A Pioneering Approach to Reducing UTIs in Care Homes

In 2012/2013, urinary tract infections (UTIs) topped the charts for emergency hospital admissions. The culprit? Dehydration. This common cause of hospitalisation prompted a groundbreaking initiative aimed at reducing UTIs in care home residents. Led by Katie Lean and her team, the project, based in the East Berkshire Clinical Commissioning Group (CCG), has achieved remarkable success. Let's delve into the details of this innovative intervention that's changing the landscape of care for our older adults.

UTIs and Dehydration

Dehydration is a silent risk factor for UTIs, leading to a cascade of issues such as confusion, falls, acute kidney injury, and hospital admissions. Recognising this, the team embarked on a mission to improve hydration and, consequently, reduce the incidence of UTIs requiring hospitalisation.

Care homes, housing a significant population over 75, often struggle with ensuring residents receive adequate fluids. The challenge is compounded by factors such as forgetfulness, difficulty swallowing (dysphagia), and staffing issues. Residents with dysphagia need special attention, and those with dementia are at a higher risk of dehydration.

Structured Drink Rounds

Seven structured drink rounds were introduced daily, accompanied by comprehensive staff training and awareness campaigns. The care homes involved had a combined total of 150 residents, the majority over 75, with over half living with dementia.

Key Components of the Intervention:

1. Awareness Campaigns: A poster and a 2-hour training session covered anatomy, symptoms of dehydration, causes, medication effects, and UTI signs. The focus was on the importance of structured drink rounds.
2. Flexible Hydration Rounds: Seven daily drink rounds, decorated to engage residents, offered a variety of hot and cold drinks. The timing was adjusted to suit each home's routine.
3. Monitoring and Adaptation: Care staff recorded drink rounds on designated sheets, allowing for honest feedback on completion. This information was crucial for continuous improvement.​

Impressive Reductions

The outcomes of the project speak volumes:

• UTIs Requiring Antibiotics: A staggering 58% reduction in UTIs needing antibiotics post-intervention.
• Hospital Admissions: A commendable 36% reduction in UTIs necessitating hospitalisation.

Sustainability and Lessons Learned

Maintaining a monthly drink rounds compliance of over 97%, the sustainability phase proved the effectiveness of the intervention. Challenges, such as high staff turnover, were addressed through supplementary drinks diaries and support tools like YouTube training clips.

Transforming Care Homes Regionally

The success of this hydration project has had a significant impact. Beyond the four care homes directly involved, the principles are being embraced by care homes throughout the Thames Valley region. A toolkit on the Oxford Patient Safety Collaborative website facilitates wider adoption, and train-the-trainer sessions ensure ongoing support.

This pioneering project, driven by collaboration and innovation, has not only achieved its goals but has exceeded expectations. Structured drink rounds are a low-cost, easily implementable intervention with a profound impact on reducing UTIs.

For more details on this transformative project, you can access the full article here.