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Systematic Review of Interventions to Reduce Urinary Tract Infection in Nursing Home Residents
Author(s) -
Meddings Jennifer,
Saint Sanjay,
Krein Sarah L.,
Gaies Elissa,
Reichert Heidi,
Hickner Andrew,
McNamara Sara,
Mann Jason D.,
Mody Lona
Publication year - 2017
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.12788/jhm.2724
Subject(s) - medicine , bacteriuria , psychological intervention , medline , cinahl , cochrane library , intensive care medicine , urinary catheterization , hygiene , urinary system , emergency medicine , randomized controlled trial , data extraction , infection control , catheter , nursing , surgery , pathology , political science , law
BACKGROUND Urinary tract infections (UTIs) in nursing homes are common, costly, and morbid. PURPOSE Systematic literature review of strategies to reduce UTIs in nursing home residents. DATA SOURCES Ovid MEDLINE, Cochrane Library, CINAHL, Web of Science and Embase through June 22, 2015. STUDY SELECTION Interventional studies with a comparison group reporting at least 1 outcome for: catheter‐associated UTI (CAUTI), UTIs not identified as catheter‐associated, bacteriuria, or urinary catheter use. DATA EXTRACTION Two authors abstracted study design, participant and intervention details, outcomes, and quality measures. DATA SYNTHESIS Of 5794 records retrieved, 20 records describing 19 interventions were included: 8 randomized controlled trials, 10 pre‐post nonrandomized interventions, and 1 nonrandomized intervention with concurrent controls. Quality (range, 8‐25; median, 15) and outcome definitions varied greatly. Thirteen studies employed strategies to reduce catheter use or improve catheter care; 9 studies employed general infection prevention strategies (eg, improving hand hygiene, surveillance, contact precautions, reducing antibiotics). The 19 studies reported 12 UTI outcomes, 9 CAUTI outcomes, 4 bacteriuria outcomes, and 5 catheter use outcomes. Five studies showed CAUTI reduction (1 significantly); 9 studies showed UTI reduction (none significantly); 2 studies showed bacteriuria reduction (none significantly). Four studies showed reduced catheter use (1 significantly). LIMITATIONS Studies were often underpowered to assess statistical significance; none were pooled given variety of interventions and outcomes. CONCLUSIONS Several practices, often implemented in bundles, such as improving hand hygiene, reducing and improving catheter use, managing incontinence without catheters, and enhanced barrier precautions, appear to reduce UTI or CAUTI in nursing home residents.