A Statewide Program to Improve Management of Suspected Urinary Tract Infection in Long‐Term Care

Abstract

BACKGROUND/OBJECTIVES Suspected urinary tract infection (UTI) is the most common indication for antibiotic use in long‐term care (LTC). Due to the high prevalence of asymptomatic bacteriuria, for which antibiotics are not warranted, these antibiotics are frequently unnecessary. We implemented a collaborative quality improvement program to improve the management of suspected UTI in LTC residents by increasing awareness of current guidelines, with a focus on decreasing treatment in the absence of symptoms. DESIGN/INTERVENTION Two separate collaboratives included workshops, webinars, and coaching calls. PARTICIPANTS A total of 31 facilities participated in the first collaborative, with 17 submitting sufficient data for analysis and 34 in the second, with data analyzed from 25. MEASUREMENTS Facilities reported monthly numbers of urine cultures, UTI diagnoses, Clostridioides difficile infections (CDIs), and resident days. RESULTS When comparing the baseline period to the first collaborative period, the intercollaborative period to the second collaborative period, and the first collaborative period to the second, the incident rate ratios (95% confidence intervals) were 0.74 (0.68‐0.81), 0.83 (0.73‐0.94), and 0.63 (0.57‐0.69), respectively, for urine culturing rate; 0.73 (0.64‐0.83), 0.86 (0.70‐1.05), and 0.60 (0.51‐0.69), respectively, for UTI diagnosis rate; and 0.56 (0.40‐0.82), 1.61 (0.71‐4.14), and 0.45 (0.27‐0.74), respectively, for CDI rate. CONCLUSION The program we implemented was associated with reductions in urine cultures, UTI diagnosis, and CDI; and it suggests that this type of intervention can promote appropriate management of UTI in the LTC setting. J Am Geriatr Soc 68:62–69, 2019

Changes in Health and Quality of Life in US Skilled Nursing Facilities by COVID-19 Exposure Status in 2020

“…Unlike the decrements in quality of life, the increased mortality among LTC residents during the pandemic was entirely limited to facilities with active COVID-19 outbreaks, while SNFs without COVID-19 and those with prior COVID-19 had a modest decrease in mortality. The cause of this decrease in mortality is unclear, but some of the decrement may be attributable to tight infection control policy that likely reduced transmission of other nosocomial infections, a chronic problem in SNFs predating the COVID-19 pandemic . There are other plausible mechanisms.…”

Resident-Related Factors Influencing Antibiotic Treatment Decisions for Urinary Tract Infections in Dutch Nursing Homes

“…Thus, guideline recommendations alone do not prevent treatment of non-specific symptoms and additional approaches to improve antibiotic prescribing behaviour are warranted. Involvement, education, and coaching of both physician and nursing staff have already been presented as strategies to improve antibiotic stewardship [ 19 , 26 , 27 , 28 , 29 , 30 , 31 ]. Additional strategies include providing communication tools to nurses to improve effective communication among healthcare workers [ 32 ] and interventions directed at appropriate urine culturing [ 33 ].…”

Virtual learning collaboratives to improve urine culturing and antibiotic prescribing in long-term care: controlled before-and-after study

“…This study aligns with promising findings from a few emerging studies looking at the value of learning collaboratives for supporting practice change across disciplines and areas of clinical practice improvement. [36][37][38][39][40] Based on the results of this study, a refined virtual implementation support model for the scale-up of this programme was developed including more tailored support for LTCHs. Engaging LTCHs in multisession learning collaboratives could be better facilitated through shorter sessions; more flexible scheduling; encouraging homes to plan ahead for staff transitions and providing additional resources for antibiotic stewardship.…”