Chijioke Iremeka
Medical experts say patients undergoing catheter-based treatment face heightened risks of developing sepsis, and kidney and bladder infections among other complications in major organs of the body including the brain.
They warned that insertion, maintenance, and removal of catheters in medical procedures should follow the recommended standard practice and a well-established antiseptic hygiene to avert these risks.
The physicians cautioned that this procedure has a high risk of introducing germs directly to the bloodstream of patients, especially the very sick ones, who have compromised immune systems and harped on best hygiene practices.
While calling for compliance with the ethical standard in handling catheters, they warned that when a catheter stays in the body for a few days or weeks, it is very likely for bacteria to get into the bladder, causing infections.
However, in a bid to reduce these catheter-related infections, the World Health Organisation published the first-ever global guidelines to prevent the occurrence of the bloodstream and other infections caused by the use of catheters placed in minor blood vessels during medical procedures.
According to the global health body, poor practices in the insertion, maintenance, and removal of these catheters carry a high risk of introducing germs directly to the bloodstream, which can lead to serious conditions such as sepsis, and difficult-to-treat complications in major organs like the brain and kidneys.
The WHO pointed out that soft tissue infections at the insertion site of the catheter can also occur, noting that “up to 70 per cent of all inpatients require the use of a catheter inserted into a peripheral vein or artery, also known as peripherally inserted catheters, at some point during their hospital stay.
“People who receive treatments through catheters often are particularly vulnerable to infections, as they might be seriously ill or have low immunity.”
It estimated that between 2000 and 2018, average mortality among patients affected by healthcare-associated sepsis was 24.4 per cent, increasing to 52.3 per cent among patients treated in intensive care units.
The WHO noted that many bloodstream infections are caused by antibiotic-resistant bacterial infections, saying that it is estimated that bacterial antimicrobial resistance was directly responsible for at least 1.27 million deaths and contributed to an additional 4.95 million deaths in 2019.
“Infections associated with health care delivery represent a preventable tragedy and a serious threat to the quality and safety of health care,” said WHO Assistant Director-General for Universal Health Coverage, Life Course, Dr Bruce Aylward.
“Implementing clean care and infection prevention and control recommendations is critical to saving lives and alleviating a great deal of avoidable suffering experienced by people around the world,” he added.
PUNCH Healthwise reports that developing and implementing guidance to prevent the spread of such infections has been a key priority for WHO as the new guideline includes 14 good practice statements and 23 recommendations on key areas for health workers.
Some of the good practices and recommendations include education and training of health workers on techniques of sepsis and hand hygiene practices, insertion, maintenance, access, removal of catheters, and catheter selection.
“WHO will continue to work with countries to develop and implement best practices to reduce the occurrence of bloodstream infections in hospitals, and to ensure all patients receive safe and effective care,” the global health body added.
However, physicians, who spoke with PUNCH Healthwise in different interviews, said if a catheter stays in for a few weeks in the body, it is most likely that bacteria will get into the bladder to cause several infections.
A Consultant Surgeon at the Havana Hospital, Lagos, Dr Ngozi Okafor, said catheter-acquired urinary tract infection is one of the most common healthcare-acquired infections, saying that between 70 and 80 per cent of these infections are attributable to the use of an indwelling urethral catheter.
She said catheter-based treatment is known to cause serious infections and that if the bacteria spread to the kidneys or blood, they can make one sick.
To avoid these infections, Okafor advise that healthcare professionals follow sterile procedures while administering catheters to minimise the risk of infections and complications.
She underscored the importance of practicing good hand hygiene before catheter insertion or maintenance, combined with proper aseptic technique during catheter manipulation, protects against infections.
The consultant surgeon said proper hand hygiene can be achieved through the use of either an alcohol-based product with soap and water with adequate rinsing, insisting that sterile gloves must be worn for placement of central catheters since a ‘no-touch’ technique is not possible.
She said, “Appropriate aseptic technique does not necessarily require sterile gloves for insertion of peripheral catheters. A new pair of disposable non-sterile gloves can be used in conjunction with a ‘no-touch’ technique for the insertion of peripheral venous catheters.
“Also, education of healthcare personnel regarding the indications for intravascular catheter use, proper procedures for the insertion and maintenance of intravascular catheters, and appropriate infection control measures to prevent intravascular catheter-related infections must be adopted.
“There is the need for routine access to knowledge of and adherence to guidelines for all personnel involved in the insertion and maintenance of intravascular catheters.”
Okafor insisted that only trained personnel who have shown competence in the insertion and maintenance of peripheral and central intravascular catheters should be allowed to carry out the procedure.
She recommended that in adults, use of an upper-extremity site for catheter insertion will be required while replacing a catheter inserted in a lower extremity site to an upper extremity site as soon as possible.
“In paediatric patients, the upper or lower extremities or the scalp (in neonates or young infants) can be used at the catheter insertion site,” she added.
Speaking on the treatment, a Public Health Physician at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Dr Okechukwu Okonkwo, said treatment of a urinary catheter infection requires some medical tests to first establish it.
He explained, “If you get a kidney or blood infection from a catheter, you will need antibiotics to treat it but if a urine test is carried out and it comes out positive but the bacteria that infected the patient doesn’t make him sick, it is usually safer not to take antibiotics.
“Antibiotic prophylaxis with trimethoprim-sulfamethoxazole on urinary catheter removal significantly reduces the rate of symptomatic urinary tract infections and bacteriuria in patients undergoing abdominal surgery with perioperative transurethral urinary catheters.”
Meanwhile, a study published in the National Library of Medicine by Dr Barbara Trautner and Dr Rabih Darouiche titled, ‘Catheter-Associated Infections’, listed two most common causes of bloodstream infections.
The authors noted that biofilm formation on the surfaces of indwelling catheters is central to the pathogenesis of infection of both types of catheters, saying that the cornerstone of any preventive strategy for intravascular catheter infections is to pay strict attention to infection control practices.
The study read in part, “Indwelling intravascular and urinary catheters are essential components of modern medical care. Unfortunately, indwelling devices significantly increase the risk of iatrogenic infection, particularly in an already fragile patient population.
“Most nosocomial infections in severely ill patients are associated with the very medical devices that provide life-sustaining care. For example, a recent survey of medical intensive care units in the United States revealed that 87 per cent of primary bloodstream infections were associated with central lines, and 95 per cent of urinary tract infections were catheter-associated.
“The organisms that colonise an intravascular device and subsequently disseminate into the bloodstream, causing bloodstream infection, can gain access to the device through four different routes including invasion of the skin insertion site, contamination of the catheter hub, haematogenous spread from a distant site of infection, or infusion of contaminated fluid through the device.
“The first two sources of infection are by far the most important. The skin site and the catheter hub can become contaminated by the patient’s endogenous skin flora and by exogenous flora carried on health care workers’ hands.”
According to the study, while organisms that gain access through the skin insertion site tend to migrate along the external surface of the catheter, organisms inoculated into the hub migrate along the internal lumen of the catheter.
“Strategies to prevent catheter-associated infections can significantly reduce morbidity, mortality, and health care costs including good and safe antiseptic techniques and hygiene,” the study added.
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