Novel care bundle of established basic and practical approaches greatly reduces urinary tract infections in nursing facility residents without indwelling catheters

Published:August 21, 2022DOI:


      • Urinary tract infections in NF residents are common, morbid, costly, and challenging.
      • Challenges are diagnosis complexity, antimicrobial resistance, and antibiotic overuse.
      • Performance improvement and PDSA methodology are suitable for UTI management.
      • Novel care bundle of basic and practical approaches can reduce UTIs in NF residents.
      • Treatment of UTIs in NFs lower hospitalizations, antibiotic use, and facility costs.



      Residents in nursing facilities (NFs) are at greater risk of developing urinary tract infections (UTIs) with higher hospitalizations and costs than people living in communities. These residents also have increased likelihood of uroseptic shock and death. The objective of the study was to prevent UTIs and to reduce UTI-associated costs among NF residents.


      Quality assurance performance improvement initiative conducted between April 1, 2018 and March 31, 2022 at a large skilled NF. Participants were 262 residents newly diagnosed with UTIs without indwelling catheters. The initiative consisted of (1) a 12-month baseline; (2) a 12-month intervention; and (3) a 24-month follow-up. A novel care bundle which included staff's hand hygiene monitoring, residents’ hydration status, effective incontinence and perineal care, and in-house UTI treatment was implemented during the intervention. The plan-do-study-act cycle was used to gauge its effectiveness.


      Quarterly UTI rates decreased from 4.2% at baseline to 0.9% at follow-up, a 79% reduction (P < .001). All 262 residents were treated in-house with no UTI-related hospitalizations. Antibiotic prescriptions fell from 373 at baseline down to 143 at follow-up, a 62% reduction. Facility costs decreased from $42,188 at baseline to $8,281 at follow-up (P < 0.001).


      This bundle was very effective in preventing UTIs and reducing UTI-associated costs. Its use in other NFs is encouraged to determine suitability elsewhere.

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