Preventing Urinary Tract Infections with Team Work in Long Term Care

According to the Center for Medicare and Medicaid Services (CMS) Minimum Data Set (MDS) Quality Indicator monthly reports from January 2008 to August 2008 for a 118 bed long term care facility, prevalence of urinary tract infections (UTI) averaged 14% as compared to a national average of 8%.  In order to reduce the prevalence of urinary tract infections a UTI Task Force was formed.  The task force consisted of nurse practitioners, registered nurses, certified nursing assistants, and a dietitian.  Evidenced based literature on preventing urinary tract infections was reviewed by the team.  Team members investigated and reported to the task force current practice within the facility related to perineal cleansing, catheter care, hydration, indwelling catheter drainage bag care and emptying, use of leg bags, specimen collection, and catheter irrigation.  Discrepancies in clinical practice guidelines and actual practice were identified.  Team members were delegated with the responsibility of returning to their practice settings to initiate evidenced based interventions for preventing urinary tract infections. Interventions initiated were: emphasis on perineal cleansing on both continent and incontinent residents, reinforcement of catheter care, hydration cart, popsicles, drainage bag covers, graduated cylinders, increase frequency of replacing urinals, drainage bag hooks for Broda chairs, and eliminating catheter irrigations.  The MDS Quality Indicator reports for March 2009 for the long term care facility showed a decreased UTI rate of 8.5%.