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.
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.