Urinary Tract Infection Prophylaxis with Cranberry Extract in the Long Term Care Setting

Abstract

BACKGROUND/OBJECTIVES: Urinary tract infections (UTIs) are the most common infections in the long-term care setting. There is little data on cranberry usefulness in long term care settings. As a part of a quality improvement project to decrease UTIs in a not-for-profit 240 bed nursing facility (age 47-99, 20% men) emphasized handwashing and oral hydration with improvement of the UTI rate. In order to improve the UTI rate further, cranberry extract pills were added to the regimen of 50 high risk residents (UTI in the previous year, presence of indwelling urinary devices, or incontinent) beginning February 2003 with the concurrence of the resident's physician. METHODS: The nursing home defined a UTI as the presence of >/= 100,000 colony-forming units(sfu/ml) in clean catch urine or >/= 10,000 cfu/ml with 2 or fewer organisms in catherized urine. These were associated with >/= 10,500 WBC, temperature above 100.5 degrees, or urinary symptoms. Data was collected in the facility standardized fashion with all information confirmed by one infection control nurse. Prior to adding cranberry extract (Sep02-Jan-03) the UTI rate in these 50 high risk residents was 4.6/1000 resident care days(RCD) compared to the other residents in the facility (rate of 1.84/1000 RCD). RESULTS: Feb 2003-June 2003 (first 5 months of cranberry extract usage) The UTI rate dropped to 2.4/1000 RCD (2.9/1000 RCD in the first month) compared to the stable UTI rate (1.83/1000 RCD) in the remaining facility residents. Cranberry extract was increased (to 850 mg, then to 1700mg) in residents with recurrent infections . The UTI rate dropped further to 1.95/1000 RCD for the high risk residents during the next four months of cranberry extract usage (Jul-Oct2003). Beginning July 2003, cranberry extract pills were given to all facility residents with their physician approval. The UTI rate fell to 0.87/1000 RCD by Oct 2003 in the facility non-high risk residents. CONCLUSIONS: Although high risk residents continue to have a higher UTI rate than non-high risk residents, both rates dropped by more than half from the prior year. Cranberry extract may have an adjunct role in UTI prophylaxis in the long-term care setting. BACKGROUND/OBJECTIVES: Urinary tract infections (UTIs) are the most common infections in the long-term care setting. There is little data on cranberry usefulness in long term care settings. As a part of a quality improvement project to decrease UTIs in a not-for-profit 240 bed nursing facility (age 47-99, 20% men) emphasized handwashing and oral hydration with improvement of the UTI rate. In order to improve the UTI rate further, cranberry extract pills were added to the regimen of 50 high risk residents (UTI in the previous year, presence of indwelling urinary devices, or incontinent) beginning February 2003 with the concurrence of the resident's physician. METHODS: The nursing home defined a UTI as the presence of >/= 100,000 colony-forming units(sfu/ml) in clean catch urine or >/= 10,000 cfu/ml with 2 or fewer organisms in catherized urine. These were associated with >/= 10,500 WBC, temperature above 100.5 degrees, or urinary symptoms. Data was collected in the facility standardized fashion with all information confirmed by one infection control nurse. Prior to adding cranberry extract (Sep02-Jan-03) the UTI rate in these 50 high risk residents was 4.6/1000 resident care days(RCD) compared to the other residents in the facility (rate of 1.84/1000 RCD). RESULTS: Feb 2003-June 2003 (first 5 months of cranberry extract usage) The UTI rate dropped to 2.4/1000 RCD (2.9/1000 RCD in the first month) compared to the stable UTI rate (1.83/1000 RCD) in the remaining facility residents. Cranberry extract was increased (to 850 mg, then to 1700mg) in residents with recurrent infections . The UTI rate dropped further to 1.95/1000 RCD for the high risk residents during the next four months of cranberry extract usage (Jul-Oct2003). Beginning July 2003, cranberry extract pills were given to all facility residents with their physician approval. The UTI rate fell to 0.87/1000 RCD by Oct 2003 in the facility non-high risk residents. CONCLUSIONS: Although high risk residents continue to have a higher UTI rate than non-high risk residents, both rates dropped by more than half from the prior year. Cranberry extract may have an adjunct role in UTI prophylaxis in the long-term care setting.