Benefits of the Insertion Tip and Closed-System Sleeve for Intermittent Catheterization

Purpose: Typically performed several times a day, intermittent catheterization (IC) is considered a generally safe and effective method for emptying the bladder and can be used on a short or long term basis as needed. Due to the potential risk of introducing bacteria into the urethra, recurrent urinary tract infections may occur even with appropriate hand washing and disinfection of the insertion site. In patients who routinely self-catheterize, catheter-associated urinary tract infections can be a serious problem. The purpose of this in vitro study was to assess the effectiveness of a closed system, which has a sleeved, pre-lubricated catheter with an insertion tip, in reducing bacterial transfer during the catheterization procedure. Materials and Methods: Nine catheters of each of two types were tested: Bard Touchless Plus Intermittent Catheter (14 Fr.) and Coloplast Self-Cath Intermittent Catheter (14 Fr.). The Bard Touchless Plus Intermittent Catheter incorporates an introducer tip and a closed system no-touch sleeve, while the Coloplast Self-Cath Intermittent Catheter consists of the catheter alone. Two tests were conducted to assess the effectiveness of these two design elements on the reduction of bacterial transfer during the catheter insertion procedure compared to the standard catheter. The first study (insertion tip test) measured the contamination of the catheter tip due to contamination from the user’s urethral meatus compared to the Bard Touchless Plus Intermittent Catheter with an insertion tip. The second study (closed system sleeve test) measured the contamination of the bare catheter shaft due to transfer from the user’s hands compared to the Bard Touchless Plus Intermittent Catheter with a no-touch sleeve. After completing simulated catheter insertion, sections of catheters were tested to determine the colony count of P. aeruginosa on the catheter after exposure to the contamination. Results: After the Insertion Tip test, the average colony count was 1.8 CFU/mL and 22.0 CFU/mL for the Bard Touchless Plus Intermittent Catheter and the Coloplast Self-Cath Intermittent Catheter, respectively. After the Closed System Sleeve test, the average colony count was 0.0 CFU/mL and 143.3 CFU/mL for the Bard Touchless Plus Intermittent Catheter and the Coloplast Self-Cath, respectively. Conclusions: In vitro studies suggest that incorporation of an insertion tip and a closed-system sleeve, as in the Bard Touchless Plus Intermittent Catheter system, reduces bacterial contamination of an intermittent catheter during the catheterization procedure. Further testing is required to determine if these in vitro findings have any impact on clinical outcomes.