Nursing Home Quality Improvement Initiative
Quality Measure Fact Sheet:
Percent of Chronic-Care Residents with a Urinary Tract Infection (UTI)
What this means:
This measure reflects the percent of chronic/long term care residents who had a urinary tract infection in the
last thirty days. Urinary tract infection (UTI) is a common infection in long term care facilities. Residents may
acquire dangerous bacteria while hospitalized and show symptoms of a UTI after coming back to the long term
care facility. Symptoms of UTIs may include: unexplained fever, painful or difficult urination, increased
frequency and urgency of urination, blood in the urine, and/or low abdominal or flank pain or tenderness. But
these symptoms are often absent in the elderly; these patients may instead show only deterioration in mental
status, such as increased confusion.
Why residents may have urinary tract infections despite good care:
Some urinary tract infections can be prevented by certain measures, such as encouraging the resident to drink
enough fluids, by assisting/encouraging the resident to empty the bladder regularly, and by keeping the
resident clean and dry.
Older women and men are more susceptible to urinary tract infections for many reasons. Structural
genitourinary abnormalities, hormonal changes, immobility (lack of moving around) and functional impairment all increase risk of UTI. Diseases such as Alzheimer's disease, Parkinson's disease, and heart disease are associated with a higher risk of UTIs, and some medications put some residents at risk for UTIs. Individuals with multiple chronic conditions and serious acute illnesses often have lower resistance to infections and may get more serious infections than do otherwise healthy people. Residents requiring a catheter to drain their bladder are at risk for UTIs. Despite good care, some residents in a long term care facility may have UTIs.
Urine containing bacteria only is not a cause for treatment with antibiotics. Many elderly individuals have bacteria in their urine because of changes in bladder structure or function due to age or disease. Having some bacteria in the urine (bacteriuria) is not the same as having a urinary tract infection (which requires evidence of inflammation). There is no evidence that treating bacteuria without symptoms reduces overall illness or risk of death. Overuse of antibiotics should be avoided as it can result in resistant bacteria that are very difficult to treat.
What conditions exclude a resident from this measure: (Risk adjustment)
Residents who have been recently admitted to the facility are omitted from this measure.
| Questions you can ask the facility if they are rated high in this measure:
- How does the facility determine when to test residents for urinary tract infections?
- How does the facility determine whether to treat incontinent residents who have positive test results for UTIs but have no symptoms?
- How does the facility try to prevent urinary tract infections?
- How are residents with recurrent urinary tract infections evaluated?
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