Combatting UTIs with juice and good labs
Here's the good news: A juice may reduce the incidences of urinary tract infections in nursing home residents by up to 50%. That has huge implications for a problem that plagues seniors, not to mention clinical staff.
Here's the bad news: The juice comes from black chokeberries.
As the McKnight's art director, Mark Speakman, said to me, “I think you just made that name up.”
It's true I had never heard of black chokeberries, also called aronia berries, before reading about this study. But the berries are common in Europe, and the study involved more than 200 residents from six nursing homes in Norway being offered either the juice or a placebo drink. Group A drank the placebo for three months and then chokeberry juice for three months, while Group B did the opposite. In Group A, 110 participants had a daily intake of 156 mL of chokeberry juice compared to Group B's 126 participants who drank 89 mL.
The incidence of UTI was reduced by 55% for Group A and 38% for Group B. Let's take a moment to consider what your facility would be like if you could cut the UTI rate in half.
The caveat, of course, is that you may not be able to find the juice in your town, although a good place to check would be a health food or nutritional store. Another option is to try the berries from a reputable online retailer, or even to try growing some yourself. Personally, I tend to kill plants by looking at them wrong, but the USDA indicates these are fairly sturdy plants that could thrive in many Northern climates.
Whether or not you want to sniff out chokeberries, it's clear from a recent analysis that nurse practitioners and physicians aren't following practice guidelines when prescribing antibiotics to long-term care residents with suspected UTIs.
In a review of a year of UTI cases at two rural Southern nursing homes, researchers found just four out of 169 cases met the diagnostic criteria for UTI, with the remainder of residents receiving inappropriate antibiotics. Even if we cut practitioners some slack — it's more difficult in long-term care to get a “clean catch” for a urine sample, which makes the strict UTI definition harder to achieve — you can sense the researchers' frustration with a lack of consistency.
“Of most concern is that the methods for collection of the urinalysis was so varied as to render the findings of the urine culture to be meaningless. We do not know if the organisms identified by the culture were from the bladder, skin, diaper, or other contamination. Clearly, initiation of antibiotics for these results is inappropriate,” they wrote in Clinical Scholars Review: The Journal of Doctoral Nursing Practice. Their recommendations were:
- Documentation of signs and symptoms of a UTI when initiating antibiotic therapy
- Avoid giving antibiotics to residents with ASB (asymptomatic bacteriuria)
- Nursing homes should enforce policies related to the “appropriate methods for collecting urinalyses from residents prior to the initiation of antibiotics.” More efforts should be made for the urine to be uncontaminated and the sample sent to the lab in a timely manner.
- Nursing homes should not report UTIs that do not meet the diagnostic criteria.
Elizabeth Newman is Senior Editor at McKnight's Long-Term Care News. Follow her @TigerELN.