How To Use This Guide
This guide highlights the main program elements and necessary steps to plan for and implement a quality improvement programfocused on reducing CAUTI and other HAIs and improving safety culture. We recommend that in order to achieve successful implementation, your plan should be inclusive of both clinical and cultural interventions. This guide provides educational bundles, tools, and resources to integrate these elements into your quality improvement plan.
Each section of this guide is further described:
- Program Elements highlights the culture change model and a summary of strategies to implement the program.
- Plan provides the steps to prepare to improve performance, including identifying opportunities for improvement, building a team, and defining data elements necessary to monitor performance.
- Implement summarizes critical success factors for implementing evidence-based practices and other strategies to improve resident safety.
- Sustain provides insight on how to establish and maintain interventions shown to reduce CAUTI and other HAIs in the LTC setting.
- Appendixes provide additional information and resources to plan for, implement, monitor, and sustain success.
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Chronic Urinary Tract Infection Causes
Urinary tract infections result from bacteria finding its way into your urine. Although urine is normally bacteria-free, there are many ways bacteria can enter your urinary tract. Causes and risk factors include:
- Sexual intercourse
- Certain types of birth control
- Low estrogen levels
- Holding in urine or not emptying your bladder completely
- Not drinking enough water
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Relief Without A Prescription
An over-the-counter drug called phenazopyridine can help ease your pain, burning, and irritation. It also controls your need to pee frequently and urgently.
But there’s a catch. It only works on your symptoms. It doesn’t cure your infection. You still need to see your doctor to make sure you get treatment to fight the bacteria that’s causing your UTI.
Also, one common side effect: It turns your pee dark red or orange while you take it.
What Is Urinary Tract Infection
The urinary system is responsible for providing the route for drainage of urine formed by the kidneys, and these should be fully functional because the damage could easily affect other body systems.
- Urinary tract infections are caused by pathogenic microorganisms in the urinary tract.
- The normal urinary tract is sterile above the urethra.
- UTIs are infections involving the upper or lower urinary tract and can be uncomplicated or complicated depending on other patient-related conditions.
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What Conditions Are Related To Recurrent Utis
Recurrent UTIs sometimes happen along with other conditions, such as:
- vesicoureteral reflux , which is found in 30%50% of kids diagnosed with a UTI. In this congenital condition, pee flows backward from the bladder to the ureters. Ureters are thin, tube-like structures that carry pee from the kidney to the bladder. Sometimes the pee backs up to the kidneys. If it’s infected with bacteria, it can lead to pyelonephritis.
- hydronephrosis, which is an enlargement of one or both kidneys due to backup or blockage of urine flow. It’s usually caused by severe VUR or a blocked ureter. Some kids with hydronephrosis might need to take daily low doses of antibiotics to prevent UTIs until the condition producing hydronephrosis gets better or is fixed through surgery.
But not all cases of recurrent UTIs can be traced back to these body structure-related problems. For example, dysfunctional voiding when a child doesn’t relax the muscles properly while peeing is a common cause of UTIs. Not peeing often enough also can also increase a child’s risk for recurrent infections. Both dysfunctional voiding and infrequent urination can be associated with constipation.
Rarely, unrelated conditions that harm the body’s natural defenses, such as diseases of the immune system, also can lead to recurrent UTIs. Use of a nonsterile urinary catheter can introduce bacteria into the urinary tract and also cause an infection.
Statistics Around Frequent Utis
While the statistics around chronic urinary tract infections are hard to find, we do know that:
- 30-44% of females with an initial UTI will experience a second UTI. And with each UTI, the risk of another UTI increases.
- Frequent UTIs may be caused by multiple organisms simultaneously.
- A significant proportion of our quiz respondents have suffered 7+ UTIs, with a recurrence every 1-3 months.
- Our own data indicate that most females who experience recurrent UTIs do so despite standard antibiotic treatment.
- Testing and treatment guidelines for chronic urinary tract infections are inadequate or do not exist in most parts of the world. This means even when doctors want to help, they generally dont have the resources or guidance they need to be able to.
- One study found that 74% of females diagnosed with Interstitial Cystitis had previously been diagnosed with recurrent UTIs. Interstitial Cystitis is a painful set of urinary tract symptoms with no identified cause and no known cure.
- 93% of the females included in the above study had also received negative test results after having their urine cultured .
In short, a significant number of females move through escalating stages of diagnosis as antibiotic treatment fails to cure them and testing fails to find a cause.
