Welcome to Preventing Urinary Tract Infections in Nursing Home Residents. This module is intended to help educate nursing home staff about the risk of urinary tract infections among the residents, and prevention strategies for helping residents stay healthy and UTI free. There are four objectives for this module. Describe the causes and risk factors for UTIs in nursing home residents. Differentiate between asymptomatic bladder colonization and symptomatic urinary tract infections in nursing home residents. Understand when and when not to test for and treat UTIs. Discuss prevention strategies to reduce the incidence of UTIs among residents. There are several definitions that you should know before proceeding with the module. A urinary tract infection is the invasion of the urinary system by a disease causing microorganism that is characterized by urinary tract specific symptoms in the setting of signficant bacteria in a urine specimen. Asymptomatic bacteriuria, or asymptomatic bladder colonization, is the presence of bacteria in the urine without any urinary tract specific signs or symptoms suggestive of a UTI. Pyuria is the presence of white blood cells, or pus, in the urine, indicating inflammation of the urinary tract due to infectious or non-infectious causes. Urinary tract infection is one of the most commonly diagnosed infections in older adults, and is the most frequently diagnosed infection in long term care residents, accounting for over a third of all nursing home associated infections. Data from several studies suggests that the rate of symptomatic UTI in non-catheterized residents is around 1.1% of the population. This is substantially lower than the rate of symptomatic UTIs among residents with an indwelling catheter, which has been measured at 5.5% of the population. UTIs are a common reason for hospitalizations, comprising almost 30% of hospital readmissions from nursing homes within 30 days. Nationally, 5 to 10% of long term care residents have urinary catheters in place. Of new residents admitted to nursing homes from hospitals, 12% have urinary catheters present upon transfer. Because of this high frequency of residents with catheters in place upon transfer to long term care facilities, it is important that a medical justification for the catheter is provided by the sending facility and the resident is assessed upon admission for continued need. The presence of bacteria in the bladders of older adults residing in long term care facilities is often normal and increases considerably with age for both men and women. For instance, in women residing in the community, the estimated prevalence of asymptomatic colonization of the bladder is 1-5%, increasing to almost 20% in women over the age of 80. In long term care facilities, the prevalence is much higher with rates reaching up to 50%. For men, the trend is the same. The use of urinary catheters predisposes men and women to asymptomatic bladder colonization. The risk in catheterized older adults ranges from 3 to 10% per day of catheterization, reaching 100% in chronically catheterized residents. To summarize, bacteria in the bladder is often a normal and expected finding and does not by itself represent an infection. A number of factors predispose older persons to urinary tract infections. The use of urinary catheters and external urinary collection devices increase the frequency of colonization of the bladder. Asymptomatic bacteriouria is more common in people with cognitive impairment and urinary and fecal incontinence. Neurological conditions such as strokes, Alzheimer's disease and Parkinson's disease are all common later in life and associated with impaired bladder emptying. Older people with diabetes also have an increased prevalence of asymptomatic bladder colonization, especially with contributing factors like neurogenic bladder and poor blood sugar control. In post menopausal women, decreased estrogen has been linked with increased colonization and increased urinary tract infections. In men, prostate enlargement leads to urinary symptoms and urinary retention, which can result in colonization and UTIs. A urinary tract infection, or UTI, occurs when bacteria or germs get into the urinary tract and multiply. The urinary tract is made up of the bladder, urethra, and the two ureters and kidneys. These germs usually enter the urinary tract through the urethra, the tube that carries urine out of the body, and travel up to the bladder. The result is redness, swelling and pain in the urinary tract. When a catheter is in place, this creates an easy avenue for the bacteria to enter the bladder. Bacteria can travel up the outside of the catheter, or can enter the bladder through the lumen of the catheter itself, especially when the system is disconnected, or the collection bag becomes contaminated. >> Previously on Gowns and Gloves, an MRSA outbreak has kept the nurses busy at Sunnyside as they work hard to contain the infection and keep their residents calm. Meanwhile, Elaine Houston and her husband Dimitri have been busy trying to confirm that Priscilla is in fact Mrs. Houston's long lost granddaughter. Will their search for answers prove fruitful, or are Mrs. Houston's infection troubles just a very sad turn of events? Will the nursing staff ever figure out the cause of the infections? And will David's recent win on The Technique cause a rift with his fellow Sunnyside nursing staff? Find out this week on Gowns and Gloves. >> [CROSSTALK]. >> Believe in it. [INAUDIBLE]. >> Where to begin. >> Amazing covers. >> I love David, crazy. Hey, David, welcome back. And congratulations on winning The Technique. >> Yes, welcome back. You're quite the celebrity. I saw you on the Today show. You and Minerva. It's Minazing! >> It's Mintastic! >> I don't know, it's getting on Minerves. >> [LAUGH] >> Oh, these are your 15 minutes of fame, you should enjoy them. >> Well fame and Minerva are fun, but now I'd rather practice my technique on people who really need me. >> Speaking of people who need you, your grandma has gone through quite an ordeal since arriving at Sunnyside. She's a funny one. You didn't tell me she and Dimitri were so intense. >> How so? >> Well, you'd almost think that they wanted to be stuck here at Sunnyside. And they keep asking for me to personally look after them. Vanessa doesn't stand a chance when she walks in the room. >> I have to admit it's getting on my nerves. >> It's funny, I was actually just gonna go see her. Wanna come with me? >> Sure, Vanessa and I were just about to go check in on her anyway. >> Great, let's go. >> Our plans are advancing. [INAUDIBLE] working to >> Grandma. >> David, sweetheart, how good to see you. I'm so proud of you for winning The Technique. I watched every episode on TV. Oh, but don't get too close. I've had all kinds of bugs. >> Grandma, tell me how you are. And by the way, I hear you've gotten close to my coworker, Priscilla. >> Oh, we have had the great pleasure of Priscilla's company and care. She has taken great care of your grandmother. Elaine, why don't you tell David about your ailments? >> Well as you know, I was admitted to Sunnyside after my hip surgery. Before I knew it, I was colonized with MRSA. Then I became infected and everybody, including Dimitri, was under contact precautions. Then I had the flu. And I had to go on droplet precautions, which means I had to wear a mask. [LAUGH] But, the funny thing is, that when both Priscilla and I had on masks, we looked so much alike that they just couldn't. >> [SOUND] Ahem. Why don't you go on with your story, dear? >> Oh, right. And now, now we're here. And I'm not feeling at all my best. >> Grandma, you need to work on gaining your strength back so that you can recuperate at home as soon as possible. >> David has a great point. You're almost ready to go home. >> Oh, [SOUND] actually I'm not feeling well at all today. I'm a little weak and woozy. >> Tell me more about your symptoms. Are you experiencing any discomfort or any changes from what is normal? >> Well, now that you mention it, I do have a little stomach pain. And I've been going to the bathroom more frequently. Sometimes I barely make it. >> Let's get a urine sample just to make sure everything's okay. Now that the MRSA outbreak is under control and no flu cases this week, we're gonna focus on getting you discharged, Mrs. Houston. But first, let's see if we can get you feeling a little bit better. >> Thank you. I appreciate that. >> Grandma, I'm heading out now. I'm on Letterman tonight, but then I'm headed home for good. >> Well, you remember to bring Minerva back with you. >> [LAUGH] Grandma. Okay. [MUSIC]
