Urinary Tract Infections (UTIs) are the most frequently diagnosed infection in long-term care residents. Approximately 10 million visits to healthcare providers are due to UTIs each year in the United States. UTIs account for over one-third of all nursing home-associated infections.¹
Symptoms of a UTI differ between the different types of residents/patients. Non-specific symptoms are anorexia, confusion, decline in functional status and falls, but these symptoms do not automatically mean the resident has an infection. Causes of these non-specific symptoms can be medical conditions, such as cancer, depression, dementia, dental problems, dehydration, new medications, pain, changes in blood pressure or inner ear problems.
These symptoms often make diagnosing a UTI harder as they warrant a review, but they do not automatically mean an infection. Distinguishing between symptomatic UTI and Asymptomatic Bacteriuria can be exceptionally challenging in older adults.
When is it appropriate to obtain urine cultures? For residents with or without urinary catheters, it is appropriate to obtain cultures for dysuria, suprapubic pain, flank pain, costovertebral angle tenderness, or septic shock. It is inappropriate for a urine culture if the resident has altered mental status or change in urine characteristics, such as color, sediment or smell.
Asymptomatic Bacteriuria is treated with antibiotics far too often in the nursing home setting, this is inappropriate and gives no benefit and can cause harm. This is a standard practice that will take an intentional and concerted effort to discontinue.
Prevention of UTIs in the nursing home best practices are to limit indwelling catheters and discontinue as soon as possible, good hydration and good hygiene. Prophylactic antibiotics should only be used for patients with recurrent UTIs at a lower dose than treatment dosing, per IDSA guidelines should NOT be used routinely in residents with catheters.²
- Access the Nursing Home Antimicrobial Stewardship Guide for more information
- Access the Agency for Healthcare Research and Quality (AHRQ) Suspected UTI SBAR Toolkit
Tired of collecting urine samples? Fed up with sending residents to the ER for something unrelated to the genitourinary system and they come back with a UTI diagnosis? Need some simple prevention tips for UTI’s? These UTI prevention sheets may be useful. Post them in your break room, give them to your residents or patients, review them at your staff meeting, or even put them in your orientation packets.
Additional Resources
- Friday Focus for Health – Up Your Protection from Infections: UTIs I Recording
- Up Your Protection From Infections Webinar I Recording
- Great Plains QIN Catheter Inserted and Left in Bladder Quality Measure (LS) Tip Sheet
- Great Plains QIN Urinary Tract Infection (UTI) Quality Measure (LS) Tip Sheet
Sources:
- Rowe TA, Juthani‐Mehta M. Urinary tract infection in older adults. Aging Health. 2013 Oct;9(5):10.2217/ahe.13.38. doi: 10.2217/ahe.13.38. PMID: 24391677; PMCID: PMC3878051. Access abstract.
- The Benefits and Harms of Antibiotic Prophylaxis for Urinary Tract Infection in Older Adults; Clinical Infectious Diseases, Volume 73, Issue 3, 1 August 2021; Published February 2021. Access article.