Background

Urinary tract infection is more common in older people living in care homes but can be difficult to recognise.

This can lead to overuse of antibiotics and may result in antibiotic-resistant infection and hospital admission.

We wanted to find out what can work in care homes to prevent and recognise UTI and what support care home staff need to enable safe care for all residents.

What we did

• We reviewed evidence from a range of sources, including research studies and improvement projects.

• We also asked care home staff, residents, family carers and healthcare professionals about their experiences.

• We combined these experiences and ideas with the evidence we found from published literature to develop an understanding of what needs to happen in care homes for older people to prevent and recognise UTI. 

What we found out

What difference will this make?

UTI can be prevented by embedding prevention activities in care routines:

• ensuring residents are hydrated

• ensuring residents with recurrent UTI are managed actively with preventative treatment

• avoiding the use of urinary catheters wherever possible
  

Unnecessary antibiotic use can be avoided by:

• involving the whole care team, resident and family in recognising UTI

• using active monitoring when there is uncertainty about UTI

• supporting care staff to develop the skills to accurately recognise UTI

• using tools that support decision-making and communication across the wider care team
  

Safe care for each resident can be achieved when:

• care staff receive education that is contextualised to their role and helps them to prioritise and deliver person-centred care

• care home managers are committed to supporting the delivery of best practice

• commissioners and regulators promote UTI prevention and recognition as a priority area for care homes

Why is this important?

Our findings suggest ways that care home providers and policy makers can support the prevention and recognition of UTI in the care of older people living in care homes. A system-wide approach is vital to enable care home managers and their staff to prioritise UTI prevention and recognition as part of person-centred care.

At policy level, there is a need to integrate UTI prevention with diagnostic and antimicrobial stewardship and to unify the content of education and decision-support resources so that care staff can see the value of their role in prevention as well as supporting diagnosis and treatment of UTI.

What next?

• Our research is the start of a process of understanding what works in care home settings and will identify where further research is needed.

• A report, summary and articles provide practical examples and recommendations relevant to care home staff, care home managers, researchers, educators, carers and relatives for use to improve the prevention and recognition of UTI in older people’s long-term care and to plan further research to investigate them.

• We are turning our findings into a range of different resources and digital communications, with input from experts who support the adoption and spread of innovation, for sharing via care home networks and associations.

Publication

Realist synthesis protocol for understanding which strategies are effective to prevent urinary tract infection in older people in care homes

Link to University of Southampton site

Research team:

•       Dr Jacqui Prieto, Joint Chief Investigator, University of Southampton

•       Professor Heather Loveday, Joint Chief Investigator, University of West London

•       Professor Jennie Wilson, Co-investigator, University of West London

•       Mrs Alison Tingle, Co-investigator, University of West London

•       Mrs Emily Cooper, Co-investigator, UK Health Security Agency

•       Dr Melanie Handley, Co-investigator, University of Hertfordshire

•       Professor Jo Rycroft-Malone, Co-investigator, University of Lancaster

•       Dr Lynne Williams, Co-investigator, Bangor University

•       Mrs Jennifer Bostock, Co-investigator, Patient and public involvement

•       Lois Woods, Information Specialist, University of Southampton

•       Simon Briscoe, Information Specialist, University of Exeter

•       Jemima Kakpa, Research assistant, University of Southampton

•       Christine Logan, Administrative assistant, University of West London

Project Advisory Group:

•       Jennifer Bostock (Chair)

•       Professor Lona Mody

•       Mr Mark Stott

•       Dr Leah Jones

•       Mrs Susan Bennett

•       Mr James McMahon

•       Mrs Annabelle Stigwood

•       Mrs Anita Astle