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J Hosp Med. 2017 May;12(5):356-368. doi: 10.12788/jhm.2724.

Systematic Review of Interventions to Reduce Urinary Tract Infection in Nursing Home Residents.

Author information

1
Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI; Department of Pediatrics and Communicable Diseases, Division of General Pediatrics, University of Michigan Medical School, Ann Arbor, MI; VA Ann Arbor Healthcare System, Ann Arbor, MI.
2
Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI; VA Ann Arbor Healthcare System, Ann Arbor, MI.
3
St. Joseph Mercy Ann Arbor, Ann Arbor, MI.
4
Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI.
5
Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI; 5 Cushing/Whitney Medical Library, Yale University, New Haven, CT.
6
Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, MI.
7
Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI; VA Ann Arbor Healthcare System, Ann Arbor, MI; Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, MI.

Abstract

BACKGROUND:

Urinary tract infections (UTIs) in nursing homes are common, costly, and morbid.

PURPOSE:

Systematic literature review of strategies to reduce UTIs in nursing home residents.

DATA SOURCES:

Ovid MEDLINE, Cochrane Library, CINAHL, Web of Science and Embase through June 22, 2015.

STUDY SELECTION:

Interventional studies with a comparison group reporting at least 1 outcome for: catheter-associated UTI (CAUTI), UTIs not identified as catheter-associated, bacteriuria, or urinary catheter use.

DATA EXTRACTION:

Two authors abstracted study design, participant and intervention details, outcomes, and quality measures.

DATA SYNTHESIS:

Of 5794 records retrieved, 20 records describing 19 interventions were included: 8 randomized controlled trials, 10 pre-post nonrandomized interventions, and 1 nonrandomized intervention with concurrent controls. Quality (range, 8-25; median, 15) and outcome definitions varied greatly. Thirteen studies employed strategies to reduce catheter use or improve catheter care; 9 studies employed general infection prevention strategies (eg, improving hand hygiene, surveillance, contact precautions, reducing antibiotics). The 19 studies reported 12 UTI outcomes, 9 CAUTI outcomes, 4 bacteriuria outcomes, and 5 catheter use outcomes. Five studies showed CAUTI reduction (1 significantly); 9 studies showed UTI reduction (none significantly); 2 studies showed bacteriuria reduction (none significantly). Four studies showed reduced catheter use (1 significantly).

LIMITATIONS:

Studies were often underpowered to assess statistical significance; none were pooled given variety of interventions and outcomes.

CONCLUSIONS:

Several practices, often implemented in bundles, such as improving hand hygiene, reducing and improving catheter use, managing incontinence without catheters, and enhanced barrier precautions, appear to reduce UTI or CAUTI in nursing home residents. Journal of Hospital Medicine 2017;12:356-368.

PMID:
28459908
PMCID:
PMC5557395
DOI:
10.12788/jhm.2724
[Indexed for MEDLINE]
Free PMC Article

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