Implementation Science and Research
Background : The American Geriatric Society recommends physicians do not use antibiotics to treat bacteriuria in older adults unless specific urinary tract symptoms are present. The Infectious Disease Society of America (IDSA), states screening for, and treatment of asymptomatic bacteria is not recommended for elderly, institutionalized persons.
During implementation of a Nurse Driven Protocol for Foley catheter removal, it was noted many cultures were requested based on urine appearance and perceived mental status change in non-catheterized patients.
To reduce unnecessary urine cultures and avoid treatment of asymptomatic residents, our team implemented a program to empower and educate staff on appropriate patient assessment for signs and symptoms of Urinary Tract Infection(UTI). Management of alternate causes were encouraged. Cultures were requested when clinical indicators were observed.
Methods : Our team initiated education on patient safety and employee empowerment. Nursing staff were empowered to use clinical assessment and surveillance definitions to guide patient management before requesting culture or antibiotics. Education included understanding constitutional criteria in the long-term care resident, and appropriate indication for culture in symptomatic and asymptomatic residents. IDSA and Agency for Healthcare Research and Quality (AHRQ) guidelines were used. Data analysis accessed Long-Term Care (LTC) Minimum Data Set (MDS) -Based Quality Measures for percent of residents with a UTI and review of total numbers of urine cultures ordered pre- and post project implementation. All positive cultures were reviewed for infection using the CDC surveillance definitions for long term care.
Results : The quality measure for UTI in LTC was reduced from a rate of 9.29 (13 events) in 2016, to 0.66 (1 event) in 2018. Requests for urine cultures were reduced by 54%.
Conclusions : Employee education and empowerment to guide management strategies in residents demonstrating a change in urine appearance or mental status change resulted in a reduction of UTI.