Effectiveness of Behavioural Interventions to Reduce Urinary Tract Infections and E. coli Bacteraemia for Older Adults Across all Care Settings: A Systematic Review

Escherichia coli bacteraemia rates in the UK have risen; rates are highest amongst older adults. Previous Urinary Tract Infections (UTIs) and catheterisation are risk factors. This review examines effectiveness of behavioural interventions to reduce E. coli bacteraemia and/or symptomatic UTIs for older adults.

Sixteen databases, grey literature and reference lists were searched. Titles and/or abstracts were scanned and selected papers read fully to confirm suitability. Quality was assessed using Critical Appraisal Skills Programme guidelines and Scottish Intercollegiate Guidelines Network grading.

21 studies were reviewed, and all lacked methodological quality. Six multi-faceted hospital interventions including education, with audit, and feedback or reminders reduced UTIs but only three provided statements of significance. Dickson et al reported decreasing catheter associated UTI (CAUTI) by 88% F(1,20)=7.25. Smith et al, reported reductions in CAUTI from 11.17 to 10.53 during Phase I and by 0.39 during Phase II (Chi-square=254). Van Gaal et al reported fewer UTIs per patient week (rr=0.39). Two hospital studies of online training and catheter insertion and care simulations decreased CAUTIs from 33 to 14 and from 10.40 to 0. Increasing nursing staff, community continence nurses, and catheter removal reminder stickers reduced infection. There were no studies examining prevention of E. coli bacteraemias.

The heterogeneity of studies means one effective intervention cannot be recommended. We suggest feedback should be considered because it facilitated reductions in UTI when used alone or in multifaceted interventions including education, audit or catheter removal protocols. Multi-faceted education is likely to be effective. Catheter removal protocols, increased staffing and patient education require further evaluation.

The Journal of hospital infection. 2018 Oct 22 [Epub ahead of print]

L F Jones, J Meyrick, J Bath, O Dunham, C A M McNulty

Public Health England., University of the West of England., Public Health England. Electronic address: .