A survey of nearly 1,000 nursing homes in the U.S. found little consistency across facilities of policies implemented to prevent urinary tract infections (UTIs), according to a new study presented at the 43rd Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC).
Led by Patricia Stone, PhD, RN, FAAN, researchers from the Center for Health Policy at Columbia University School of Nursing surveyed nursing homes across the U.S. in 2014. Responses from 955 nursing homes with 88,135 residents were linked to infection data from the Centers for Medicare & Medicaid Services to identify policies and practices associated with lower UTI prevalence. According to the study, 5.4 percent - or more than 4,700 nursing home residents - suffered from a UTI every month. If a resident had a catheter, they were four times more likely to get a UTI than if they did not have a catheter at all. However, more infections were not associated with catheter use than those that were.
"UTIs are the most common infection in nursing homes, and we wanted to determine what policies and procedures would help these facilities lower UTI prevalence," said the study's lead author Carolyn Herzig, PhD, MS, project director, Columbia University School of Nursing. "What was particularly interesting about this study was that there were more UTIs that were not associated with catheterization than those that were. This means that a larger focus should be placed on identifying practices to prevent UTIs regardless of catheter placement."
The study examined nine UTI prevention policies and found the following policies were associated with lower infection prevalence:
Nursing homes that had a policy for using portable bladder ultrasound scanners to determine if all of the urine was being voided were 10 percent less likely to have high rates of UTIs that were not associated with catheter use. Only 22 percent of surveyed facilities had this policy.
Nursing homes that had a policy in place for cleaning the urine collection bag attached to the resident's leg were 20 percent less likely to have high rates of catheter-associated UTIs. Yet only 44 percent of surveyed facilities had this policy in place.
Nursing homes with infection preventionists on staff who took a national course through APIC were 20 percent less likely to have high rates of UTIs. However, only 9 percent of respondents had taken an APIC training course.
"Infection prevention in long-term care is going to become an increasingly important issue because of the aging of the U.S. population. Every day 8,000 baby boomers reach the age of 65, and by 2020 the number of older adults will outnumber the number of children younger than five," said APIC 2016 President Susan Dolan, RN, MS, CIC, hospital epidemiologist, Children's Hospital Colorado. "Recognizing the severity of UTIs for older adults, and implementing policies in nursing homes and long-term care facilities to prevent and effectively treat these infections, is critical."