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Introduction
This paper aims to critically analyze fifteen different research articles that addressed the problem of urinary tract infections (UTI) in nursing homes.
Agata, Loeb, and Mitchell (2013)
The primary aim of this study was to characterize how UTI presents itself in advanced dementia nursing homes and how these features affect the criteria to initiate antimicrobial therapy. They employed a 12-month prospective study design involving 266 participants to address their study question. The study established that only 16% attained the set minimum criteria for antimicrobial therapy initiation when signs and symptoms are used. However, when the authors initiated antimicrobial therapy on all the residents with indicator symptoms, the treatment outcome was the same whether the resident met the minimum criteria or not. From the findings, there is, therefore, a need to reconsider the advanced diagnosis of UTI among dementia patients or reset the minimum criteria for antimicrobial treatment initiation. This article supports the need to initiate all dementia residents with UTI indicators irrespective of their score on the set criteria. Coupled with improved diagnosis, this move will largely help in reducing UTIs in dementia residents.
Hyang, Blegen, and Harrington (2014)
The main objective of this study was to determine the relationship between the number of registered nurses (RN) and different quality indicators in a nursing home on several outcome measures, among them was UTI. This study is very ideal for the health problem of interest. The authors reported that the level of RN had minimal effect on the development of UTI; a significant effect was only seen on pressure ulcers. From these findings, the authors concluded that it is important for people to understand the relationship between the level of RN and the quality outcomes in nursing homes. These findings seem ambiguous, particularly in relation to UTIs. There is a need for further research to determine the exact impact of RN levels on UTI, this is critical as sufficient nurses are required to help aging persons suffering from the syndrome, while protecting others from being exposed to predisposing factors.
Shang, Larson, Liu, and Stone (2015)
The basis of this study was that residents of Home Health Care (HHC) have a higher risk of developing infections. They, therefore, sort to establish the rate of infection in different care centers and the factors associated with the observed rates of infection. The study reported that more than 70% of all unplanned hospitalizations from HHC occurred due to infections from these centers. However, the rate varied greatly between different centers ranging from as low as 0% to as high as 34%. From the findings, the authors concluded that the observed differences may be due to differences in disease control practices and policies in the centers. These findings are of value in the management of UTIs among nursing homes. It shows that effective management of the condition needs a uniform and comprehensive health plan applicable to all. Such a plan should detail how to prevent, diagnose, and treat UTI in nursing homes.
Carlsson et al. (2013)
This study analyzed the relationship between nutritional status and UTI. Most of the residents of the nursing homes were malnourished and found to be at a higher risk of developing UTI in the first year of admission. However, the rate of UTI for the years that followed thereafter was independent of the nutritional status. Since the exact factors accounting for this observed trend could not be established, the authors recommended further studies to establish fill this informational gap. These findings demonstrate the importance of a nutritious diet in the management of UTIs. However, it will be of great use if the upcoming studies identify specifically which foods are necessary to protect the aging residents from UTIs.
Chang et al. (2014)
This study analyzed the consequences and risk factors associated with Long Term Care Facilities (LTCF) in Taiwan. They established that 5.32 cases of infection occurred in every 1000 resident days, with infected members most likely to die. Those at higher risk of contracting infections were those using urinary catheters and/or feeding tubes. Though other factors may have played a role in the rate of infection, it can be stated that the use of catheters was the primary cause of UTI within these facilities. The authors could have sorted further and established the actual factors related to catheter use that contributed to increased risk of infection. Such findings will help greatly to reduce the incidences of UTIs.
Zorman et al. (2013)
This study examined the differences between elderly people living in nursing homes and those that lived within the community who were admitted to a hospital as a result of bacterial infection. It was shown that elderly people from nursing homes were more dilapidated and older as compared to their counterparts from the community. The difference is due to the high bacterial load within the nursing homes and generally the differences in hygienic conditions in these two settings. Those from nursing homes had a higher probability of succumbing to death. These findings show that there is a need for better sanitary measures in nursing homes in order to reduce UTIs, as bacterial infection is a major predisposing factor for UTI.
