze swabs fall directly on the sterile field and do not touch anything else. The midwife cleaned the woman’s genital area with 0.5% chlorhexidine solution for sterility. When doing so she used the clean hand-dirty hand technique, as she used one hand for the unused cotton ball and then utilized the other hand to remove the used cotton ball and dispose of it. During this time she also used a clean area and a dirty area. The clean area was where she had the sterile sheet. On this sterile sheet she put the sterile container containing the cotton balls soaked in the chlorhexidine solution. The dirty area was located on the trolley, where there was another container in which the used cotton balls could be disposed of. Apart from that, she also used the bottom shelf of the trolley as a place where to dispose used packages, as she then threw everything away in the general waste bag at the end of the procedure.
The midwife carried out good infection prevention techniques, but I believe that some things could have been done more attentively. Before procedure started neither the bench nor the trolley were cleaned. The trolley was used before hand in the epidural procedure. Even though the equipment used in catheterization did not directly touch the bench or trolley as they were put on a sterile field, they should have been both cleaned with soap and water as this was an aseptic and invasive procedure. Apart from that, hands were not properly washed as how the World Health Organisation (W.H.O) recommends. The W.H.O’s step by step hand washing is vital before this aseptic procedure. Quick hand washing may result in skipping areas in your hands, leaving them contaminated, or else contaminating them afterward either when closing the tap or when petting them dry. An apron was not worn by the midwife, therefore there wasn’t any barrier from the midwife and the patient. Wearing an apron is important as it not only protects the person doing the procedure, but also protects the patient. Moreover, use of alcohol hand rub was minimal, especially before opening any sterile package.
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