Senior in hospital bed

A New York City nursing home cut its urinary tract infection rate and related care costs in half by implementing a bundle of “basic and practical” prevention strategies, according to findings presented at the PALTC Virtual Annual Conference 2021.

Gouverneur Health, a 295-bed public skilled nursing facility with full-time medical staff affiliated with the New York City Health & Hospitals, implemented the initiative in April 2019. In the planning phase, its quality improvement team opted to adopt a bundle of basic UTI-prevention strategies with the aim of reducing its UTI rate by 50% from a 15-month pre-intervention average rate of 4.39%.

The team developed a new care protocol with key components of the bundle, including:

  • Close monitoring of hand hygiene compliance; 
  • Check of residents’ hydration status; 
  • Effective incontinence and perineal care and regular diaper/brief changes by certified nursing aides; 
  • Education of residents and families through council meeting by social workers and therapeutic recreation staff; and 
  • Local treatment of UTIs instead of hospitalization through the physicians’ use of evidence-based guidelines.

The QAPI initiative resulted in an average UTI rate of 2.13%, a decrease of 52% from the pre-intervention rate and lower than New York state and national benchmarks, according to presenting author Emalyn Bravo, director of quality and risk management at Gouverneur Health. In addition, the facility’s UTI-related costs fell from a pre-intervention average value of $59,559 to a post-intervention average value of $28,720 — a 52% reduction, Bravo and colleagues from NYC Health & Hospitals said.

“Given its effectiveness, the use of this bundle in other nursing facilities is encouraged to determine its suitability elsewhere,” they concluded.