Prevention of Urinary Tract Infections in Spinal Cord Injury Patients

1. Standardized Operation

After carefully washing hands according to the six-step handwashing method, strictly adhere to aseptic operation principles. Use appropriate disinfectants to disinfect the urethral opening and surrounding skin and mucosa. Each cotton ball should only be used once and must not be reused. Properly place sterile drapes to avoid contamination of the urethral opening and maintain maximum sterile barrier.

Key Prevention Points During Catheter Insertion:

 Since patients may experience urethral spasm during catheterization, movements must be gentle, and patients should be instructed to relax and cooperate with the procedure. The catheter should be inserted to an appropriate depth according to the patient's urethral length. Throughout the procedure, mechanical injury to the urethral mucosa must be avoided. Do not be overly aggressive in the operation simply because the patient has sensory impairment and cannot feel pain. During the bladder emptying process, take care to prevent urine reflux that could cause retrograde infection.

2. Maintain Cleanliness and Dryness of the External Genitalia

During intermittent catheterization, the perineal area and skin and mucosa around the urethral opening should be cleaned with clean water or rinsed daily to maintain cleanliness, which can reduce the chance of urinary tract infection. Cleaning should generally be performed 2-3 times per day. However, for SCI patients with fecal incontinence, especially when experiencing diarrhea with watery stools, cleaning should be performed immediately to prevent bacteria from feces from invading the urinary system.

Given the characteristic short urethra in women, special attention should be paid to keeping the perineal area clean and dry, maintaining relative sterility of the urethral opening, and preventing intestinal bacterial infection.

For patients with urinary incontinence using diapers or disposable protective bags, these should not be reused repeatedly. Minimize wearing time and keep the perineal area dry. If necessary, a hair dryer or similar device can be used to prevent local moisture, which creates favorable conditions for bacterial growth.

3. Avoid Mechanical Bladder Irrigation

Patients should be encouraged to drink plenty of water, with a daily intake of more than 2000ml. In principle, artificial bladder irrigation is not recommended. Artificial bladder irrigation does not prevent infection; on the contrary, it increases the possibility of infection (bladder irrigation can damage the bladder mucosa or cause chemical irritation that increases the chance of infection, or cause chemical cystitis that aggravates urinary tract infection). Therefore, patients should be encouraged to drink plenty of water to increase urine output, which provides a natural bladder flushing effect while reducing the opportunity for bacteria to enter the bladder through the catheter. Additionally, on the basis of drinking large amounts of water, combined with frequent position changes (once every 2 hours) and active and passive exercises within one's capacity (standing and walking using assistive devices), urinary calcium concentration can be rapidly reduced, achieving the purpose of preventing urinary stones and preventing infection.

However, when water intake is insufficient and the urine drained from the catheter is turbid with sediment or clots, if bladder irrigation is necessary, the frequency of bladder irrigation should be minimized. Furthermore, strict aseptic technique must be observed. It is best to use a three-way Foley catheter, with one lumen being the balloon port for injecting 5-10ml of sterile water for injection. Of the remaining two lumens, one is connected to the irrigation device (using an infusion set to puncture the disinfected catheter tail for rapid drip infusion), and the other is connected to the drainage bag, thus forming a closed bladder irrigation system that avoids opening the connection points to minimize contamination as much as possible. On this basis, the color and volume of urine should be monitored at all times. If infection is found to have occurred, timely treatment should be initiated to prevent retrograde bacterial infection.

4. Enhance Body Resistance

Attention should be paid to improving the patient's overall condition and enhancing their immune function and anti-infection capacity. The diet must contain adequate nutrients, including vitamins and trace elements, ensuring the supply of sugar, protein, and carbohydrates to strengthen the body's resistance. Vitamin A promotes the synthesis of glycoproteins; proteins on the cell membrane surface are mainly glycoproteins, and immunoglobulins are also glycoproteins. When vitamin A intake is insufficient, respiratory epithelial cells lack resistance and are often susceptible to illness. When vitamin C is deficient, the vitamin C content in white blood cells decreases, weakening the fighting capacity of white blood cells, making the body susceptible to disease. In addition, trace elements such as zinc and selenium, as well as vitamins B1, B2, and many other elements are all related to the body's non-specific immune function.

**5. Select an Appropriate Catheter**

The selection of catheter should be based on the patient's age, gender, and urethral condition to choose a catheter of appropriate size and material, minimizing urethral injury and urinary tract infection to the maximum extent. Carefully inspect the sterile catheterization package; if expired, with damaged outer packaging, or damp, it should not be used.

The selection of catheter size is very important: a thinner catheter should be selected—size 12 Fr for adults and size 8 Fr for children—to reduce damage to the urethra and bladder. Maintain catheter sterility; if accidentally contaminated, it must be replaced. Never reinsert a catheter that has been removed. Movements during insertion should be gentle to avoid damaging the urethral mucosa.

6. Implement Appropriate Disinfection and Isolation Measures

Since the hands of medical personnel are a transmission medium for infectious diseases, urinary tract infections can be transmitted through hands. Therefore, strict handwashing is an important means of preventing cross-infection, and hygienic handwashing should be performed when necessary. Cross-transmission between patients can occur through bedside tables, bed sheets, catheters, and other media. It is best that patients with urinary tract infections and those without do not share the same room or adjacent beds. Urinals used by patients should be regularly disinfected or replaced.

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