Rash of UTIs

[SuesquatchRN, BSN, RN]

We have entirely too many, as far as I am concerned, and it comes down to poor peri care.

Does anyone have any suggestions for how to get the aides to do this properly? I work with a bunch of very defensive, dismissive aides and they are backed up by some very defensive, dismissive nurses.

Thanks in advance.

[Sonjailana]

Maybe make it a competition..like if your unit can reduce UTI's by half or some such number, there's a reward for everyone. It could be as simple as pizza or monetary. Or, as my company does, if the goal isn't met, no one gets raises. I personally prefer the more positive approach.

Also, post some reminders about peri-care. Do you have any nursing students that need to make posters or do teaching?

[NotFlo]

Are you sure it comes down to poor peri-care? Do you think the CNAs aren't wiping front to back, aren't doing peri-care at all, or enough?

What I've noticed is a huge correlation between fluids and UTIs. In addition to providing some inservicing about peri-care issues, I would really stress to everyone to push fluids and make sure not only fresh water pitchers but also other fluids of choice are readily available and encouraged. I have seen the single biggest difference in UTI rates on a unit by encouraging fluid consumption than any other intervention.

When it was noted that one unit in particular had a much-higher than average UTI rate the infection control/staff development nurse did an inservice for everyone. She showed all the staff (unit manager, nurses and CNAs so no one felt singled out) the numbers of UTIs on that unit verses the others, explained how the state will be looking at that information when they come, and went over interventions to try to decrease the rate of UTIs. She did it in a very non-accusatory way and involved everyone in coming up with ideas, etc. That unit ended up having their UTI rate go down almost to nothing. Do you have a staff development person who can take the role of inservicing the staff so you don't get any backlash from it?

[SuesquatchRN, BSN, RN]

No staff development.

I'm sure a lot of it is poor peri-care because when someone stinks it means he wasn't washed properly.

But pushing fluids is a great idea. One problem I encounter is that my residents hate the hydrolyte thickened liquids.

[Whispera, MSN, RN]

I'm slipping into teacher and psych nurse mode. Behavioral modification theory says that rewards work far better than punishments--punishments just give anger rather than improving things, generally. So I agree with a previous poster about setting up a reward system....

[Sonjailana]

Can your patients follow the Frasier Water Protocol and be allowed just plain, unthickened water between meals?

[SuesquatchRN, BSN, RN]

Can your patients follow the Frasier Water Protocol and be allowed just plain, unthickened water between meals?

I don't know what that is. But I'm off to Google to find out!

[SuesquatchRN, BSN, RN]

I like that idea, but I think I might find considerable resistance from OT/Speech.

Many of my resident WILL drink thickened tap water if it is cold. Maybe I can get a couple of pitchers delivered with nourishments and offer them freely.

I'm also going to ask my DON if she'll let me track all UTIs in the facility by resident and see if there's a correlation between incontinence, dysphagia diets, and UTIs. I'd also be interested into seeing how much urinary retention we have among some of the more debilitated residents.

If there is a link with the thickened liquids and UTIs I may have some ammunition.

Thanks, Sonja. You've been really helpful. So has everyone else. I appreciate the inpout.

[lpnflorida]

Are the UTI's being discovered due to symptoms or by urinalysis? My darlin who is a urologist always says with the elderly treat the patient not the test

[Whispera, MSN, RN]

Another thought about water intake. Having it there isn't always all that's needed. People forget to drink if not reminded, and some can't reach for the glass, get the straw in their mouth, or pour from the pitcher. If encouraging fluids is the idea, someone has to be there to do it often. I think patients get concentrated urine lots of times because while fluid is there, thickened or not, they aren't able to do what they need to do to get it in themselves.

[SuesquatchRN, BSN, RN]

Are the UTI's being discovered due to symptoms or by urinalysis? My darlin who is a urologist always says with the elderly treat the patient not the test

The symptoms. The problem with some is that they are already so demented that symptoms only show when they need to be hospotalized from urosepsis.

[SuesquatchRN, BSN, RN]

Another thought about water intake. Having it there isn't always all that's needed. People forget to drink if not reminded, and some can't reach for the glass, get the straw in their mouth, or pour from the pitcher. If encouraging fluids is the idea, someone has to be there to do it often. I think patients get concentrated urine lots of times because while fluid is there, thickened or not, they aren't able to do what they need to do to get it in themselves.

We do help them. It's definitely more of a problem with those on thickened liquids, though. They just hate them. All they want is a glass of cold, clear water. I'm definitely talking to my DON today about Frazier and getting some thickened ice water for the unit.