Foley and how to prevent infection

[TinkRN8]

Hi all,

I am not a nurse yet, still plugging away in school. I have a question for all the nurses out there. I had surgery in May for Fibroids and endometrios and, of course, had a Foley insterted. I ended up with a pretty severe infection 1.5 wks later and ended up back in the hospital for 2 wks and then an add'l 6 wks with home healthcare. It was a pretty rotten summer! Anyway, I am taking Microbiology and wanted to find out what "bug" caused by infection, since I am studying that kind of thing. It turns out the "bug" that caused my infection was Enterococcus faecalis, which is a pretty nasty critter. My mom was convinced it was the surgeon's negligence that caused the infection, but after studying E. faecalis, I am convinced that it was the catheter that was the root of the infection. I know it is a pretty common nosocomial infection and that it particularly likes catheters. My question to you is, what asceptic techniques do you employ to make sure that your Foley patients do not develop nosocomial infections during their hospital stay? Of course, I was out when they inserted the Foley, so I have no way of knowing what was done, how it was done, etc. Or, is this just something that happens, and there is nothing really you can do to prevent it? Just curious, because when I become a nurse, I want to make sure that I do everything I can to make sure what happened to me does NOT happen to any of my patients. I certainly wouldn't want anyone to go through what I did. Anyway, your input, as always, would be appreciated.

Thanks!

[Agnus]

Foley use should be minimized. It should be removed asap. Never kept in longer than absouletly necessary. In the case for your type of surgery it is generally standard to remove it the next day. Keep the bag below the level of the bladdar. Never ever lift it even momentairly above the level of the bladdar. Do not allow it to touch the floor. We once did frequent "foley care" this meant wiping the catheter around the meatus. Current practice based on research says this increase risk for infection. However, frequent handwashing (not just gloves) and perineal hygene (wiping/washing front to rear and use of soap and water or an antibacterial cleanser in this area is important.) Getting pt up early after surgery to ambulate. All contribute to reduced bladdar infection.

Foley insertion is ideally done under sterile conditions. When prepping pt one swipe with each wipe never more. If a foley enters another orifice such as lady parts do not use that cathater. Get a new one and start over. Leaving a misplace foley where it lies while inserting a new one prevents entering the lady parts a second time with the new catheter.

You are correct you likely picked up the infection from the foley.

[TinkRN8]

Agnus,

Thanks for your reply! Interestingly enough, the infection didn't start in my bladder, it started in my uterus. That was the largest abcess. It then spread and I had 2 other abcess, one near my liver and one in my lower pelvic/abdominal area. In all her 20+ yrs of practice, my GYN said she had NEVER seen an abcess in a uterus before. I love being the first! Anyway, they had all kinds of theories as to how I got the infection, but I do think it was the Foley. Plus, my immune system was compromised because I was severly anemic (had to have 6 units of blood 2nd time in hospital). This was certainly a learning experience, and it will surely make me a better nurses.

Thanks again!

[Agnus]

Agnus,

Thanks for your reply! Interestingly enough, the infection didn't start in my bladder, it started in my uterus.

Thanks again!

I don't see where the Foley could be effectively blamed in this case.

[TinkRN8]

Sorry, more clarification, the uterus is where the infection ended up. One of the theories I was given was that the bacteria was introduced via the urinary tract, migrating into the uterus, where there was pooled blood from the surgery, and the bacteria multiplied from there. The Dr.'s were unable to explain where the bacteria came from in the first place, but the Foley seemed, to me at least, the most likely culprit.

[Agnus]

Sorry, more clarification, the uterus is where the infection ended up. One of the theories I was given was that the bacteria was introduced via the urinary tract, migrating into the uterus, where there was pooled blood from the surgery, and the bacteria multiplied from there. The Dr.'s were unable to explain where the bacteria came from in the first place, but the Foley seemed, to me at least, the most likely culprit.

Well I guess we will never really know and can only theorize at this point. However, for a number of reasons I would expect the route of introduction was more likely the reproductive tract. You did say this was an entero bacteria. These live in the GI tract and the lady parts and rectum are in just too close proximity to favor the foley theory over this route. IMHO.

Not that I rule out the foley entirely.

The reason this bug "likes foleys" is again the proximity. But entering the bladdar to get to the uterus from the rectum is like going though the front door to get to the back of the house when there is a back door and the visitor started out behind the house.

You did not clarify if the bladdar was infected. It seems unlikely that IF it was the foley you would not have a bladdar infection. It is unlikely the bugs would completely pass though the bladdar straight to the uterus and none of them hang out in the bladdar.

[danissa, LPN, LVN]

How long was the foley in situ?

[TinkRN8]

Agnus,

Good to know. It was a theory anyway, based on my vast medical knowledge (ha! ) I just thought of the Foley because my microbio book & other info I found mentioned the indwelling catheter as notorious for spreading E. faecalis. There are so many ways, though I could have gotten it. The endo was all over my bowel, so it could have come from there, etc. Although my bowel was intact and not perforated in any way. I will never know, I guess.

Thanks!

[TinkRN8]

Danissa,

They removed it day after surgery.

[Agnus]

Can anyone be absolutely certain that the bowel was not microscopically nicked and subsequently healed on its own so that a perferated bowel would not be evident on further inviestigation?

Again more speculation.

[Tweety, BSN, RN]

How to insert a foley and care for a foley is Nursing 101 that we all learn. In nursing school you will learn this.

It's not appropriate to continue to discuss your personal case. Thanks.