Many people around the world rely on catheters every day to empty their bladder – especially people with spinal cord injuries. After a well-respected publication concluded that catheters could be reused without an increased risk of infection, a professor and researcher from the University of British Columbia began to question.
Dr. Andrei Krassioukov, a professor of medicine at UBC and chair of rehabilitation research with ICORD, who works closely with groups such as the American Paraplegic Society, and the Canadian Association of Physical Medicine and Rehabilitation, just this past summer spoke to a few of the wheelchair athletes that participated in the Summer Paralympics in London about the single-use versus multiple-use issues on catheters.
“Wheelchair athletes from wealthier countries would only use each catheter once while athletes from developing countries would clean and reuse their catheters again and again,” says Krassioukov. “The athletes who used catheters only once experienced three-to-four times fewer urinary tract infections than athletes who reused catheters.”
A urinary tract infection (UTI) is an infection in any part of your urinary system — your kidneys, ureters, bladder, and urethra. Most infections involve the lower urinary tract — the bladder and the urethra. It can be an extremely painful and incapacitating infection. Antibiotics like amoxicillin, are used to heal the infection and soothe the symptoms. Sexually active women and patients that use catheters, like spinal cord injury patients are at higher risk of infection.
It has been a debate amongst the medical community of whether or not to reuse catheters. The instrument can cost anywhere from $5 to $30, and for people with spinal cord injuries – they need a new one every time they release their bladder.
Around the world, and even within Canada, there are price and coverage differences that will add up to the individual. In France, it is illegal to reuse catheters; and in other countries, they simply can not afford the healthcare costs of single-use.
Cochrane Canada, a non-profit, non-governmental organization formed to organize medical research findings to facilitate evidence-based choices about health inventions, reviewed evidence from 31 clinical trials of single vs. multi-use catheters and urinary tract infections in 2014. Their statement is that there was no convincing evidence that the incidence of infection was linked by catheterization.
From Krassioukov’s clinical experience and study conducted at the Paralympics he instinctively knew that these results were false. He assembled a team of experts from around the world to re-examine the evidence. Due to the sufficiency of the errors they found in the previous concluding evidence, Cochrane has since withdrawn their conclusion.
“Until evidence can confidently demonstrate that multiple-use is as safe as single-use, health-care providers should advocate for single-use of catheters since catheter cleaning is a major issue,” says Krassioukov. “This will affect the direction on how we manage patients.”
While there have been new developments on how to make catheters sterile and ready for multi-use, they have yet to be fully confident that it will not reimpose infection.