Trinkoff et al. (2015)
This study analyzed the effect of levels of training of nursing home directors and administrators and patient outcome. It was shown that generally, the provided care among these homes improved with an increased level of education of the administrators and the nursing director. The authors then concluded that certain health outcomes within nursing outcomes can be improved by employing a highly educated administrator and a director of nursing services. In terms of UTIs, these findings are highly applicable in that having on board a person with a greater understanding of health dynamics will greatly reduce incidences of infections within these homes, including UTIs. Such officers will also be vital in setting out policies and guidelines that may prevent or reduce occurrences of such infections and their associated fatal impacts.
Shang, Ma, Poghosyan, Dowding, and Stone (2014)
This study was a systematic review of the prevalence of infections and the associated risk factors among different Home Health Care (HHC). The authors noted significant differences in the rate of infection between different homes. From the findings, the authors proposed several guidelines that can help reduce the infection rate, including developing an HHC disease surveillance system, quick identification of high-risk population, development of education programs specific for each HHC, and enhancement of communication between the different facilities. Though these findings are timely and will reduce the incidences of UTIs, there is a need for further research that will necessitate the development of education programs specifically for UTIs and the improvement of UTI surveillance services in the homes.
Figueiredo (2014)
Figueiredo (2014) focused on establishing the role nurses play in preventing the incidence of infections while performing Peritoneal Dialysis (PD). UTI is the major infection that results from this procedure; therefore, the findings of this study are true and applicable to UTIs. The study demonstrated that nurses play a critical role in preventing infections as well as associated morbidity and mortalities. Other strategies that were found to greatly reduce the rate of infection are continuous staff training, strictly adhering to the treatment protocol, paying special attention to every detail, proper catheter implantation, and effective management of patient risk factors. Such measures will surely reduce and put under control incidences of UTIs. As the author puts it, the nurses should ensure the safety of the residents is their primary objective.
Flanagan et al. (2014)
This study aimed at reviewing interventions targeting incontinence, which is the main problem with older people residing in care homes. From the study, the authors proved that effective management of incontinence and the subsequent promotion of continence in care homes is a very complex process, requiring a lot of resources in terms of time and cost. Further studies to determine the economic impact of maintaining high levels of continence within these homes should be done. In relation to my health problem of interest, this study doesn’t provide a detailed link between incontinence and UTI. It could be prudent if the authors also analyzed the economic impact of treating UTIs that resulted due to failure ineffective management of incontinence.
Van Gaal et al. (2014)
This study described the coexisting incidences between UTI, pressure ulcers, hospital falls, and the nature of preventive care provided. The authors also explored the link between the preventive care given and the associated adverse events. The study found out the incidence and prevalence rates of these infections are very high in nursing homes and hospitals. The most disturbing finding is that affected persons do not receive adequate care to help them deal with their conditions. The importance of these findings is that they can be used by relevant authorities to develop policies or mechanisms that will lead to better health outcomes in these homes. Given that the residents in these homes are old, lack of sufficient strategies to help them deal with fatal diseases such as UTI will only serve to see them succumb to death.
Kihlgren et al. (2014)
This study analyzed the rate of referrals of older residents of nursing homes by RNs and the main cause of their referrals. Falls accounted for the majority of referrals, followed by cardiovascular diseases, problems of the gastrointestinal systems and infections respectively. The fact that UTI was not recorded as one of the major causes of referral raises multiple questions. Is it because UTI is less common among these residents? Or is it because the condition is largely undiagnosed and therefore untreated? Further research needs to be done to establish the exact extent of referral resulting from UTI as this information is necessary for developing a UTI control mechanism.
Ping, Traynor, and Hailey (2014)
This article majorly explored urinary continence (UC), and how it is managed within nursing homes in Australia. From the study, the authors identified areas within these homes that need improvement when it comes to UC. Such areas include: identifying the terms when older people majorly void themselves, strict compliance and adherence to the established management plans and practices, developing caregiving capacity in terms of personnel and resources and continuous training to enhance UC management skills. These recommendations are relevant to the topic of UTI in that effective management of UC automatically results in effective control of UTI. Further studies are however required to assess the economic implications of these proposed measures.
Teramura-Gr Ö Nblad et al. (2010)
The study investigated the risks associated with use of proton-pump inhibitors among frail elderly residing in nursing homes. The study reported that those using PPIs had a higher risk of having diarrhea and experiencing a hip fracture compared to non-users. As such, clinicians were advised to avoid overusing PPIs among frail elderly unless it is the only remaining option. The use of therapeutic agents in most cases has a negative effect on other physiological conditions. They can also predispose one to other diseases such as diarrhea in this case. The authors, however, did not examine the effect of these PPIs on UTIs. In addition to this drug, there is a need to examine the role played by multiple therapeutic agents given to frail elders and the rate of UTIs. This will help in designing therapeutic measures that will safeguard the patients from the disease.
