Wisconsin Long-Term Care
Urinary Tract Infection Toolkit
 

Module 1: Overview and Rationale

This module is organized into three sections. Each section includes a slide deck presentation.

Section 1: Overview -+

 

Overview PowerPoint (PPTX) (PDF)

Section 2: Clinical Rationale -+

Staff & Provider Infographic

Clinical Rationale PowerPoint (PPTX) (PDF)

Section 3: Regulatory Rationale -+

 

Regulatory Rationale PowerPoint (PPTX) (PDF)

Resident and Family Education Tools & Resources -+

Antibiotic Stewardship in Nursing Homes: How You Can Prevent Antibiotic Resistance Nursing home staff, residents, and families can reduce antibiotic resistance by prescribing or using antibiotics only when they are needed. The video provides information on when antibiotics are needed and not needed, and how inappropriate antibiotic use can harm patients.

Family Education Brochure This single-sided brochure can be used to educate residents and family members/representatives about the facility's approach to managing suspected UTIs. The brochure highlights the importance of correct antibiotic use, describes steps taken by staff when a resident shows signs of a possible UTI and offers an explanation of active monitoring.

Family Education Letter This template may be customized with the facility logo and included in a resident welcome folder to provide background information on the facility's approach to managing suspected UTIs.

Family Education Video This video targets residents and family members/representatives education. Through a role-play telephone conversation between a family member and provider, it demonstrates an example of communication about a resident's change in condition, related to a suspected UTI.

