Current Practices in Infection Prevention: A 3-year Survey of Michigan Nursing Homes’ Urinary Tract Infection Prevention Strategies

Abstract

Background Robust infection prevention and control (IPC) programs with evidence-based policies, audits, staff education and data-sharing are critical to safe nursing home (NH) resident environments. The purpose of this study was to identify outcome and process measure data in NHs to prevent both non-catheter and catheter-associated urinary tract infections (UTIs and CAUTIs). Methods Over a three-year period, 58 NHs participated in a 12-month program to reduce healthcare-associated infections by enhancing relationships between NHs and hospitals. A 36-question survey on IPC characteristics was distributed prior to the start of each cohort for years 2018-2020. All surveys were completed prior to March 2020 when the first case of COVID-19 was identified in Michigan. Surveys were completed by infection preventionists, directors of nursing, or NH administrators. Results 55 NHs (95%) completed the survey. Most were aware of their UTI and CAUTI rates (93%, 87%). Policies on catheter insertion, care and other UTI/CAUTI prevention practices were common, but frequency of staff training was inconsistent with some NHs providing education at hire (55%), annually (70%), “when needed” (60%) or never (4%). Less than half were aware of their hand hygiene rates (45%); 36% were aware of gown/glove use. 100% shared infection data with NH leadership, 70% with bedside nursing staff and 26% with residents and families. UTI/CAUTI prevention strategies included hydration practices (77%); nurse-initiated indwelling urinary catheter (IUC) discontinuation (59%); stop orders (45%); indwelling device rounds (28%); and electronic alerts (25%). 57% used cranberry juice/tablets to prevent UTI/CAUTI despite weak evidence of efficacy. Conclusions While awareness of UTI and CAUTI rates is high, process measures like hand hygiene rates and gown/glove use are not evaluated consistently. Hand hygiene and use of personal protective equipment have heightened priority during the current COVID pandemic. NHs have made significant progress operationalizing many evidence-based infection prevention practices but gaps exist.