Urinary tract infection (UTI) related to urinary catheter use can cause many problems in nursing home residents. A USA nationwide project to improve care in this area successfully reduced the number of catheter-associated UTIs.
A urinary catheter is a small flexible tube inserted via the urethra into the bladder to drain urine. It is used in a several medical situations – for example, when there is a blockage preventing urine passing, following some types of surgery, or in patients with nerve damage. Although not an ideal solution, catheters are sometimes used to ease nursing care of patients who are incontinent. Urinary catheters, especially if used long-term, lead to an increased risk of urinary tract infection (UTI). When a catheter is used, it must be expertly inserted and managed to minimize infection risk.
Although several programs have been put in place to improve health-care practices surrounding the use of urinary catheters, there have been few studies about how to implement such programs in nursing homes. As an increasing number of people are being cared for in nursing homes, the Agency for Healthcare Research and Quality in the USA funded a large-scale infection prevention project in nursing homes in an attempt to reduce catheter associated UTIs. The results of this project were recently reported in JAMA Internal Medicine.
Community-based nursing homes across 48 states, Washington DC and Puerto Rico were recruited to the study. The Safety Program for Reducing Catheter Associated UTI in Hospitals was modified for use in nursing homes. The program included two main elements:
- Improving the knowledge and technical skills of care professionals in the appropriate use, insertion, maintenance and removal of urinary catheters, infection prevention techniques, and the appropriate use of urine tests.
- Enhancing attitudes and behaviors to infection prevention practices and overall resident safety in nursing homes – creating safety teams and involving all those concerned in resident care, including residents themselves and their families.
Education and training was provided in a comprehensive program throughout the project, with regular coaching sessions and reviews to allow discussion of any problems. Local and national team leaders coordinated the activities.
Of the 568 community-based nursing programs recruited to the program, 404 completed the 12-month project and provided data for analysis. Catheter-associated UTI rates steadily decreased throughout the study – with an overall 54% reduction. Three quarters of the nursing homes included in the analysis showed a 40% or greater reduction. Urine culture order rates (used to check for UTI) also decreased by 15% overall during the study.
Catheter usage rates remained steady during the project. The researchers noted that the use of urinary catheters in nursing home residents was already low at the start of the project. They suggested that even prior to this project nursing home staff had already developed an attitude of only using catheters when medically necessary, as they limit the independence of nursing home residents.
The researchers concluded that the program aimed at improving technical practice and overall attitudes to infection control successfully reduced the rate of catheter-associated UTI in nursing home residents.
Written By: Julie McShane, Medical Writer