Avoiding Urinary Tract Infections - Part 2

Posted by Nurse Linda in Life After Paralysis on June 24, 2020 # Health

This blog is a continuation of ideas to avoid urinary tract infections. Part 1 appeared on June 17, 2020 which was a review of techniques. This blog, part two extends further into daily life.

Changing TechniqueCatheter

If you have multiple bladder infections that are documented by your healthcare provider within a timeframe, your insurance may authorize a different urine collection system for you. This typically works within intermittent catheterization where you might be eligible for touchless catheters or a sterile intermittent catheter system. These catheterization systems are much more expensive which is why you must qualify. The process works with private insurance as well as Medicaid. Check in your policy manual to see the parameters specified by your individual policy. Your insurance nurse case manager should also be able to direct you. Even though this is a great option, you want your goal to be to avoid infection altogether and hopefully will not collect enough infections to need it.

If you use clean catheter technique, you can modify your equipment on your own by purchasing sterile gloves. Catheters are packaged sterile or extremely clean. Most of you have half of a sterile system already with just the catheter. You can use non-sterile gloves as well as they might be cleaner than your hands. Non-sterile gloves can be put on just before catheterization, not before you push your chair or transfer. Good hand washing technique needs to be done even if you use gloves.

Lubricant placed on the catheter is extremely important to ensure a smooth entry into the bladder. Be sure you use water soluble lubricant as other substances tend to clog in the urethra creating a seal which can breed bacteria. Water is not an acceptable lubricant as it does not provide the glide needed for the catheter and water use can make small cuts in the urethra. Any opening in the skin or mucous tissue can create an opening for bacteria to enter. A small opening in the lining of the urethra can leak body fluid into the urethra that can harbor bacteria then enter the body or the bladder.

Drop lubricant onto the catheter. NEVER put the catheter into the tube of lubricant as you will have contaminated the entire tube. Don’t let the rim of the lubricant tube touch the catheter. It can be loaded with bacteria that you could then put into your bladder.

Remember, a catheter that touches any part of your body, clothes, bed, chair, toilet, or anything other than your urethra is contaminated with bacteria. It is no longer safe for entry into your bladder.

Males that have an erection when starting the catheterization process need to wait until the erection resolves before inserting the catheter into the urethra. Erections are caused by blood flow to the penis. This blood flow will cause the urethra to become constricted making the catheter more difficult to pass. The constriction can lead to trauma to the urethra making small cuts which become open areas for bacteria to enter. If you have erections at every catheterization time, talk to your healthcare provided about medication to resolve the stimulation response. This is not a sexual response but one of misinterpreted messages to the brain. It can be common in men with cervical or thoracic injury as an indication of too much tone (spasticity).

Hygiene

Before and after catheterization, you need to clean your hands. Notice when you are washing your hands. This should be done immediately prior to gloving with sterile technique or catheterization in clean technique. If you wash your hands and then transfer, propel your chair, adjust your clothes, or touch anything, your hands are no longer clean.

Wash your hands with warm water, soap, and friction for 20 seconds. If water and soap are not available, hand sanitizer can be used. When outside of your home or work, you can bring a clean, wet paper towels with soap in a self-closing plastic container and wet paper towels in another bag that are wet, without soap for rinsing. Baby wipes or adult toilet hygiene wipes are another alternative.

It is very important to rinse soap or skin cleaner. These products are extremely drying to the urethra which can cause small openings where bacteria can enter. A dry urethra develops cracks or cuts that bacteria can enter. Soap can irritate the urethra producing internal redness and swelling. It can also be carried into the urethra as you catheterize. Cleaning as well as rinsing can reduce drying the delicate urethral tissue.

Today, most individuals are provided with catheters that are used one time and then disposed. Some might have reusable red rubber catheters, especially if you have been at this for a while. These can be sterilized according to the process you were taught. Boiling the catheters is the usual technique. Boiling must be at a rolling boil for 10-12 minutes. Keep the catheter covered to prevent bacteria from contaminating it. A clean pillowcase is a good storage as it allows the catheter to dry while keeping the catheter clean.

Females must be particularly careful of their hygiene prior to catheterization. The labia must be cleaned. Remember, bacteria love to live in warm, moist, dark areas of the body. The female labia fit this description perfectly. To catheterize, the labia need to be separated with one hand to expose the urethral opening. If the labia close for any reason, you will need to start over as the area is now re-contaminated. The rest of the catheterization procedure is performed completely with the other hand. The labia cannot be closed until the catheterization process is completed and the catheter is removed. There are devices that can be purchased to keep the labia open. They should be cleaned between uses.

Input

What you take into your body affects your urine output. You need to take fluid in as dehydration can lead to bladder infection. You always want your urinary system to be flushing out. Too much fluid leads to incontinence. Discuss with your healthcare provider the amount of fluid you should be taking in. Some healthcare issues can affect the amount of fluid that should be ingested. The amount of fluid intake for children will vary based on their size.

Intake of fluid should be slowly over the day. Big amounts of water lead to big dumps of fluid in your bladder. Smaller but consistent intake of fluid across time, still reaching your intake goal, is helpful to avoid overfilling or underfilling your bladder between catheterizations. Women’s bladder capacity is 350ccs of urine on average, males hold 400-450cc. This is between one and a half to two cups of urine. If your output of urine at catheterization time is greater, you might be overstretching your bladder.

