Closed urine-drainage system
The establishment of a closed urine-drainage system minimises
ascending microorganism contamination of the catheter lumen.
This is achieved by connecting an indwelling catheter to a valve
or a sterile drainage bag, usually a leg bag (Mangnall, 2011).
This system should only be broken when the valve or the leg
bag is changed (generally every 5–7 days or as recommended
by the manufacturer) unless clinically indicated e.g. the leg
bag is damaged or malodorous (NCGC, 2012). Research by
Moody and McCarthy (2015) into experiences of leg-bag users
suggested that, especially in the summer or during a urinary
tract infection, odour can become more of a problem.
If a night-drainage bag is required, it is attached to the
outflow of the leg bag and the leg-bag tap is opened. The
majority of valves allow a drainage bag to be attached,
allowing night drainage or leg-bag use should the release of
a valve during the night be inconvenient (NCGC, 2012).
Bard Medical manufacture PreConnect, catheters which
are already attached to a leg or bed bag designed for hospital
use. Madeo et al (2009) reported, in a prospective study of
205 patients, that the rates of CAUTIs were 41% lower in
the intervention group using the pre-connected catheter
when compared with the conventional catheter and bag
system, suggesting that a degree of protection is achieved.
Although they would incur greater cost, pre-connected
catheters have been documented by NICE (2014) in a briefing
paper, regarding prioritised quality improvement areas for
development. NICE (2014) referenced Hooton et al (2010)
from the Infectious Diseases Society of America, who discuss