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An effective and acceptable cleaning method for re-use of catheters for intermittent catheterisation (IC)
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
217
An effective and acceptable cleaning method for re-use of catheters for intermittent catheterisation (IC) Eur Urol Suppl 2017; 16(3);e375
Wilks S.1, Morris N.2, Delgado D.2, Prieto J.1, Moore K.3, Macaulay M.4, Fader M.1 1
University of Southampton, Dept. of Health Sciences, Southampton, United Kingdom, 2Bristol Urological Institute, Dept. of Learning and Research, Bristol, United Kingdom, 3University of Alberta, Faculty of Nursing, Alberta, Canada, 4University College London, Continence & Skin Technology Group, London, United Kingdom INTRODUCTION & OBJECTIVES: In the UK, IC catheters are licensed for single use. In some equivalent countries, community dwelling IC users typically re-use their catheters (multi-use). Concerns raised about UTI rates with reused catheters are not supported by evidence (1). If catheters are reused, users and clinicians must be confident that re-use is safe. In this study, we aimed to test potential cleaning methods for uncoated PVC catheters and conduct clinical testing. MATERIAL & METHODS: 1. Laboratory testing: 2 cm sections of uncoated PVC catheters (tip, shaft, funnel) were exposed to known concentrations of bacterial uropathogens in artificial urine over 0, 3, 6, 24 h followed by 6 cleaning methods (steam, boiling, ultrasonic, vinegar, soap & water or sodium hypochlorite soak (Milton) plus a tap water rinse control. Each method was assessed for effectiveness via culture. Episcopic differential interference contrast microscopy (EDIC-M) was used to show biofilm development and surface changes. 2. Clinical testing: The most effective and acceptable methods were then used by IC users at home (16 m; 13 w). Cleaning instructions were provided by a nurse expert. Catheters were cleaned and re-used in a step-wise manner from one clean/re-use to maximum of 28 cycles and returned for repeated analysis. Catheter urine specimens were taken at baseline and prior to each cycle increment. Culture analysis on selective chromogenic agar provided quantification of culturable population and species identification.
: RESULTS: 1. Laboratory testing: EDIC-M showed attachment of bacteria in control samples (tap water rinse). Milton soak, steam and boiling were the most effective at removing uropathogens. Heat-based cleaning treatments caused surface damage and were less acceptable to IC users. Soap & water and soap & water plus Milton soak (Milton Method) were thus selected as the most effective and acceptable methods for clinical testing. 2. Clinical testing: Initial testing at home showed cleaning with Milton Method to be the most effective and was therefore adopted for subsequent testing (up to 28 re-uses). Urine specimens indicated a high degree of bacterial contamination prior to re-use of catheters. Culturable bacteria following cleaning were found on < 10% of samples but, where present, tended to be the same species found in the urine and included E. coli, Enterococcus faecalis, Klebsiella pneumoniae and Staphylococcus aureus. EDIC-M showed no visible damage to catheters and no evidence of biofilm
Eur Urol Suppl 2017; 16(3);e375
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
217
An effective and acceptable cleaning method for re-use of catheters for intermittent catheterisation (IC) Eur Urol Suppl 2017; 16(3);e376
formation. The effectiveness of Milton Method continued with up to 28 re-uses. CONCLUSIONS: Milton Method was effective and acceptable to IC users at home and could be the foundation of a mixed package of multi and single use. Further research is required to test the method in a multi-centre trial. (1) Prieto. Cochrane 2014 doi: 10.1002/14651858.CD006008.pub3
Eur Urol Suppl 2017; 16(3);e376 Powered by TCPDF (www.tcpdf.org)
217
An effective and acceptable cleaning method for re-use of catheters for intermittent catheterisation (IC) Eur Urol Suppl 2017; 16(3);e375
Wilks S.1, Morris N.2, Delgado D.2, Prieto J.1, Moore K.3, Macaulay M.4, Fader M.1 1
University of Southampton, Dept. of Health Sciences, Southampton, United Kingdom, 2Bristol Urological Institute, Dept. of Learning and Research, Bristol, United Kingdom, 3University of Alberta, Faculty of Nursing, Alberta, Canada, 4University College London, Continence & Skin Technology Group, London, United Kingdom INTRODUCTION & OBJECTIVES: In the UK, IC catheters are licensed for single use. In some equivalent countries, community dwelling IC users typically re-use their catheters (multi-use). Concerns raised about UTI rates with reused catheters are not supported by evidence (1). If catheters are reused, users and clinicians must be confident that re-use is safe. In this study, we aimed to test potential cleaning methods for uncoated PVC catheters and conduct clinical testing. MATERIAL & METHODS: 1. Laboratory testing: 2 cm sections of uncoated PVC catheters (tip, shaft, funnel) were exposed to known concentrations of bacterial uropathogens in artificial urine over 0, 3, 6, 24 h followed by 6 cleaning methods (steam, boiling, ultrasonic, vinegar, soap & water or sodium hypochlorite soak (Milton) plus a tap water rinse control. Each method was assessed for effectiveness via culture. Episcopic differential interference contrast microscopy (EDIC-M) was used to show biofilm development and surface changes. 2. Clinical testing: The most effective and acceptable methods were then used by IC users at home (16 m; 13 w). Cleaning instructions were provided by a nurse expert. Catheters were cleaned and re-used in a step-wise manner from one clean/re-use to maximum of 28 cycles and returned for repeated analysis. Catheter urine specimens were taken at baseline and prior to each cycle increment. Culture analysis on selective chromogenic agar provided quantification of culturable population and species identification.
: RESULTS: 1. Laboratory testing: EDIC-M showed attachment of bacteria in control samples (tap water rinse). Milton soak, steam and boiling were the most effective at removing uropathogens. Heat-based cleaning treatments caused surface damage and were less acceptable to IC users. Soap & water and soap & water plus Milton soak (Milton Method) were thus selected as the most effective and acceptable methods for clinical testing. 2. Clinical testing: Initial testing at home showed cleaning with Milton Method to be the most effective and was therefore adopted for subsequent testing (up to 28 re-uses). Urine specimens indicated a high degree of bacterial contamination prior to re-use of catheters. Culturable bacteria following cleaning were found on < 10% of samples but, where present, tended to be the same species found in the urine and included E. coli, Enterococcus faecalis, Klebsiella pneumoniae and Staphylococcus aureus. EDIC-M showed no visible damage to catheters and no evidence of biofilm
Eur Urol Suppl 2017; 16(3);e375
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
217
An effective and acceptable cleaning method for re-use of catheters for intermittent catheterisation (IC) Eur Urol Suppl 2017; 16(3);e376
formation. The effectiveness of Milton Method continued with up to 28 re-uses. CONCLUSIONS: Milton Method was effective and acceptable to IC users at home and could be the foundation of a mixed package of multi and single use. Further research is required to test the method in a multi-centre trial. (1) Prieto. Cochrane 2014 doi: 10.1002/14651858.CD006008.pub3
Eur Urol Suppl 2017; 16(3);e376 Powered by TCPDF (www.tcpdf.org)