Reduction in inappropriate prevention of urinary tract infections in long-term care facilities.
BACKGROUND
Urinary tract infection (UTI) is the most common diagnosis made in prescribing antimicrobials in long-term care facilities (LTCF). The diagnostic criteria for UTI vary among institutions and prescribers. Our aim was to reduce the inappropriate use of antimicrobials in LTCFs.


METHODS
A team comprising infectious disease consultant, infection control nurse, and geriatrician visited all LTCFs for older persons (2,321 patients in 25 primary care hospitals and 39 nursing homes and dementia units) in the Central Finland Healthcare District (population 267,000) during 2004-2005. The site visits consisted of a structured interview concerning patients, ongoing systematic antimicrobials, and diagnostic practices for UTI. Following the visits, regional guidelines for prudent use of antimicrobials in LTCFs were published, and the use of antimicrobials was followed up by an annual questionnaire.


RESULTS
The proportions of patients receiving antimicrobials in 2005, 2006, 2007, and 2008 were 19.9%, 16.9%, 16.2%, and 15.4%, respectively. Most of the antibiotics were used for UTI (range by year, 66.6%-81.1%). From 2005 through 2008, the proportion of patients on antibiotic prophylaxis for UTI decreased from 13% to 6%. The decrease was statistically significant in both types of settings.


CONCLUSIONS
The visits and guidelines were associated with a reduction in the usage of antimicrobials. To sustain this, UTI surveillance and close collaboration between infection control experts and LTCFs are crucial.
Central Finland Healthcare District, Jyväskylä, Finland. maija-liisa.rummukainen@ksshp.fi
Maija-Liisa
ML
Rummukainen
Aino
A
Jakobsson
Maire
M
Matsinen
Salme
S
Järvenpää
Antti
A
Nissinen
Pertti
P
Karppi
Outi
O
Lyytikäinen
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000592:standards* / Q000706:statistics & numerical data; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D005387:Finland; D006707:Homes for the Aged; D006801:Humans; D017053:Infection Control / Q000639:trends*; D008134:Long-Term Care; D008297:Male; D009735:Nursing Homes; D011795:Surveys and Questionnaires; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control
D000900:Anti-Bacterial Agents