Water is the best fluid to take in as it does not have any other substances in it. If you have well water as your source, call the public health department to have the quality of your water checked periodically. You need to be sure your source of water is clean. Most public water systems are checked on a routine schedule. Private well water is not.

You certainly can drink other fluids. Be careful of moderation to maintain your bladder capacity. Coffee or tea, although helpful in the bowel program, are diuretics which will create urine more quickly in your bladder. Soda contains caffeine as well as sugar or sugar substitute. Soda and energy drinks fill the bladder quickly. Sugar, or sugar substitute are a bacteria food favorite. These drinks often contain sodium or salt that can cause your body to retain fluid in the cells instead of that fluid passing out through your bladder.

Alcohol dehydrates your body. Large amounts of alcohol will pass through your body quickly as it takes fluid out of your cells. Your bladder can accommodate a small amount of alcohol, but larger amounts will lead to an overstretched bladder or urinary incontinence.

Medication

Medication can affect your urine output. Diuretics can cause large amounts of urine to develop quickly in the bladder. You might need to empty your drainage bag more often if you have an indwelling or external catheter. Those that use intermittent catheterization will notice when your body is responding to the diuretic by the amount of urine removed when you catheterize. You might need to catheterize closer to the four-hour mark with diuretic treatment.

Some medications will affect your urine output by amount or even color. Know your medications to be aware that changes in your urinary output that can occur. Even knowing a medication can affect urine color, it is always a surprise to see it.

Most people are aware that smoking can lead to lung cancer. However, smoking can lead to a variety of cancers including bladder cancer which is second to lung cancer in smoking caused occurrence. The nicotine and other chemicals from smoking are removed from the body in urine. Since urine sits in the bladder until it is removed, time allows the smoking residues to irritate the bladder which can lead to infection and even cancer.

Antibiotics are the treatment for urinary tract infections. Different antibiotics were developed to treat specific types of infections. If you think you have a urinary tract infection, you will want to have a urinalysis done. If infection is present, the urine is then tested by a culture and sensitivity test to determine which antibiotic will treat your specific infection. You may be placed on an antibiotic with the first sign of infection but once the culture and sensitivity tests are completed in three days, the antibiotic might be changed to better treat your specific infection.

Taking the entire prescription of antibiotic is critically important. Antibiotics are developed to rid specific bacteria. If you stop taking the antibiotic before the prescription is completed, the bacteria will still be present but will have learned to mutate into something else making it even more difficult to resolve. You might feel better during the course of the prescription, but the bacteria are still there until the end of the prescription time. Antibiotics are designed to kill bacteria within the timing of the entire prescription.

Treating an infection early is critical as many bacteria can be treated early in an infection. Waiting gives time for the bacteria to become stronger, mutating along the way. It is easier to treat a new infection than an established one. Of course, avoiding an infection is best.

Some people have used supplements in an attempt to change the acidity of their urine. Cranberry juice was popular in years past, but the sugar content was overwhelming. Bacteria love to live on sugar. Also, insulin resistance can be an issue for individuals with spinal cord injury, so the added sugar was not beneficial to general health or the bladder. Currently, there is no scientific evidence that this is effective. Then cranberry powder tablets were tried but that was also unsuccessful. Today there are new cranberry and sugar products on the market. These were not effective previously so we will have to see if the new formulation is helpful. If you use these, you can purchase urine pH strips to check the acidity of your urine. This will help you to evaluate the product.

Movement

Urine in the bladder remains still if you remain still. Still urine becomes stagnant. Stagnant urine gives bacteria time to multiply, connect with other bacteria and to attach to the bladder wall. This creates an environment for bacteria to proliferate.

If you move your body, through rolling in bed, pressure releases, range of motion activities and exercise, you are also moving your bladder which disrupts the clumping of bacteria. A lone bacterium or two have a more difficult time in connecting with other bacteria when the bladder vessel is frequently shaken.

Immunosuppression

Individuals with spinal cord injury have a compromised immune system. This is due to a slow acting autonomic nervous system (ANS). The autonomic nervous system is the part of the nervous system that controls automatic functions of the body such as your heart beating, breathing and bowel moving. It also controls the body’s response to infection. A slowed ANS could result in a slowed reaction to responding to the infection or an ineffective ability to respond to the infection. Added challenges such as lack of movement, catheterization, and a compromised respiratory system leads to a less active immune system.

Keeping the immune system healthy is critical. The immune system can be enhanced by following a healthy diet, moving your body including the body below the level of injury, stopping smoking, vaping, or other recreational inhalations, and learning to control stress.

Hopefully, some of these ideas will help you avoid an infection. Many people with spinal cord injury have urinary tract infections, some just a few, some a lot, and even others never have one. Infection risk has a lot to do with your genetic makeup, overall health, and level of injury.

Some of these ideas should help you reduce the number of infections that you acquire. Do what you can to help yourself but remember, even if you are doing everything to avoid it, an infection can still develop. Some people get more infections as they age, with or without a spinal cord injury. Nurse Linda

Pediatric Consideration: Doing all the activities needed to maintain health is difficult for everyone. Children can easily become overwhelmed with all the needs and rules. Many of the prevention measures can become routine through daily living and by setting examples. For instance, offering healthy meals should be a family lifestyle, not something for just one family member. Learning to deal with stress is something all parents should teach every child. Teaching your child to care for themselves is a parenting task. Making the situation normal for everyone is ideal. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.