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A Statewide Program to Improve Management of Suspected Urinary Tract Infection in Long-Term Care
Susanne Salem-Schatz1, Paula Griswold2, Ruth Kandel3
1HealthCare Quality Initiatives, Boston, MA.
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.
Insights
A quality improvement program reduced unnecessary antibiotic use for suspected urinary tract infections (UTIs) in long-term care (LTC) facilities. The intervention decreased urine cultures, UTI diagnoses, and Clostridioides difficile infections (CDIs).
Area of Science:
- Gerontology
- Infectious Diseases
- Quality Improvement in Healthcare
Background:
- Suspected urinary tract infections (UTIs) are a primary reason for antibiotic prescriptions in long-term care (LTC).
- High rates of asymptomatic bacteriuria often lead to unnecessary antibiotic use in LTC residents.
- Current management practices for suspected UTIs in LTC require improvement to align with evidence-based guidelines.
Purpose of the Study:
- To implement and evaluate a collaborative quality improvement program aimed at optimizing UTI management in LTC settings.
- To reduce the incidence of unnecessary antibiotic prescriptions for suspected UTIs in LTC residents.
- To increase adherence to guidelines for diagnosing and treating UTIs, particularly by decreasing treatment in the absence of symptoms.
Main Methods:
- A collaborative quality improvement program involving workshops, webinars, and coaching calls was implemented across multiple LTC facilities.
- Two separate collaborative initiatives were conducted, with a defined number of facilities participating in each.
- Data on urine cultures, UTI diagnoses, Clostridioides difficile infections (CDIs), and resident days were collected and analyzed monthly.
Main Results:
- The program was associated with significant reductions in the rates of urine culturing and UTI diagnoses across collaborative periods.
- Incident rate ratios indicated a decrease in urine culturing and UTI diagnosis rates compared to baseline and inter-collaborative periods.
- A notable reduction in Clostridioides difficile infections (CDIs) was observed, although one comparison showed an increase.
Conclusions:
- The implemented quality improvement program effectively reduced urine cultures, UTI diagnoses, and CDI rates in LTC facilities.
- This type of collaborative intervention demonstrates potential for promoting appropriate UTI management in the LTC setting.
- The findings suggest that targeted educational and quality improvement initiatives can positively impact antibiotic stewardship for UTIs in older adults.
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