Health Day had an interesting article about a recent study about urinary tract infections (UTIs).   A team from New York City’s Columbia University School of Nursing surveyed 955 nursing homes in 2014. The researchers also analyzed data from the Centers for Medicare and Medicaid Services.

They found that in any given month, for over 88,000 nursing home residents in the study, an average of 5.4 percent of them — more than 4,700 people — had suffered a UTI.  This research finds the infections are common in nursing homes, often due to a lack of proper prevention and use of catheters. In fact, in the Columbia study, nursing home residents with catheters were four times more likely to get a UTI than those without catheters.  UTIs in nursing home residents can often have serious effects, including delirium, debilitating falls and even fatal blood infections.

“It is obvious, based on this random survey of nursing homes, that there is a lack of education and inconsistent practices that can raise the risk for infection,” Donna Armellino, a nurse and vice president of infection prevention at Northwell Health, in Lake Success, N.Y said.  UTIs often occur “when bacteria enters the urinary tract through the urethra and move up the tract to infect the bladder or kidneys,” she explained. “This infection is often related to an inserted device referred to as an indwelling urinary catheter.”

“UTIs in the elderly can have a significant health impact by leading to a confused delirious state or — if undiagnosed — leading to dehydration or infection in the bloodstream,” explained Dr. Paula Lester, a geriatrician at Winthrop-University Hospital, in Mineola, N.Y.

Many nursing home residents suffer from dementia, or have conditions that rob them of their ability to communicate, therefore caregivers must be properly educated and trained to prevent UTIs, and recognize the signs and symptoms such as painful urination, foul odor of urine or increased frequency of urination of a UTI.

The findings were presented this month at the annual meeting of the Association for Professionals in Infection Control and Epidemiology (APIC), in Charlotte, N.C.  Read more about APIC at Eureka Alert.

Nursing homes typically have four main ways of lowering UTI rates.

  1. Nursing homes that used portable bladder ultrasound scanners to confirm that a patient had voided all urine were 10 percent less likely to have high rates of UTIs not associated with catheter use.  Unfortunately, only about one in every five facilities surveyed had this policy, the researchers found.
  2. Regularly cleaning the urine collection bag attached to the resident’s leg. That step cut catheter-linked UTI rates by 20 percent.  However, only 44 percent of facilities had this policy in place.
  3. Nursing homes with “infection preventionists” on staff — who also took a national course through APIC — were also 20 percent less likely to have high rates of UTIs, the study found.  But again, only 9 percent of the nursing homes in the study had such staff.
  4.  Prevent UTIs by make sure the patient is mobile when possible, has “regular toileting” and is kept clean and dry.

According to Armellino, other things to look for if you visit an infirm loved one in a nursing home include:

  • Making sure that urinary catheters are inserted “only when clinically needed,” assessed daily and removed when no longer necessary.
  • Urine collection bags are kept below the bladder.
  • Urine flows freely in the drainage tube.
  • The device is “secured to the leg to minimize movement.”
  • Patients are washed frequently with soap and water.
  • Staff members use proper hand hygiene before and after touching the catheter device.

 

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