© Evereth Publishing, 2018
ANTISEPTIC NONTOUCH TECHNIQUE PROFILAKTYKA ZAKAŻEŃ
ZWIĄZANYCH Z ZAŁOŻONYM CEWNIKIEM MOCZOWYM
ANTISEPTIC NONTOUCH TECHNIQUE ANTT PREVENTION OF CATHETERASSOCIATED URINARY
TRACT INFECTIONS
Infection Prevention and Control Team, Galway University Hospital,
Saolta Health Care Group, New Castle Road, Galway, Ireland, e-mail: profilaktykazakazenszpitalnych
@gmail.com Wpłynęło: 28.07.2018 Zaakceptowano: 10.08.2018 DOI: dx.doi.org/10.15374/FZ2018036 STRESZCZENIE: Zakażenia układu moczowego należą do jednych z najczęściej
występują-cych postaci zakażeń szpitalnych, z których nawet do 80% związanych jest z założonym cew-nikiem moczowym. Niniejsza praca jest skierowana do pracowników medycznych we wszyst-kich placówkach opieki zdrowotnej; przedstawiono w niej przegląd wytycznych dotyczących zapobiegania zakażeniom układu moczowego związanym z założonym cewnikiem moczo-wym. Wytyczne oparte są na ocenie obecnie dostępnych dowodów.
SŁOWA KLUCZOWE: ANTT, pielęgnacja cewnika moczowego, wytyczne, zakażenia układu moczowego
ABSTRACT: Urinary tract infections (UTIs) are one of the most frequently occurring nosoco-mial infections, eighty percent of which are related to a catheter placed in urinary tract. These recommendations are directed to medical workers in all healthcare facilities and present the guidelines concerning prevention of catheter-associated UTIs. The guidelines are based on the assessment of currently available evidence.
KEY WORDS: ANTT, guidelines, urinary tract catheter care, urinary tracts infections
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Materiał Rekomendowane zastosowanie Zalety Wady
Polichlorek winylu
Polichlorek winylu, cewnik bez balonu
Tylko do zastosowania krótkotermino-wego
Szerokie światło umożliwiają-ce szybki przepływ
Nadaje się do jednorazowego użytku do podawania leków
Sztywne i nieelastyczne, co może powo-dować dyskomfort u pacjenta Teflon pokryty lateksem Krótkoterminowo, do 28 dni Bardziej gładka zewnętrzna
powierzchnia, co ułatwia zało-żenie cewnika
Nieodpowiedni dla pacjentów uczulo-nych na lateks
Powłoka teflonowa może zrobić się cienka, jeśli cewnik pozostanie założo-ny na dłużej
Silikon Długoterminowo, do 12 tygodni Szerokie światło drenażu może zmniejszyć ryzyko in-krustacji
Odpowiedni dla pacjentów z alergią na lateks
Może wystąpić trudność z usunięciem cewnika, jeśli stosuje się go jako cewnik nadłonowy ze względu na „mankieto-wanie” balonu
Lateks powlekany hydrożelem Długoterminowo, do 12 tygodni Może zmniejszać tarcie na błonie śluzowej cewki moczo-wej podczas zakładania Może zmniejszyć potencjał in-krustacji
Nieodpowiedni dla pacjentów z aler-gią na lateks
Lateks pokryty elastomerem silikono-wym (silikonowe łączenie z zewnętrz-ną i wewnętrzzewnętrz-ną powierzchnią)
Długoterminowo, do 12 tygodni Może pomóc w zmniejszeniu możliwości inkrustacji Może zmniejszać podrażnie-nie błon śluzowych
Nieodpowiedni dla pacjentów z aler-gią na lateks
Silikon pokryty hydrożelem Długoterminowo, do 12 tygodni Może zmniejszać tarcie bło-ny śluzowej cewki moczowej podczas zakładania cewnika
Odpowiedni dla pacjentów z alergią na lateks
© Evereth Publishing, 2018
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Sposób przygotowania krocza przed cewnikowaniem Wytyczne
Używanie sterylnych rękawiczek, serwet, gąbek, odpowiedniego antyseptycznego lub sterylnego roztworu do oczyszczenia cewki moczowej oraz lubrykantu w jednorazowym opakowaniu do zakładania cewnika moczowego
Wytyczne CDC: Guideline for prevention of catheter-associated urinary tract infections – Healthcare Infection Control, Practices Advisory Committee (HICPAC), 2009 [7]
Przed wprowadzeniem cewnika okolicę cewki moczowej należy oczyścić zgodnie z lokal-nymi wytyczlokal-nymi lub procedurami (na przykład przy użyciu sterylnej soli fizjologicznej)
Wytyczne NICE: Infection prevention and control. Quality state-ment 4: urinary catheters – National Institute for Health and Care Excellence, 2014 [70]
Do oczyszczenia ujścia cewki moczowej należy użyć sterylnego roztworu soli fizjologicz-nej lub sterylfizjologicz-nej wody. Stosowanie roztworu antyseptycznego w porównaniu ze steryl-ną solą fizjologiczsteryl-ną do przygotowania ujścia cewki moczowej przed założeniem cewni-ka pozostaje nierozwiązane
Health Protection Surveillance Centre: Guidelines for the preven-tion of catheter-associated urinary tract infecpreven-tion, 2011 [71] Przed założeniem cewnika należy umyć ujście cewki moczowej, używając sterylnego
roztworu soli fizjologicznej
epic 3: national evidence-based guidelines for preventing health-care-associated infections in NHS hospitals in England, 2014 [72]
Używanie sterylnych rękawiczek, serwet, gąbek, odpowiedniego antyseptycznego lub sterylnego roztworu do oczyszczenia cewki moczowej oraz lubrykantu w jednorazowym opakowaniu do zakładania cewnika moczowego
Strategies for prevention catheter-associated UTI in acute care ho-spitals Society for Healthcare Epidemiology of America (SHEA) and Infectious Diseases Society of America (IDSA), 2014 [73] Przed założeniem cewnika moczowego zaleca się dokładne umycie wodą z mydłem
okolicy ujścia cewki moczowej, a następnie przemycie jałowym roztworem soli fizjolo-gicznej lub jałową wodą przy użyciu jałowego gazika albo gąbki
Stosowanie antyseptyków do przygotowania okolic ujścia cewki moczowej przed cew-nikowaniem pozostaje kwestią nierozwiązaną ze względu na brak badań oceniających skuteczność takiego postępowania w profilaktyce zakażeń układu moczowego związa-nych z założonym cewnikiem moczowym
Strategia zapobiegania lekooporności w oddziałach intensyw-nej terapii. Rekomendacje profilaktyki zakażeń w oddziałach in-tensywnej terapii – Narodowy Program Ochrony Antybiotyków, 2013 [35]
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KONFLIKT INTERESÓW: nie zgłoszono.
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