If preoperative assessment is to be patient centred, enjoying high levels of patient satisfaction, attention to patients' individual needs must be a priority.

Since the Foley catheter was introduced in the 1930s it has become one of the primary sources of hospital acquired infections and long term urinary catheters used in community based patients account for some 4% of community nurses’ time. This burden is likely to increase given the projected rise in life expectancy and size of the ageing population. This article considers the current literature around indwelling urinary catheterization and its management with a focus on long term catheterization in the community. The authors discuss contemporary strategies to manage or prevent CAUTI that are based on best practice guidelines. However, it is clear from the dearth of empirical evidence that there is an urgent need to establish well constructed research studies to investigate the prevalence of long term urinary catheterization in the community and the prevention and management of CAUTI.

The cost of caring for people in the community with long-term indwelling catheters varies widely but represents a significant amount of NHS spending. A rapid access catheter clinic was established at a Bristol hospital, for people experiencing difficulties with their long-term catheters, to facilitate prompt assessment and treatment. Many patients were found to be severely disabled with mobility problems and relied on hospital transport to attend the clinic for flexible cystoscopy. As a consequence the concept of undertaking this procedure on a domiciliary basis was introduced with a view to cutting costs, improving time management and offering a more reliable service to patients. A prototype battery-powered flexible cystoscope was developed to facilitate this service and five visits were undertaken. Feedback from patients indicated a preference for the domiciliary service and cost benefits were identified. As a result of these initial experiences, we are now planning a pilot study to establish the feasibility and costs of providing a domiciliary service on a permanent basis and gather qualitative data from patients on quality-of-life issues.

The practice of giving prophylactic antibiotics to patients at the time of urinary catheter insertion, change or removal is variable since guidelines for their use have yet to be established. The use of prophylactic antibiotics to prevent urinary catheter-related infections and the possibility of bacteraemia and septicaemia, despite a lack of evidence for their efficacy, is a matter of concern in light of the reported overuse of, and increased resistance to, antibiotics. This article describes an audit of, and increased resistance to, antibiotics. This article describes an audit conducted in one trust to establish the current practice of antibiotic prophylaxis for urinary catheter procedures. The audit confirmed that in 60% of the recorded catheter procedures, patients were given antibiotics, usually gentamicin. Variations in gentamicin prophylaxis were revealed, including differences in the timing of administration relative to the catheter procedure. This audit revealed that intramuscular gentamicin was given simultaneously with the procedure or after the procedure in a number of cases, suggesting that on these occasions "prophylaxis" was suboptimal.