Five steps to significantly reduce a patients risk of UTIs

Five steps healthcare professionals can take to significantly reduce a patients risk of developing urinary tract infections.

Summer and warmer weather means medical professionals see an increase in urinary tract infections (UTIs) as a result of dehydration. So it’s a good time to go back to basics and remind ourselves of the simple ways we can encourage people to help prevent UTIs.

Helen Greaves, the Lead Clinical Nurse Specialist and member of the Infection Prevention Society, provides the following practical tips for staff to share with their patients on how to prevent UTIs.

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Ensure adequate hydration

  • Drinking enough fluid (six to eight cups a day) helps to increase the bladder’s capacity and the amount of urine the bladder can hold. Encouraging patients to release their bladder periodically helps to flush out bacteria.
  • Remind patients not to restrict their fluid intake in order to help manage bladder symptoms- this will only make things worse. Concentrated urine is a bladder irritant and may cause frequent trips to the toilet, an urgency to get there which quite often results in episodes of incontinence.
  • Ask them to use the urine chart to map colour, 1-3 is good, 4-8 – you must hydrate
  • Ensuring that they have increased fluid intake reduces the risk of repeated infections

Hygiene and effective hand washing

  • Effective hand washing, especially after visiting the bathroom, can massively reduce the presence of E. colic ells in our immediate surroundings. Surface cleaning and disinfecting also plays an important role
  • Tell patients to avoid prolonged baths, as bath water may fairly quickly become contaminated by skin florae: sitting in a tub allows bacteria to reach the bladder opening area
  • Make sure female patients always wipe from front to back
  • A moist toilet tissue wipe can be used following a bowel movement but remember not to flush the wipe down the toilet
  • If containment aides are used –carers must remove these from front to back.

Undertake baseline observations

  • Measure temperature, blood pressure,  pulse and blood sugars if diabetic.
  • If catheter infection suspected, change the catheter if not done in past 7 days and take a sample of urine from the clean catheter. Send the sample for culture and sensitivity.
  • If a urinary tract infection is suspected and patients are symptomatic, send a mid-stream urine sample.
  • Urine from older people has a greater variability of uropathogens compared with younger individuals, and questions the reliability of dipstick.
  • Best practice guidance states do not use urinalysis dipsticks in patients with an indwelling catheter and in patients who are over 65 years of age.
  • In post-menopausal women, atrophic changes in the genital area increases the risk of getting a UTI - consider a topical vaginal oestrogen.

Address bowel symptoms

  • If you are concerned about constipation or faecal incontinence in a patient, review medications that could cause bowel problems-a simple medication change may resolve the problem.
  • Advise two wheat husks daily, add in four to six prunes for constipation.
  • Commence patients on a twenty-eight-day bowel chart to identify their bowel timings and the signal  ‘call to stool’.
  • If bowels are loose commence a food diary to help identify triggers.
  • Review laxatives, are they used appropriately as most can take up to 4 days to take effect.
  • Advise patients to sit on the toilet 15-30 minutes post meal in response to the gastrocolic reflex.
  • Inform patients and advise use of correct defecating dynamics which in layman’s terms is a squatting position. This can be achieved by the use of a footstool.

Limit caffeine and other irritants

  • Certain foods and drinks can put patients at greater risk of getting or exacerbating a UTI.
  • There are a number of common foods and drinks that should be avoided - these include: artificial sweeteners, spicy foods, alcohol, tea, coffee, acidic fruits, citrus, or caffeinated drinks.
  • All of the above products can irritate the bladder, and may worsen UTI symptoms (if any) it is best to steer clear of them.

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