Columbia Nursing Researcher Wins Blue Ribbon Abstract Award at Infection Control Meeting

A new study from Columbia University School of Nursing found little consistency in the adoption of nursing home policies aimed at preventing urinary tract infections (UTIs). The study, presented by Senior Project Director Carolyn Herzig, PhD, was one of six Blue Ribbon Abstract award winners at the Association of Professionals in Infection Control and Epidemiology (APIC) annual meeting in June.

 

The research was led by Centennial Professor of Health Policy Patricia Stone, PhD, as part of the Prevention of Nosocomial Infections and Cost-Effectiveness in Nursing Home (PNICE-NH) study. It was funded under a National Institute of Nursing Research grant to the Center for Health Policy at Columbia Nursing.

 

UTIs are the most commonly reported infection in U.S. nursing homes with an estimated one in 20 or more residents infected each month. These infections have a large impact, particularly on older patients, causing pain, discomfort and even cognitive impairment. Preventing them, says Herzig, will reduce hospitalizations, help curb overuse of antibiotics and improve residents’ quality of life.

 

According to the study, non-catheterized residents were 11 percent less likely to have a UTI in facilities that use portable ultrasounds to measure urine voiding and 20 percent less likely to get them in facilities with a staff member who completed a national APIC training course. For catheterized residents, the likelihood of UTI was 20 percent lower if there was a policy in place for cleaning the urine collection bag.

 

“These policies appear effective but are unevenly implemented,” says Herzig. “In just nine percent of the facilities in our survey, the person in charge of the infection control program had taken a national APIC infection control training course, 22 percent use portable bladder ultrasound scanners and less than half, 44 percent, have leg bag cleaning protocols in place.”

 

Herzig stressed that while the study found having an indwelling catheter increases an individual’s risk of UTI more than four-fold, most infections in nursing homes are not related to catheterization. “The focus in nursing homes needs to be on identifying ways to prevent all UTIs, not just those resulting from catheter placements,” says Herzig.

 

But most of the policies in place in nursing homes have been adopted from ones designed specifically to reduce catheter-associated infections in acute-care settings. “We need to understand the severity of UTIs in this setting and we would benefit from having more evidence about the factors contributing to the high prevalence,” says Herzig. In addition to catheterization, risk factors for UTI include diabetes, dementia, incontinence, anemia, and increasing age, among others.

 

The Columbia Nursing study was the largest nationally representative survey of infection control in nursing homes at the time it was conducted. It included data from more than 88,000 residents of 955 freestanding nursing homes across the country with between 30 and 900 beds.

 

The investigators linked their survey data, which assessed infection control program staffing and UTI prevention policies and practices, with the 2013 Minimum Data Set reports of UTI prevalence and indwelling catheter placements, and the Certification and Survey Provider Enhanced Reporting (CASPER) data on facility characteristics.

 

“Our ultimate goal is to improve the quality of life of nursing home residents,” says Herzig. “This study is a great first step, but more research is needed to figure out the right formula for setting-specific interventions to reduce the infection risk in nursing homes.”