• Ensure an indwelling urinary catheter is appropriate
• Use an indwelling catheter only after alternative methods of management have been considered.
• Regularly review the clinical need for catheterization and remove the catheter as soon as possible.
• Use intermittent catheterization in preference to an indwelling catheter if this is clinically appropriate and is a practical option for the person.
• Prevent the introduction of infection
• Healthcare personnel should be trained and assessed in their competence to perform urethral catheterization using aseptic procedures.
• Urine samples should be obtained from a sampling port using an aseptic technique.
• Catheters should be changed only when clinically necessary (for example, to prevent blockage), or according to the manufacturer's recommendations.
• When changing catheters, antibiotic prophylaxis should only be used for people with a history of catheter-associated urinary tract infection following catheter change.
• Do not use:
• Bladder instillations or washouts.
• Prophylactic antibiotics when changing catheters in women with a heart valve lesion, septal defect, patent ductus, or prosthetic valve.
• Topical antiseptics or antibiotics applied to the catheter, urethra, or meatus; daily washing of the meatus with soap and water is sufficient.

These recommendations are based on guidelines from the National Institute for Health and Clinical Excellence (NICE) [NICE, 2003].

Minimizing the use of indwelling urinary catheters

• The recommendations on training and practical ways to minimize the use of indwelling urinary catheters reflect guidelines from NICE [NICE, 2003].
• NICE based their recommendation to use intermittent catheterization rather than an indwelling urinary catheter on a systematic review which included 22 studies and 10 further studies.

Not using bladder instillations or washouts

• Bladder instillations and washouts are discouraged because the NICE systematic review found good evidence that they do not prevent urinary tract infections, and there is concern that they may have local toxic effects [NICE, 2003].

Not using prophylactic antibiotics or antiseptics

• The recommendation not to use prophylactic antibiotics when changing catheters is based on findings from two studies in the NICE systematic review that not using antibiotic prophylaxis did not increase the risk of urinary tract infection [NICE, 2003].
• The recommendation not to use prophylactic antibiotics when changing catheters in women with a heart valve lesion, septal defect, patent ductus, or prosthetic valve is based on the NICE clinical guideline on prophylaxis for infective endocarditis, which found this not to be cost-effective [NICE, 2008b]. 
• The recommendation not to use topical antiseptics or antibiotics applied to the catheter, urethra, or meatus is based in findings from six clinical studies that compared meatal cleansing with a variety of antiseptic/antimicrobial agents or soap and water; use of antiseptics and antimicrobial agents did not reduce the rate of bacteriuria [NICE, 2003].