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UTI Problems? Consider Treating the Environment, Not Just the Resident

By Linda McConnell

Having been a nurse in long-term care for more than 10 years, I have seen my fair share of urinary tract infections. Gram-negative bacteria such as E. coli, Proteus mirabilis and Klebsiella pneumoniae are just some of the usual culprits. Tracking and trending can become exhausting and overwhelming at times. Proper staff training and education and even making rounds to ensure these things are being performed properly do not guarantee an actual decrease in the number of residents with UTIs.

UTIs in the geriatric population

Identifying a UTI in the geriatric population in and of itself can be difficult. Geriatric residents do not always have the common symptoms associated with a UTI. They can exhibit increased confusion, behavioral symptoms and even balance problems leading to increased fall risk, but might not complain of actual discomfort from dysuria or the typical lower back pain. Diagnosis can be overlooked if based solely on the classic symptoms.

Complications from UTIs, especially in the elderly, can be devastating. Residents face problems with dysuria, frequency, fever, dehydration and even possible hospitalization from urosepsis. The evolution of antibiotic-resistant bacteria is also a huge problem for repeat infections due to the use of multiple antibiotics.

Look to the environment for answers

If the problem of urinary tract infections seems to be a routine dilemma in your facility, I suggest that you consider treating your environment, not just the resident. Residents at our facility had been experiencing UTIs whose origins left me puzzled. I obtained cultures of our shower chairs and whirlpool after properly sanitizing the devices with the sanitizer we had always used. The results were astonishing. The culture results showed the presence of three gram-negative bacteria.

Once the problem was identified, we implemented a change in our view of UTI prevention. The first thing we did was change the sanitizing agent we were using, fearing that the bacteria that were present had become resistant to the previous product. The next steps were to educate the staff on the proper use of the new agent and reeducate them on how to properly sanitize the shower chairs and whirlpool between each resident.

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