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UTI's in the Nursing Home


The problem of poor antibiotic stewardship in the nursing home population is a well-known and researched issue that can be prevented.

According to the Centers for Disease Control and Prevention (CDC), approximately 70% of nursing home residents receive a course of systemic antibiotics each year. Regrettably, 40-75% of them have received antibiotics inappropriately (CDC, 2015).

Therefore, there is an area of opportunity for nursing home healthcare providers to improve the treatment of Urinary Tract Infection (UTI) and Asymptomatic Bacteriuria (ASB). Poor antibiotic stewardship is a problem in nursing homes due to varying knowledge of healthcare providers in UTI's and ASB management.

UTI's are the predominant bacterial infection in the nursing home that healthcare providers prescribe (Crnich, Jump, Trautner, Sloane, Mody, 2015). Consequently, this is the population of interest for this post. Let us educate each other to prevent this potentially dangerous error from reoccurring.

A UTI is just a urinary tract infection, and ASB is what we call a colonized person. ASB is a condition common in the elderly where bacteria in the urine occur, such as Escherichia coli, without symptoms. Therefore, treatment is not needed. Unfortunately, most residents in the nursing home with a change in mental status are automatically treated with antibiotics.


The Cooper Urinary Surveillance Tool pocket algorithm is an excellent intervention to help healthcare providers manage UTIs and ASB. There was a preponderance of evidence supporting this intervention. A decision-making aid has shown to be incredibly beneficial to healthcare providers in improving antibiotic stewardship (McMaughan, Nwaiwu, Zhao, Frentzel, Mehr, Imanpour, Phillips, 2016). Assisting the healthcare providers in the proper diagnosis and management of UTI's and ASB multiple patients will benefit. In addition to using the tool, studies have shown didactic education, and onsite champions are beneficial to decreasing the rate of inappropriate antibiotic use. Therefore, the healthcare providers will be adequately equipped, and the nursing home staff will take an active role in improving their resident's care. Having buy-in from all stakeholders involved will enhance the potential for a positive impact on antibiotic stewardship in a nursing home (Furuno, Comer, Johnson, Rosenberg, Moore, MacKenzie, Hirshon, 2014, White, Dudley-Brown & Terrhar, 2016).


This quality improvement project is easy for you to implement at your facility. So, what is the CUST, and how is it used. It a 72-hour algorithm used to monitor patients with suspected UTIs before ordering a urinalysis or urine culture. The CUST algorithm includes a series of checkboxes that help healthcare practitioner's narrow down the symptoms of a UTI.

If there are 3 or more symptoms in a none indwelling catheterized resident or 2 or more symptoms for residents with indwelling catheter patients, then the checklist continues.

Here are the symptoms:



New Flank or suprapubic or testicular pain or tenderness

Change in character of urine

Change in mental status per MDS

Change in functional status per MDS

This project will improve UTI's and ASB management that is necessary to provide high-quality patient care in nursing homes. A well conceptualized and planned study will offer a smoother change implementation process and lead to a positive outcome.

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