UTI Infections in Long Term Care & Skilled Nursing Facilities

By March 4, 2022 March 7th, 2022 Education

Residents of skilled nursing homes and assisted living facilities are among those most at risk for developing a urinary tract infection (UTI). People take accommodations in one of these types of long-term care homes because they’re unable to fully take care of themselves or attend to the tasks of daily living, including going to the bathroom and bathing. Furthermore, many nursing home residents also have trouble with incontinence or fully emptying their bladder, two conditions that increase the likelihood of developing an infection in the urinary tract.

When urine is in the bladder for more than a few hours, bacteria can spread into the urinary tract, putting individuals at higher risk of getting a UTI. Or, for people who wear adult protective garments for incontinence, not changing them regularly can also cause UTIs. The bacteria in the expelled urine can move from the diaper into the urinary tract, causing both a UTI and a bladder infection.

Left untreated, both types of infections, UTI and bladder, can cause someone to be quite sick and may even be fatal to those with compromised immune systems. Learning the causes of UTIs and the conditions that heighten the chance of developing one can help administrators of long-term care facilities and caregivers working there better care for residents, helping them reduce their risk of UTIs.

Catching a urinary tract infection early also increases the patient’s responsiveness to treatment. Regular UTI testing for nursing homes and assisted living communities should be part of the patient care protocol.

“We’ve seen a rise over the last couple years in requests for testing for urinary tract infections from many our long-term care & nursing home clients around the country.  Capstone Healthcare’s molecular UTI testing utilizes real-time PCR technology for faster detection, increased specifity & better improved sensitivity,” says Rhyan Walcott, Chief Executive Officer at Capstone Healthcare.

How Common are UTIs in Long Term Care & Assisted Living Facilities?

UTI is the number one most common cause of nursing home acquired bacteremia, though it has a lower mortality rate (8%) than pneumonia (56%). Through testing in long term care facilities studies have shown that prevalence of asymptomatic bacteriuria is higher than that of symptomatic UTI. UTIs account for one-third of all hospilized patients from long term care facilities. In one study, upon testing admitting long term care residents with bacteremia, a urinary source was identified in 51-56% of cases.

Research shows that the rate of incidence is 1-2.4 per 1,000 resident days. Of asymptomatic bacteria, the rate is 30-50% for women and 15-40% for men. The rate of acquiring bacteriuria is high, with 10-20% of non-bacteriuric residents acquiring bacteriuria by 6 or 12 month follow-up. 25-30% of initially bacteriuric residents will become non-bacteriuric during this time. The strongest indicated risk factor for bacteremia was use of a urinary catheter. With an estimated one quarter of the population of older adults at some point living in long term care facilities, the need to identify cases far-reaching.

What Is a UTI?

A urinary tract infection is caused by the presence of bacteria, specifically Escherichia coli (E. coli), Chlamydia, and mycoplasma bacteria. When these bacteria enter the urethra, they cause infection and inflammation. Plus, the bladder and urinary tract are ideal environments for bacteria to multiply and spread, traveling into the bladder and causing a bladder infection.

Chronic urinary tract infections can lead to hospitalization, as repeat infections can weaken other organs in the body. In addition, a patient who has repeated UTIs may be compromising their own care through improper toileting habits and may need a higher level of care.

The most common way for these bacteria to enter the urethra is through a soiled diaper or contaminated catheter. Nursing home caregivers must be especially diligent in checking for UTI symptoms since many of them may be disguised by other conditions or may present as something else, especially in women. Yeast infections, ovarian cysts, Lyme disease, and bladder cancer also present the same symptoms as a UTI.

What are the Symptoms of a Urinary Tract Infection?

Common symptoms of a UTI for both men and women include:

  • Persistent urge to urinate
  • Burning sensation when they urinate
  • A strong smell to the urine
  • Dark, cloudy, or bloody urine
  • Pain or soreness in the lower abdomen or the upper back and side

Pain in the side and upper back can be a sign that the UTI has developed into a bladder infection and needs medical treatment as soon as possible.

Can UTIs Be Prevented?

It’s easier for nursing homes to have Best Practices that help prevent residents from developing UTIs, and in many cases, a UTI is 100% preventable. However, prevention can be challenging in nursing homes, especially for residents who are mostly immobile, unable to use a toilet, or unwilling to have their diapers changed regularly. Still, caregivers can help residents drink plenty of water, wipe properly to prevent bacteria from entering the urethra, and check catheters and diapers often.

How Are UTIs Diagnosed?

Many trained nurses and CNAs know the symptoms that can indicate a UT. Often, they’re caused by bacteria from the gut entering the urethra. Routine checks for a UTI can include checking the causes of a possible UTI, such as a catheter that gets loose and collects bacteria from the anus, which then infects the urinary tract. Or, an improperly handled r infected catheter can also deliver bacteria to the bladder. Monitoring residents with mobility issues or those prone to removing catheters can help reduce the chances of bacteria infecting the urinary tract.

Regular laboratory testing for UTIs is also essential. Routine checks can be incorporated into each patient’s treatment plan so that the nursing home can catch a UTI early when it’s easily treatable. Any indication that a patient may have a UTI should trigger an automatic diagnostic test from a reliable testing lab.

Laboratory testing for urinary tract infections include:

  • Urine culture
  • Leukocyte esterase dipstick or urinalysis
  • Blood culture

If a doctor or nurse finds indications that another underlying condition is presenting with the same symptoms of a UTI, then they may order a CT scan to check for possible kidney problems or obstruction in the elimination system.

How are UTIs Treated?

Depending on the severity of the infection, a patient may receive one or more of the following treatments:

  • Antibiotics
  • Anti-infection agents
  • Care for the fever and dehydration, such as an IV
  • Antiemetics
  • Pain relief and pain control medication
  • Massage and relaxation techniques

Treating a UTI early with antibiotics is typically the best course of action.

Capstone Healthcare’s CEO, Rhyan Walcott states, “Although UTI testing using cultures are the most common form of urinary tract infection testing, our molecular method is able to provide 33% more accuracy. While cultures may take 1-3 days to grow, our molecular format can produce results in as little as 5 hours. Many of our physicians in the primary care & hospital setting also love the antibiotic resistance (ABR) results that we include on their reports upon request.”

The Importance of Effective UTI Testing For Nursing Homes

Having the latest and most advanced testing for UTIs can make a difference in the overall health of residents in long-term care communities. Incorporating accurate, reliable, and fast UTI testing into patient care procedures enhances their longevity and quality of life and helps nurses and caretakers treat the infection promptly, avoiding fatal complications. Regular testing for urinary tract infections helps nursing homes better care for their patients and provide the least invasive treatment methods.

Lab testing for UTIs should be both fast and accurate. The quicker a diagnosis is made, the faster treatment can begin, and the less chance that the infection will spread.

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