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Implementation of UTI prevention policies varies across nursing homes
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Observance of various urinary tract infection prevention policies and practices appears inconsistent across nursing homes in the United States, according to survey results of nearly 1,000 facilities recently presented at the Association for Professionals in Infection Control and Epidemiology annual conference.
Carolyn Herzig, PhD, MS, project director at Columbia University School of Nursing; Patricia Stone, PhD, RN, centennial professor of health policy at the Columbia University School of Nursing; and colleagues distributed surveys on infection control staffing, procedures and prevention practices to 2,550 randomly sampled nursing homes. They linked responses to 2013 Minimum Data Set assessments of UTI and catheter use prevalence, and Certification and Survey Provider Enhanced Reporting (CASPER) data on each facility’s characteristics. The researchers then conducted a multivariable analysis of UTI prevalence, catheter use and implementation of nine prevention policies controlling for bed size, occupancy, payer mix, staffing levels, census region and metropolitan setting.
Carolyn Herzig
Patricia Stone
Herzig, Stone and colleagues received data for 955 nursing homes and 88,135 residents. Among these, the overall mean monthly prevalence of UTI was 5.4%, while catheter-associated UTI was 0.9% among residents. The researchers reported an indwelling or intermittent catheterization prevalence of 4.7%, and catheterization was associated with increased risk for UTI (OR = 4.4; P < .0001).
“[Catheter-associated] UTIs in hospitals are actually much more common than what we found [in nursing homes],” Herzig told Infectious Disease News. “Also, while the main predictor of developing a UTI is prolonged use of an indwelling catheter, a lot of UTIs in nursing homes were not associated with catheters.”
Herzig said implementation of the nine observed infection control policies and practices, however, was inconsistent across the sampled facilities. Of note, just 22% of nursing homes employed portable bladder ultrasound scanners to confirm voided urine, which the researchers determined was associated with reduced noncatheter-associated UTI incidence (OR = 0.9; P = .04). Policies for leg bag cleaning, which also reduced the risk for CAUTI (OR = 0.8; P = .01), were reported by 44% of the responding facilities. Only 9% of respondents reported previous enrollment in a national course through APIC, and nursing homes with these respondents on staff had reduced incidence of noncatheter-associated UTI (OR= 0.8; P = .003).
Herzig acknowledged that many nursing homes are faced with limited resources and may not be fully capable of implementing UTI prevention procedures for each resident. However, she also noted a dearth of information on UTI and catheter-associated UTI prevention data specific to nursing homes.
“Part of the issue is awareness of our understanding of what works and what does not work in this setting,” Herzig said. “Many of the guidelines right now focus primarily on what’s known in the acute care setting and not nursing homes. We need to develop more evidence.” – by Dave Muoio
Reference:
Herzig C, et al. Abstract 1202-18. Presented at: Annual Conference of the Association for Professionals in Infection Control and Epidemiology; June 11-13, 2016; Charlotte, N.C.
Disclosures: Herzig reports no relevant financial disclosures. Infectious Disease News was unable to determine Stone’s disclosures at the time of publication.