Improved Practice and Decreased Antibiotic Utilization for Urinary Indications in Long Term Care Facilities After an Educational Intervention
Antibiotics are among the most commonly prescribed medications in long-term care facilities. Reports show that 25-75% of systemic antimicrobials are prescribed inappropriately, often for asymptomatic bacteriuria.
We developed a collaborative program to improve the management of suspected urinary tract infection in the elderly. The program provided useful tools for promoting a careful approach to indications for urine testing (including the appropriate evaluation of mental status changes) and the interpretation of urine test results. The curriculum reviewed appropriate culture and treatment indications during 2 full day workshops, webinars, four conference calls and one-to-one coaching sessions. To analyze the effectiveness of the program we measured urine culture rates, facility rates of diagnosis of urinary tract infection, and C. difficile infection rates before and after the program.
Seventeen long term care facilities throughout Massachusetts participated and submitted monthly data. Urinary tract infections decreased by one-third after the intervention (IRR=0.67, CI=0.59, 0.76) and urine cultures decreased by one quarter (IRR=0.73, CI=0.66, 0.79). Incidence of C. difficile decreased by nearly one-half after the initiation of the collaborative (IRR=0.55, CI=0.39, 0.78).
Following a collaborative program to improve practice in testing and diagnosis of bacteriuria, there was a decrease in infection diagnoses and urine cultures rates reflective of an improved understanding of when to culture and an improvement in appropriate diagnosis. During this time period, there was a marked decrease in C. difficile infection rate which may have been due in part to decreased antibiotic usage, although this was not measured. These data support a reasonable model for other health care systems to utilize to improve care of long-term care facility residents who are at risk for unnecessary antibiotic treatment for asymptomatic bacteriuria.
S. Salem-Schatz, None
P. Griswold, None
D. Pallin, None
R. Kandel, None
E. Mchale, None
N. Simmons, None
A. Demaria Jr., None