Catheterization: Sterile Technique vs Clean Technique
January 25, 2018
Catheterization: Sterile Technique vs. Clean Technique
On January 23, 2018, I reported to Lyle Torrant School for my community clinical. While orienting to the school, I notice the many different types of students, requiring many different levels of medical and physical assistance. The students ranged from high functioning (with minimal assistance needed) to complete medical and physical dependence. While assigned to my classroom, I observed a catheterization of a teenager with Cerebral Palsy and noticed that sterile technique was not used. This raised the following question: Are pediatric patients requiring urinary catheterization, at an increased risk for UTI’s, using clean technique versus sterile technique?
Since starting the nursing program at Jackson College, I have been taught sterile technique is the best way to avoid UTI’s. When I saw Dave, a caregiver at the school, using what appeared to be a clean technique, I was kind of confused. I should have asked him for clarification right then and there, but with so much going on around me, I didn’t. I decided to look into it when I got home, and found some interesting facts regarding catheterization and sterile technique versus clean technique.
In a recent article, a randomized controlled study was performed using 122 pediatric patients whom met the sample selection criteria. These students were divided into three groups. Group one was cleaned with povidone iodine before catheterization, group two was cleaned with chlorhexidine, and group three was cleaned with water. The results of the study showed group one had a 15% infection rate, while group two had 4.8%, and group three had 7.5% (Duzkaya, Uysal, Yakut, & Citak, 2014/2014, p. 64). I was surprised at the results, I expected the povidone iodine to be much lower, and the water to be much higher.
While continuing to research this subject, I discovered another article talking about sterile vs. clean technique. As I read the article, I was reminded that your home is considered a sterile environment to you, a lesson I learned in fundamentals of nursing class. The bacteria growing there, you have built a tolerance to (“Catheterizing: Clean vs. sterile,” 2015). I think this would apply to a school environment as well, since they are there five days a week.
While watching Dave get ready to do the catheter, I was surprised that there weren’t any alcohol wipes or antiseptic soap used to clean the penis before catheter insertion. He used what appeared to be a baby wipe. I talked to my wife, who is an RN, about the procedure I watched. I explained how this went against everything I’ve been taught so far. She talked to me about our niece who is in a wheelchair and needs to be catheterized every four hours. She explained how the catheterization was done using a clean technique and baby wipes were an acceptable cleaning product before insertion (M. Fry, personal communication, January 25, 2018).
In addition, to clean vs. sterile, I learned that catheters are reused multiple times. Some insurance companies will only pay for four catheters a month. Some catheters are sterilized by placing them in a microwave oven, while others are sterilized using isopropyl alcohol, bleach/water mix or a betadine/water mix at home (Tobias, 2017, p. 273). I was surprised to discover these techniques.
In conclusion, as a student nurse, knowing the urethra and bladder are sterile, I thought sterile technique was the only way to catheterize someone. Through this clinical experience, followed up by research, I’ve learned that that is not the case. By completing this assignment, I have gained a better understanding of clean versus sterile technique and the human body.
Catheterizing: Clean vs. sterile. (2015). Retrieved from http://www.spinalcordinjury-paralysis.org
Duzkaya, D. S., Uysal, G., Yakut, T., & Citak, A. (2014). A randomized controlled trial: Povidone iodine, chlorhexidine or water for periurethral cleaning before urinary catheterization in pediatric intensve care. The World of Critical Care Nursing , 9(3), 64. Abstract obtained from WFCCN World Congress. Antayla, Turkey, 13-15, 2014, .
Tobias, N. E. (2017, November-December). Practical considerations and current best practice for pediatric clean intermittent catheterization. PEDIATRIC NURSING, 43(6), 267-274. Retrieved from http://web.b.ebscohost.com.ezproxy.jccmi.edu