Wysocki et al. (2014)
This study analyzed the possibility of having hospitalization that is potentially preventable, both from the nursing homes and from community-based services. The medical conditions accounting for preventable hospitalization were similar in both settings, and UTI was among them. However, those from nursing homes had a lower rate of hospitalization from both potential and non-potentially preventable hospitalization as compared to those receiving care from community-based services. This suggests that where possible, nursing homes should be used. However, due to financial strains and space limits in these homes, community services should be strengthened to minimize unwanted hospitalization, particularly for UTIs.
References
Agata, E. D., Loeb, M. B., & Mitchell, S. L. (2013). Challenges in assessing nursing home residents with advanced dementia for suspected urinary tract infections. Journal of the American Geriatrics Society, 61(1), 62-66.
Carlsson, M., Haglin, L., Rosendahl, E., & Gustafson, Y. (2013). Poor nutritional status is associated with urinary tract infection among older people living in residential care facilities. Journal of Nutrition, Health & Aging, 17(2), 186-191.
Chang, C., Chen, L., Liu, L., Lin, M., Peng, L., & Chen, L. (2014). Lymphopenia and poor performance status as major predictors of infections among residents in long-term care facilities (LTCFs): A prospective cohort study. Archives of Gerontology & Geriatrics, 58(3), 440-44.
Figueiredo, A. E. (2014). The challenges in preventing infection in peritoneal dialysis: a nurse’s viewpoint. Renal Society of Australasia Journal, 10(3), 120-125.
Flanagan, L., Roe, B., Jack, B., Shaw, C., Williams, K. S., Chung, A., & Barrett, J. (2014). Factors with the management of incontinence and promotion of continence in older people in care homes. Journal of Advanced Nursing, 70(3), 476-496.
Gaal, B. G., Schoonhoven, L., Mintjes-de Groot, J. A., Defloor, T… & Habets, H. et al. (2014). Concurrent incidence of adverse events in hospitals and nursing homes. Journal of Nursing Scholarship, 46(3), 187-198.
Hyang, L., Blegen, M. A., & Harrington, C. (2014). The effects of RN staffing hours on nursing home quality: A two-stage model. International Journal of Nursing Studies, 51(3), 409-417.
Kihlgren, A., Wimo, A., & Mamhidir, A. (2014). Older patients referred by community nurses to emergency departments – a descriptive cross-sectional follow-up study in a Swedish context. Scandinavian Journal of Caring Sciences, 28(1), 97-103.
Ping, Y., Traynor, V., & Hailey, D. (2014). Urinary continence care in Australian nursing homes. Australian Journal of Advanced Nursing, 32(2), 39-46.
Shang, J., Larson, E., Liu, J., & Stone, P. (2015). Infection in home health care results from National Outcome and Assessment Information Set data. American Journal of Infection Control, S0196-6553(14)01424-2.
Shang, J., Ma, C., Poghosyan, L., Dowding, D., & Stone, P. (2014). Major article: The prevalence of infections and patient risk factors in home health care: A systematic review. AJIC: American Journal of Infection Control, 42479-484
Teramura-Grönblad, M., Hosia-Randell, H., Muurinen, S., & Pitkala, K. (2010). Use of proton pump inhibitors and their associated risks among frail elderly nursing home residents. Scandinavian Journal of Primary Health Care, 28(3), 154-159.
Trinkoff, A. M., Lerner, N. B., Storr, C. L., Han, K., Johantgen, M. E., & Gartrell, K. (2015). Leadership education, certification and resident outcomes in US nursing homes: Cross sectional secondary data analysis. International Journal of Nursing Studies, 52(1), 334-344.
Wysocki, A., Kane, R. L., Golberstein, E., Dowd, B., Lum, T., & Shippee, T. (2014). The association between long-term care setting and potentially preventable hospitalizations among older dual eligibles. Health Services Research, 49(3), 778-797.
Zorman, J., Lusa, L., Strle, F., & Maraspin, V. (2013). Bacterial infection in elderly nursing home and community-based patients: a prospective cohort study. Infection, 41(5), 909-916.
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