Urinary tract infection is more common in older people, particularly those living in care homes. This is because they are more likely to have other conditions and age-related changes that increase the risk of infection, such as bacteria in the urine, urinary incontinence, reduced feelings of thirst, dehydration and cognitive impairment.
It can be hard to recognise UTI in an older person as they may not have the typical signs and symptoms of infection. Also, early signs and symptoms are not easy to distinguish from other conditions and infections. For example, symptoms of dehydration, including tiredness and increased confusion, can be mistaken for a UTI. This can lead to antibiotic treatment for UTI when this is not the actual cause of the problem and may result in admission to hospital.
We wanted to understand how UTI can be prevented in older people living in care homes and what support care home staff need to help prevent and recognise UTI.
WHAT WE DID
Using a literature review method called ‘realist synthesis’ we reviewed evidence from a range of sources, including research studies and improvement projects. We also asked care home staff, residents, family carers and healthcare professionals about their experiences. We combined these experiences and ideas with the evidence we found from published literature to develop an understanding of what needs to happen in care homes for older people to prevent and recognise UTI.
Our findings focus on three strategy (theory) areas:
1. Strategies to support accurate recognition of UTI
2. Care strategies for residents to prevent UTI and catheter-associated UTI (CAUTI)
3. The support and systems required to make best practice happen
WHAT WE FOUND
1. Supporting accurate recognition of UTI
Care staff who work most closely with residents have a key role in recognising a UTI, especially when a resident is less able to communicate how they are feeling. We found evidence for three strategies that supported the accurate recognition of UTI. The first of these focused on education to enable care staff to accurately recognise UTI signs and symptoms, the second described use of decision support tools and the third related to protocols for active monitoring of residents with early, non-specific signs and symptoms.
2. Care strategies for residents to prevent UTI and CAUTI
We found evidence for four interventions that contributed to the prevention of UTI or catheter-associated urinary tract infection (CAUTI). Two of these were focused on ensuring that residents were well-hydrated, the second describing strategies for residents with poor fluid consumption. The third related to preventing individual residents developing repeated UTI and the fourth described strategies aimed at preventing UTI associated with urinary catheters (CAUTI).
3. Making best practice happen
We found evidence on the components of successful implementation of strategies for both the prevention and accurate recognition of UTI. These encompassed care home leadership and culture and the development of knowledgeable care teams.
Our findings reveal the need to integrate UTI prevention with diagnostic and antimicrobial stewardship and to unify the content of education and decision-support resources so that care staff can see their role in prevention as well as supporting diagnosis and treatment. A system-wide approach is vital to enable care home managers and their staff to prioritise UTI prevention and recognition as part of person-centred care.
Further information about the StOP UTI study can be found by following this link: https://www.southampton.ac.uk/research/groups/bladder-bowel-management/preventing-urinary-tract-infections