The Fourth Edition of the Best Practice Guide (2019/20) has been developed as a tool for commissioners, continence leads and those involved with the care pathway for patients with continence problems. It reflects our growing work in infection prevention and alignment with the antimicrobial resistance (AMR) agenda. It contains examples of best practice in continence care and catheter management, as a way of preventing UTI and CAUTI which are leading drivers of AMR and calls on the Government to do more to recognise this link.
The Guides aims to transform continence care through sharing best practice. It provides a constructive platform for decision makers across the NHS, government and political parties to ensure the goal of a better system of continence care becomes a reality.
How the Guide was produced
The Best Practice Guide was first launched in November 2015 and the fourth edition of the Guide was launched at the UACC Annual Parliamentary Reception in February 2020. This edition reflects the Committee’s alignment with the Government’s ambition on Infection Prevention Control (IPC) and Antimicrobial Resistance (AMR). The Guide recognises the importance of alignment with these issues, particularly given that failed treatment of the most common infections, including Urinary Tract Infections (UTIs), is a leading and increasing cause of AMR. Data from 2016 showed that for every 100,000 persons, 73 of them acquired an e-coli bacteraemia; 47% of those infections were from UTIs. Of these UTI infections a significant number are associated with catheter.
As such, correct catheter management can help reduce UTIs and in turn helps reduce antimicrobial usage, helping to tackle AMR. The updated Best Practice Guide is about highlighting the clear link between poor standards of catheterisation, UTIS and in turn unplanned admissions into secondary care. The Best Practice Guide is a tool to share and promote these examples of continence care best practice to improve patients’ lives.
Recommendations of the Fourth Edition Best Practice Guide:
The following recommendations have been made to improve patient outcomes, and we are continuously working to ensure these are adopted and utilised:
The Government should do more to recognise the link between urinary tract infections (UTIs) and antimicrobial use. We call on the Government to support initiatives to reduce unnecessary antibiotic use as a way to address antimicrobial resistance (AMR).
A nationally run educational campaign promoting the correct use and management of urinary catheters, with a particular focus on community and primary care settings.
NHS England/Improvement should work with collaborative bodies such as the UACC to ensure best practice is shared across the UK.
There should be training opportunities for health care practitioners to learn about best practice regarding the management of catheters, with a focus on reducing catheter-associated urinary tract infections (CAUTIs) thereby reducing infections and antimicrobial prescription.
A national public health campaign promoting bladder health should be initiated and there needs to be overall better signposting of information for patients.
GPs should be comfortable asking questions to patients presenting with symptoms of urinary incontinence and should instigate a patient management plan. As a part of this, they should use a standardised pathway for care to rule out of ‘red flags’.
There should be a financial incentive to diagnose incontinence issues in patients and instigate a patient management plan, such as a Quality Outcomes Framework (QOF).
Bladder ultrasound scanning should be used as the first choice to help a healthcare professional make an informed decision about the clinical management of a patient presenting with urinary bladder complications. A business case for scanners can be downloaded from the Online Toolkit.
Intermittent catheterisation (IC) should be the method of choice to drain retained urine wherever feasible.
All relevant healthcare environments should invest in appropriate staff training in catheterisation, which could include e-learning.
All Trusts should promote the use of catheter passports. A template catheter passport can be downloaded from the Online Toolkit.
Every Trust should have one named person responsible for continence. This continence lead should be responsible for promoting education and training.
GPs should receive training on the different continence products available and/or refer to community continence teams where the specialist knowledge is based.
Patient management systems should be used to improve prescribing, patient care and quality of life whilst reducing cost.
There should be a financial incentive to diagnose incontinence issues in patients and instigate a patient management plan, such as a Quality Outcomes Framework (QOF).