References List -+

  1. Zimmer et al. A Practical Guide to Prescribing in Nursing Homes. J Am Geriatr Soc 1986;34(10):703-10. doi: 10.1111/j.1532-5415.1986.tb04301.x
  2. Katz et al. Antibiotic Use in the Nursing Home Physician Practice Patterns. Arch Intern Med 1990;150(7):1465-8. doi: 10.1001/archinte.1990.00390190111017
  3. Warren et al. Incidence and characteristics of antibiotic use in aged nursing home patients. J Am Geriatr Soc 1991;39(10):963-72. doi: 10.1111/j.1532-5415.1991.tb04042.x
  4. Pickering et al. The appropriateness of oral fluoroquinolone-prescribing in the long-term care setting. J Am Geriatr Soc 1994;42(1):28-32. doi: 10.1111/j.1532-5415.1994.tb06069.x
  5. Loeb M, Simor AE, Landry L, et al. Antibiotic use in Ontario facilities that provide chronic care. J Gen Intern Med. 2001;16:376-383. doi: 10.1046/j.1525-1497.2001.016006376.x
  6. Vergidis P, Hamer DH, Meydani SN, Dallal GE, Barlam TF. Patterns of antimicrobial use for respiratory tract infections in older residents of long-term care facilities. J Am Geriatr Soc. 2011;59(6):1093–8. doi: 10.1111/j.1532-5415.2011.03406.x
  7. Crnich CJ et al. Factors influencing the measurement of antibiotic utilization in nursing homes. Poster presentation at the Society for Healthcare Epidemiology of America Spring Conference, April 2019, Boston, MA.
  8. Crnich CJ. Unpublished data. Used with permission.
  9. Daneman N, Gruneir A, Bronskill SE, et al. Prolonged antibiotic treatment in long-term care: role of the prescriber. JAMA Intern Med 2013; 173(8):673-82. doi: 10.1001/jamainternmed.2013.3029
  10. Gurwitz JH, Field TS, Avorn J, et al. Incidence and preventability of adverse drug events in nursing homes. Am J Med 2000: 109 (2):87-94. PMID: 10967148
  11. Field et al. Risk Factors for Adverse Drug Events Among Nursing Home Residents. Arch Intern Med 2001;161(13):1629-34. doi: 10.1001/archinte.161.13.1629
  12. Gurwitz JH, Field TS, Judge J, et al. The incidence of adverse drug events in two large academic long-term care facilities. Am J Med 2005; 118(3): 251-8. doi: 10.1016/j.amjmed.2004.09.018
  13. Handler SM, Wright RM, Ruby CM, et al. Epidemiology of medication-related adverse events in nursing homes. Am J Geriatr Pharmacother 2006; 4(3): 264-72. doi: 10.1016/j.amjopharm.2006.09.011
  14. Rotjanapan et al. Potentially Inappropriate Treatment of Urinary Tract Infections in Two Rhode Island Nursing Homes. Arch Intern Med 2011;171(5):438-43. doi: 10.1001/archinternmed.2011.13
  15. Costelloe C, Metcalfe C, Lovering A, et al. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ 2010;340:c2096. doi: 10.1136/bmj.c2096
  16. Drinka PJ, Crnich CJ, Nace DA. An antibiotic prescription induces resistance at the individual level more than the group level. JAMDA 2013; 14(9):707-8. doi: 10.1016/j.jamda.2013.05.007
  17. Carmeli et al. Health and Economic Outcomes of Antibiotic Resistance in Pseudomonas aeruginosa. Arch Intern Med 1999;159(10):1127-32. PMID: 10335691
  18. Cosgrove et al. Health and Economic Outcomes of the Emergence of Third-Generation Cephalosporin Resistance in Enterobacter Species. Arch Intern Med 2002;162(2):185-90. doi: 10.1001/archinte.162.2.185
  19. Engemann et al. Adverse Clinical and Economic Outcomes Attributable to Methicillin Resistance among Patients with Staphylococcus aureus Surgical Site Infection. Clin Infect Dis 2003;36(5):592-8. doi: 10.1086/367653
  20. Lautenbach et al. Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae: Risk Factors for Infection and Impact of Resistance on Outcomes. Clin Infect Dis 2001;32(8):1162-7. doi: 10.1086/319757
  21. Cosgrove et al. Comparison of Mortality Associated with Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Bacteremia: A Meta-analysis. Clin Infect Dis 2003;36(1):53-9. doi: 10.1086/345476
  22. Patel et al. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol 2008;29(12):1099-1106. doi: 10.1086/592412
  23. Daneman N, Bronskill SE, Gruneir A, et al. Variability in antibiotic use across nursing homes and the risk of antibiotic-related adverse outcomes for individual residents. JAMA Intern Med 2015; 175(8): 1331-9. doi: 10.1001/jamainternmed.2015.2770
  24. Mody L, Crnich CJ. Effects of excessive antibiotic use in nursing homes. JAMA Intern Med 2015; 175(8):1339-41. doi: 10.1001/jamainternmed.2015.2774
  25. Crnich C et al. Clonal relationships of methicillin-resistant Staphylococcus aureus isolates recovered from long-term care facility residents. Poster presentation at the 2013 American Society for Microbiology Scientific Meeting, May 2013, Denver, CO.
  26. Capitano et al. Cost Effect of Managing Methicillin-Resistant Staphylococcus Aureus in a Long-Term Care Facility. J Am Geriatr Soc 2003;51(1):10-16. doi: 10.1034/j.1601-5215.2002.51003.x
  27. Warren et al. Cephalexin for Susceptible Bacteriuria in Afebrile, Long-term Catheterized Patients. JAMA 1982;248(4):454-8. PMID:7045440
  28. Nicolle et al. Bacteriuria in Elderly Institutionalized Men. N Engl J Med 1983;309:1420-5. doi: 10.1056/NEJM198312083092304
  29. Nicolle et al. Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized elderly women. Am J Med. 1987;83(1):27-33. PMID: 3300325
  30. Abrutyn et al. Does Asymptomatic Bacteriuria Predict Mortality and Does Antimicrobial Treatment Reduce Mortality in Elderly Ambulatory Women? Ann Intern Med 1994;120(10):827-33. doi: 10.7326/0003-4819-120-10-199405150-00003
  31. Ouslander JG, Schapira M, Schnelle JF, et al. Does eradicating bacteriuria affect the severity of chronic urinary incontinence in nursing home residents? Ann Intern Med 1995;122(10):749-54. PMID: 7717597
  32. Nace et al. Clinical uncertainties in the approach to long term care residents with possible urinary tract infection. J Am Med Dir Assoc 2014;15(2):133-9. doi: 10.1016/j.jamda.2013.11.009
  33. Finucane TE. “Urinary Tract Infection” – Requiem for a heavyweight. J Am Geriatr Soc 2017;65(8):1650-55. doi: 10.1111/jgs.14907
  34. Crnich C & Drinka P. Improving the management of urinary tract infections in nursing homes: It’s time to stop the tail from wagging the dog. Ann Long Term Care 2014; July: 43-7.