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Things You Can Do Yourself
To help ease symptoms of a urinary tract infection :
- takeparacetamolup to 4 times a day to reduce pain and a high temperature for people with a UTI, paracetamol is usually recommended over NSAIDs such as ibuprofen or aspirin
- you can give childrenliquid paracetamol
- rest and drink enough fluids so you pass pale urine regularly during the day
- avoid having sex
Some people take cystitis sachets or cranberry drinks and products every day to prevent UTIs from happening, which may help. However, there’s no evidence they help ease symptoms or treat a UTI if the infection has already started.
De Novo Or Increasing Lower Urinary Tract Symptoms During Covid
1Department of Urology, School of Medicine, Sakarya University, 54100 Sakarya, Turkey
22Department of Microbiology, School of Medicine, Sakarya University, 54100 Sakarya, Turkey
3Department of Infectious Diseases, School of Medicine, Sakarya University, 54100 Sakarya, Turkey
DOI:10.31083/j.jomh1808161Vol.18,Issue 8,August 2022 pp.1-6
31 August 2022
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When Should I Call The Doctor
As soon as you think that your child has a UTI, call your doctor. The doctor may recommend another urine test after treatment to be sure that the infection has cleared.
If your child has from recurrent UTIs, consult a pediatric urologist, who can do a thorough evaluation and order tests for urinary system abnormalities. In the meantime, follow your doctor’s instructions for treating a UTI.
How Can Parents Help
At home, these things can help prevent recurrent UTIs in kids:
Drinking Fluids Encourage kids to drink 810 glasses of water and other fluids each day. Cranberry juice and cranberry extract are often suggested because they may prevent E. coli from attaching to the walls of the bladder. Always ask your doctor, though, if your child should drink cranberry juice or cranberry extract, because they can affect some medicines.
Good Bathroom Habits Peeing often and preventing constipation can help to prevent recurrent infections.
No Bubble Baths Kids should avoid bubble baths and perfumed soaps because they can irritate the urethra.
Frequent Diaper Changes Kids in diapers should be changed often. If poop stays in the genital area for a long time, it can lead to bacteria moving up the urethra and into the bladder.
Proper Wiping Girls should wipe from front to back after using the toilet to reduce exposure of the urethra to UTI-causing bacteria in poop.
Cotton Underwear Breathable cotton underwear is less likely to encourage bacterial growth near the urethra than nylon or other fabrics.
Regular Bathroom Visits Some kids may not like to use the school bathroom or may become so engrossed in a project that they delay peeing. Kids with UTIs should pee at least every 3 to 4 hours to help flush bacteria from the urinary tract.
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Urinary Tract Infection Diagnosis
Your doctor will review your symptoms with you first and conduct a physical exam.
A urine sample is then taken to test for microbes. It is important to use a clean-catch sample for testing, which is done midstream rather than at the beginning. This helps to eliminate bacteria or yeast from your skin.
A large number of white blood cells in your urine indicate an infection, and a urine culture will help identify the specific microbe causing the infection.
Special testing is required if a viral infection is suspected, but they are rare causes of UTIs. Viral UTIs are more common in those with weakened immune systems or those who have had organ transplants.
If your doctor thinks you may have an upper tract infection, a blood count and culture is necessary to make sure the infection has not yet spread to your bloodstream through infected kidneys.
Some individuals have recurring UTIs, and these involve additional testing to identify possible abnormalities in the tract that could be the cause.
Uti Or Something Else
Although burning during urination is a telltale sign of a UTI, it can also be a symptom of a number of other problems such as a vaginal yeast infection or certain sexually transmitted diseases . These include chlamydia, gonorrhea, and trichomoniasis. Simple lab tests are available to distinguish a UTI from an STD. Interstitial cystitis also has many of the same symptoms as a urinary tract infection. It can happen in both men and women and can start after a UTI. A cystoscopy, a thin tube and camera that is inserted into the bladder, can not diagnosis interstitial cystitis, but it can help identify abnormalities in the badder that cause cystitis.
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When To See Your Doctor
See your doctor right away if you have signs of a urinary tract infection. A bladder infection is generally not a medical emergency — but some people have a higher risk for complications. This includes pregnant women, the elderly, and men, as well as people with diabetes, kidney problems, or a weakened immune system.
Urinary Tract Infections In Babies And Young Children
Babies and children are at risk of UTIs. These infections always need to be investigated as they may indicate a serious underlying condition, such as urinary reflux. Reflux is caused by a bladder valve problem allowing urine to flow back into the kidneys from the bladder. Reflux can cause the urine to stay inside the body increasing the risk of infection. It may lead to kidney scarring, which in turn leads to high blood pressure and sometimes kidney problems.
