Help! UTIs in LTC

[RNAndi]

I'm a relatively new nurse working in LTC. Im trying to reduce the incidence of UTIs and pressure ulcers in my facility. So far the conventional methods of prevention have done little to prevent UTIs or pressure ulcers from forming. So I'm asking any other nurses that may have had experience in this area, what works? Any ideas to help increase other staff (nurses and CNAs) to be more diligent with their cares and documentations? thanks in advance for any help!

[JasBSN]

As a nurse manager in a LTC, I've found that frequent education is key to any change. When we a had an epidemic of UTI's, we re educated all of our CNA's on proper peri care and had them do return demonstrations on a dummy, then we observed them doing peri care on residents and re educated as needed. Now we are to the point of just doing spot checks on their peri care and constantly reminding and re educating. It has helped quite a bit. As for the pressure ulcers, do you have any type of specialty mattresses available? We base the type of mattress a resident has on their Braden score. High braden scores get a regular foam mattress, mid range we put them on an alternating pressure mattress, and for the ones with horribly low Braden's, we try to get a dolphin bed or clinitron, but getting the company to spring for a clinitron is next to impossible. But we have a very a low rate of CAPUs, and most of the ones we do get are Kennedy Terminal ulcers and deemed unavoidable. I hope this helps, and good luck!

[hppygr8ful, ASN, RN, EMT-I]

Two important factors are hygiene and hydration. I have worked in LTCs and no one seems to consider the importance of these factors. People who feed the residents need to give the residents more liquids, one cup of liquid per meal is not enough. Also, residents need to have perineal care on a regular basis.

When I worked LTC we had a pretty good prevention model for pressure wound prevention. In fact most of the wounds we encountered were acquired in the acute hospital prior to admission to LTC. The wound doctor who made rounds once a week said that turning and repositioning were only a small part of the battle. Would happens due to poor positioning and acute weight loss which results in protein catabolism. So along with turning we used, skin conditioning with moisture resistant barrier creams and protein, vitamin and mineral supplementation ( C, A, Zinc) and a high protein diet if the patients renal system could support it. Medicare will only cover a low air loss mattress if the wound is stage 4.

As for UTI's that's a whole other conundrum proper hydration and hygiene seem to be the keys.

Some patients just seem to get them more often for no apparent reason. One doctor told me that the use of calcium carbonate (TUMS) for GERD causes the urine to become more alkaline which allowed for greater concentrations of bacteria especially ESBL (The new MDRO on the block).

As with all things Hand washing has been shown to be the best prevention against the spread of infection. The infection control nurse at our facility recommends it over alcohol based hand gels because she said CDC shows many organisms especially Viruses and spore producing organisms are immune to it. Haven't done my own research on this just repeating what was reported to me.

Hppy