Abstract
Urinary tract infections (UTI) in long-term care (LTC) are over-treated with antibiotics. Asymptomatic Bacteriuria (ASB), a nontreatable finding, appears similar to UTI and is common in LTC residents. Antibiotic treatments can cause adverse effects and C. difficile infections, as well as increase healthcare costs and antibiotic resistance. The project purpose was to implement evidence-based practices toward prevention of UTI recurrence, to improve knowledge of ASB, and to improve assessment of UTI symptoms in LTC residents, aimed to reduce UTI incidence and inappropriate treatment of suspected UTI. Research supports a variety of signs/symptoms associated with UTI. Clarity is missing for the specific signs/symptoms and the number necessary to confirm diagnosis. Subsequently, large number of inappropriate antibiotic treatments for UTI occurs. An implementation project was initiated at a 151-bed LTC facility in Southeastern Michigan guided by the Iowa Model of Evidence-Based Practice. The multifaceted intervention strategies used included didactic education, a newly developed algorithm, and change champions. A pre–post analysis was used. The primary outcomes measured were UTI rates, percentage of inappropriate antibiotic treatments for suspected UTI, urinalysis rates, and nurse/provider knowledge. UTI rates for the pre period averaged 2.99 per 1,000 resident-days and for the post period, averaged 0.95 per 1,000 resident-days. Inappropriate antibiotic treatments equaled 77.78% in the pre period and 14.29% in the post period. Both UTI rates and percent inappropriate antibiotic treatments were found to be statistically significant (p < .001 and p < .004, respectively). Urinalysis rates per 1,000 resident-days were 3.87 in the pre period and 2.43 in the post period. These differences were not found to be statistically significant (p = .251). Knowledge assessment scores improved from pre-education to post-education and fell slightly after project completion (49%, 73%, and 63%, respectively). This project provided nurses with a framework for understanding, clear assessment criteria, and a well-defined process to improve accurate treatments. If widely disseminated, this project has the potential to significantly reduce inappropriate treatments of UTIs, reduce costs, reduce adverse effects, reduce incidence of C. difficile, and reduce antibiotic resistance.