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Advance Nursing Practice 2018
J u n e 2 1 - 2 2 , 2 0 1 8
P a r i s , F r a n c e
Page 28
6 t h I n t e r n a t i o n a l C o n f e r e n c e o n
Advance Nursing Practice
Journal of Nursing and Health Studies
ISSN 2574-2825
Urinary tract infections (UTIs) are of the most prevalent infections diagnosed
among nursing home residents. Due to impairments of cognition or
communication these residents are not always able to express the typical
complaints of UTIs, such as frequency, stranguria, and dysuria. Observations
of the nurses are important to support the doctor to confirm or to reject the
diagnosis of a UTI. In our 370 bed long-term care facility, over a period of six
months all putative UTIs treated with antibiotics (n=153) were recorded. In
60%, the prescriptions didn’t meet minimum criteria to start antibiotic therapy.
In 75%, the doctor based his diagnosis on the information of the nurses only.
The most prevalent signs the nurses reported were a positive nitrite and leuco
test (83%) and the patient was not herself (58%). Both symptoms are not
objective signs to diagnose a UTI; however these residents were (incorrectly?)
treated with antibiotics as having a UTI. Nitrite and leuco tests are frequently
positive which indicate the presence of bacteriuria, but not the presence of a
symptomatic UTI. Similarly, there are many reasons for the resident not being
herself. Changes in cognition, behavior or general well-being without local
urinary complaints, do not mean that the resident has a UTI. More detailed
medical history, clinical observations and psychical examination are strongly
recommended before a more reliable diagnosis of UTI can be made. In
conclusion, if nurses know which findings are vital for the diagnosis of UTI
in nursing home residents, they could play an important role by performing
a careful clinical evaluation and guiding doctors in their decision-making
process. This will result in a reduction of the incorrect use of antibiotics and
consequently contribute to the control of the antibiotic resistance problem.
Biography
Jobje Haaijman completed her training as a General
Practitioner in 1999 and as an Elderly care physician in 2005
(this is a distinct medical speciality in NL). She is now working
on a Geriatric Rehabilitation Ward and takes part in national
workforces for the development of guidelines for the diagnosis
and treatment of UrinaryTract Infections and Lower Respiratory
Tract Infections in frail elderly. She performs research on
Antibiotic Stewardship in Nursing Homes.
Ellen Stobberingh is a medical microbiologist with special
interest in prevalence and control of antibiotic resistance in
the community, long term care facilities and general practice
patients.
The role of nurse (practitioner) to improve the diagnosis of
urinary tract infections in nursing home residents
J Haaijman1 and E Stobberingh 2
1River Region Elderly care centre, NL
2University of Maastricht, Netherlands
J Haaijman et al., J Nurs Health Stud 2018, Volume: 3
DOI: 10.21767/2574-2825-C3-008