Urinary tract infections (UTIs) in nursing home residents can often have serious effects, including delirium, debilitating falls and even fatal blood infections.
Now, new research finds the infections are common in nursing homes, often due to a lack of proper prevention.
UTIs “can have a devastating impact on frail, debilitated individuals,” said Donna Armellino, a nurse and vice president of infection prevention at Northwell Health, in Lake Success, N.Y. She reviewed the new findings.
“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,” she said.
In younger people, UTIs can be a painful nuisance that is usually treated with an antibiotic. But in the infirm elderly, the risk to health can be much greater, another expert explained.
“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.
Since so many nursing home residents suffer from dementia, or have conditions that rob them of their ability to communicate, identifying a UTI can be difficult, she said.
“Nonverbal patients, or those with cognitive impairment, usually cannot report traditional UTI symptoms of painful urination, foul odor of urine or increased frequency of urination,” Lester noted.
So, how good a job are U.S. nursing homes doing in preventing these infections?
To find out, 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.
As Armellino noted, catheters used in nursing home care can be a prime source of the infections.
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.”
In fact, in the Columbia study, nursing home residents with catheters were four times more likely to get a UTI than those without catheters.
However, UTIs were more often linked to causes other than catheter use, according to the study.
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.
“What was particularly interesting about this study was that there were more UTIs that were not associated with catheterization than those that were,” said study lead author Carolyn Herzig, project director at Columbia’s School of Nursing.
“This means that a larger focus should be placed on identifying practices to prevent UTIs — regardless of catheter placement,” she said in an APIC news release.
Nursing homes typically have four main ways of lowering UTI rates, Herzig’s team noted. However, facilities rarely implemented such measures.
For example, 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.
Another helpful policy: 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, Herzig’s team found.
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.
APIC President Susan Dolan said the issue is only going to get more pressing with time.
“Infection prevention in long-term care is going to become an increasingly important issue because of the aging of the U.S. population,” she said in the news release. “Every day, 8,000 baby boomers reach the age of 65, and by 2020 the number of older adults will outnumber the number of children younger than 5.
“Recognizing the severity of UTIs for older adults, and implementing policies in nursing homes and long-term care facilities to prevent and effectively treat these infections, is critical,” she concluded.
“A UTI can also go beyond infection of the urinary tract and the bacterium can go into the bloodstream and potentially result in death,” she said. “Standards of care to minimize a UTI exist in acute care facilities and are imbedded into bedside practice, but it appears to be lacking in long-term care facilities.”
She said that quality nursing homes can help 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.
Armellino stressed that since a UTI is always a possibility when catheters are in place, “residents with an indwelling urinary catheter require continuous assessment for symptoms related to infection.”
If a UTI is detected, “prompt and appropriate treatment to minimize progression of the infection into the bloodstream and potentially avoiding hospitalization,” she said.
Because this research was presented at a medical meeting, the findings should be considered preliminary until published in a peer-reviewed journal.
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more on urinary tract infections in older adults.
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