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How Can I Prevent Chronic Urinary Tract Infections
- Keep your genital area clean
- Wipe from front to back after a bowel movement
- Drink plenty of fluids, particularly water, to flush bacteria out of your urinary system
- Urinate immediately after intercourse to help eliminate any bacteria
- Use forms of birth control other than a diaphragm and spermicides
- Avoid douches, powder and deodorant sprays
- Wear un-dyed, full cotton underwear
Other prevention measures being studied include drinking cranberry juice and, for women past menopause, the use of estrogen cream or pills.
How Are Recurrent Utis Treated
Treatment for recurrent UTIs depends on what’s causing them. Sometimes the answer is as simple as teaching a child to empty their bladder as soon as they have the urge to go.
If a condition like VUR is causing the infections, the solution is a bit more complicated. Kids with VUR must be watched closely, because it can lead to kidney infection and kidney damage. Most kids outgrow the condition. Some might need surgery to correct the reflux.
Some kids with VUR benefit from daily treatment with a small amount of antibiotics, which can also make surgery unnecessary. Kids with VUR should see a pediatric urologist, who can decide if antibiotic treatment is the best option.
In some cases, surgery is needed to correct VUR. The most common procedure is ureteral reimplantation, in which one or both of the ureters are repositioned to correct the backflow of urine from the bladder. This procedure requires only a small incision and, in some children, can be done using robotic-assisted laparoscopy. When surgery is necessary, the success rate is high, but not everyone is a good candidate for it.
Kids may be candidates for ureteral reimplantation if they:
- have an intolerance to antibiotics
- get recurrent infections while on antibiotic treatment
- have severe, or “high-grade,” reflux
- are older kids and teens with reflux
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The Myth Of Interstitial Cystitis And Bladder Syndromes
IC and bladder syndromes are known as diagnoses by exclusion. They dont identify a reason for a patients symptoms, they simply describe collections of symptoms. For example, the NHS Choices website describes IC as a poorly understood, incurable condition.
There is no agreed cause or cure for IC and bladder syndromes. But there is a view among many doctors based on tests which are known to be ineffective that they are not caused by bacteria. Sufferers are offered surgery or prescribed painkillers, including opiates, bladder relaxants and bladder instillations to alleviate symptoms.
Bladder instillations had no more effect than a placebo, a recent large-scale study found. A growing body of evidence suggests that long-term bladder and urinary pain may be caused by infections missed by tests that dont work.
What Causes Chronic Urinary Tract Infection
This is where the science gets a little more complicated.
Weve talked elsewhere about what causes UTIs. And above, we explained that recurrent UTIs can be attributed to a persistent bladder infection that is not properly eradicated by treatment.
A persistent bladder infection can last for years in the form of a chronic urinary tract infection. For many females, the cycle of acute and symptom-free periods is never broken, and some move on to be diagnosed with the conditions mentioned above, such as Interstitial Cystitis , or Painful Bladder Syndrome . More on that later.
Why has it been so difficult to detect and treat these infections?
There is a culprit here, so lets take a closer look. Behind the misdiagnosis of hundreds of thousands of people, are embedded chronic urinary tract infections that involve biofilms.
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How Does A Chronic Uti Start
A chronic UTI starts with an acute infection that doesnt get better or seems to clear up but comes back repeatedly. Short courses of between one to three days are too short to clear infection and symptoms return a few days after finishing the course of antibiotics.
Needing to pee all the time, pain when you pee, passing tiny amounts of urine, bladder and urethral pain, pain in your belly, back and legs, difficulty passing urine, problems with incontinence. The symptoms of chronic UTI are similar to acute infections but they vary from person to person.
Its not clear why some people suffer from chronic infections while others get better. But what is known is that chronic UTIs wreck lives. Sufferers are left with debilitating, life-changing symptoms including urinary frequency , urinary urgency, agonizing pain, unable to sleep properly, work, look after children and have normal sexual relationships. Their lives grind to a halt.
Strengths And Limitations Of This Study
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Recurrent urinary tract infection is one of the most common reasons for long-term antibiotic use in the frail elderly. We systematically reviewed trial evidence to address clinical uncertainties around this practice.
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We did not identify any trials in older men nor any trials in frail care home residents.
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We identified only three small European trials, with follow-up ranging from 6 to 15 months, in older women.
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Only one trial measured the impact of long-term antibiotics on antibiotic resistance.
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Trial evidence suggests long-term antibiotics reduce the risk of UTI recurrence in older women. Many clinical uncertainties remain unaddressed.
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What Is A Urinary Tract Infection
Infections of the lower urinary tract affect the bladder and urethra . UTIs happen when disease-causing bacteria gain the upper hand amongst the normal urinary tract bacteria and attack the tissues of the urinary tract.
Women are more likely to suffer from UTIs but the explanations for this are based on speculation. But men and children also get UTIs. Theres not enough research to understand why some people never experience a UTI, why some people have one or two infections and why some people develop chronic infections.