UTI policies inconsistent across nursing homes, study finds

A new study of nursing homes has found little consistency among them regarding policies used to prevent urinary tract infections.

Researchers with the Center for Health Policy at Columbia University School of Nursing conducted a survey in 2014 of nearly 1,000 nursing homes across the country, with more than 88,000 residents. The facilities' UTI prevention practices were compared to data from the Centers for Medicare & Medicaid Services to see which tactics helped lower infection prevalence.

Results of the study showed that 5.4% — more than 4,700 residents — developed a UTI each month. Residents with catheters were four times more likely to get a UTI than those who did not have a catheter, researchers found. Despite that increased risk, more of the infections identified by the team were not associated with catheter use.

“What was particularly interesting about this study was that there were more UTIs that were not associated with catheterization than those that were,” said lead author Carolyn Herzig, Ph.D., MS.  “This means that a larger focus should be placed on identifying practices to prevent UTIs, regardless of catheter placement."

Of the nine infection prevention practices analyzed by Herzig and her team, three were found to be directly linked to lower infection prevalence.

Facilities that used portable bladder ultrasound scanners to check if residents were voiding all of their urine were found to be 10% less likely to have high rates of non-catheter associated UTIs. Only 22% of the facilities surveyed had policies on scanner use in place.

Just 44% of the facilities included in the survey were found to have policies on cleaning the urine collection bag for residents with catheters. Those with a cleaning policy in place were 20% less likely to have a higher rate of catheter-related UTIs.

Nursing facilities that employed a staff infection preventionist who took a course on UTIs through the Association for Professionals in Infection Control and Epidemiology were 20% less likely to have high infection rates. Despite that, just 9% of surveyed facilities had a staff member take an APIC training course.

The full results of the Columbia team's research were presented at APIC's annual conference in Charlotte, NC, and published online in the American Journal of Infection Control.