Major articleSustained reduction in inappropriate treatment of asymptomatic bacteriuria in a long-term care facility through an educational intervention
Section snippets
Methods
A 33-month prospective study from February 1, 2002, to October 31, 2004, was conducted in the long-term care facility of the Cleveland Department of Veterans Affairs Medical Center. The long-term care facility contains 190 beds on 5 separate wards and is separate from the acute care hospital. The facility is staffed with 1 infection control nurse, approximately 80 licensed nurses, and 6 full-time primary care providers. The educational intervention and monitoring of ASB rates were conducted by
Results
Interviews conducted at the beginning of the educational intervention revealed several factors that could contribute to unnecessary treatment of ASB. Many of the nurses reported that urine specimens were routinely sent for culture for a variety of reasons in the absence of signs or symptoms of infection. Such reasons included foul-smelling or cloudy urine, after urethral catheter changes, upon admission to the ward, after treatment of UTI to document cure, and for nonspecific symptoms unrelated
Discussion
Prior to an educational intervention, we found that most antibiotic prescriptions for urinary indications in our long-term care facility were for ASB. An educational intervention directed at nursing staff and primary care providers resulted in significant reductions in inappropriate submission of urine cultures and in the overall rate of treatment of ASB. Interestingly, when inappropriate urine cultures were sent and ASB was identified during the initial 6 months of the intervention, there was
References (14)
- et al.
Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized women
Am J Med
(1987) Urinary tract infections in long-term-care facilities
Infect Control Hosp Epidemiol
(2001)Urinary tract infection in long-term-care facility residents
Clin Infect Dis
(2000)- Nicolle LE, Bjornson J, Harding GKM, MacDonell J. Bacteriuria in elderly institutionalized men. N Engl J...
- et al.
Does eradicating bacteriuria affect the severity of chronic urinary incontinence in nursing home residents?
Ann Intern Med
(1995) - et al.
Does asymptomatic bacteriuria predict mortality and does antimicrobial treatment reduce mortality in elderly ambulatory women?
Ann Intern Med
(1994) - et al.
Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults
Clin Infect Dis
(2005)
Cited by (114)
Assessment of implementation strategies adopted for antimicrobial stewardship interventions in long-term care facilities: a systematic review
2024, Clinical Microbiology and InfectionManagement of Asymptomatic Bacteriuria and Urinary Tract Infections in Patients With Neurogenic Bladder and Factors Associated With Inappropriate Diagnosis and Treatment
2024, Archives of Physical Medicine and RehabilitationIdentification of novel factors associated with inappropriate treatment of asymptomatic bacteriuria in acute and long-term care
2022, American Journal of Infection ControlImpact of antimicrobial stewardship program on antimicrobial-resistance and prescribing in nursing homes: a systematic review and meta-analysis
2022, Journal of Global Antimicrobial ResistanceNursing Home Antibiotic Stewardship Policy and Antibiotics Use: 2013–2017
2022, Journal of the American Medical Directors AssociationNurse role and contribution to antimicrobial stewardship: An integrative review
2021, International Journal of Nursing StudiesCitation Excerpt :There is a need for information to be made readily available to nurses, for clear policies to support nurses to provide appropriate care, and for nurses to be actively involved in the planning and in the implementation of antimicrobial stewardship activities, to ensure that expectations are practical, and that practice changes reflect nursing workflow. Applying behaviour change theory to inform implementation of local antimicrobial stewardship interventions has been recommended, (Lorencatto et al., 2018; Davey, 2015; Charani et al., 2011) and interventions that encompassed behaviour strategies, were associated with improvements that were impactful on antimicrobial use, (Zabarsky et al., 2008; Messina et al., 2015; Saha et al., 2017) suggesting this may provide the foundation of an effective approach for encouraging nurse involvement. Clearly, implementation needs to assess both context, and potential impact on nursing workflow.
Supported by the Infection Control Department, Louis Stokes Cleveland VA Medical Center, and by an Advanced Research Career Development Award from the Department of Veterans Affairs (to C.J.D.).