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Effectiveness of behavioural interventions to reduce urinary tract infections and Escherichia coli bacteraemia for older adults across all care settings: A systematic review

Jones, Leah; Meyrick, Jane; Bath, Julian; Dunham, O.; McNultry, C.A.M

Effectiveness of behavioural interventions to reduce urinary tract infections and Escherichia coli bacteraemia for older adults across all care settings: A systematic review Thumbnail


Authors

Leah Jones

Jane Meyrick Jane.Meyrick@uwe.ac.uk
Senior Lecturer in Health Psychology

O. Dunham

C.A.M McNultry



Abstract

© 2018 Background: Escherichia coli bacteraemia rates in the UK have risen; rates are highest among older adults. Previous urinary tract infections (UTIs) and catheterization are risk factors. Aim: To examine effectiveness of behavioural interventions to reduce E. coli bacteraemia and/or symptomatic UTIs for older adults. Methods: Sixteen databases, grey literature, and reference lists were searched. Titles and/or abstracts were scanned and selected papers were read fully to confirm suitability. Quality was assessed using Critical Appraisal Skills Programme guidelines and Scottish Intercollegiate Guidelines Network grading. Findings: Twenty-one 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 supplied statements of significance. One study reported decreasing catheter-associated UTI (CAUTI) by 88% (F (1,20) = 7.25). Another study reported reductions in CAUTI from 11.17 to 10.53 during Phase I and by 0.39 during Phase II (χ2 = 254). A third study reported fewer UTIs per patient week (risk ratio = 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. Conclusion: The heterogeneity of studies means that one effective intervention cannot be recommended. We suggest that feedback should be considered because it facilitated reductions in UTI when used alone or in multi-faceted 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.

Citation

Jones, L., Meyrick, J., Bath, J., Dunham, O., & McNultry, C. (2019). Effectiveness of behavioural interventions to reduce urinary tract infections and Escherichia coli bacteraemia for older adults across all care settings: A systematic review. Journal of Hospital Infection, 102(2), 200-218. https://doi.org/10.1016/j.jhin.2018.10.013

Journal Article Type Article
Acceptance Date Oct 15, 2018
Online Publication Date Oct 22, 2018
Publication Date Jun 1, 2019
Deposit Date Oct 23, 2018
Publicly Available Date Oct 23, 2019
Journal Journal of Hospital Infection
Print ISSN 0195-6701
Electronic ISSN 1532-2939
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 102
Issue 2
Pages 200-218
DOI https://doi.org/10.1016/j.jhin.2018.10.013
Keywords urinary tract infections, E.coli, AMR, older adults, interventions, systematic review
Public URL https://uwe-repository.worktribe.com/output/858483
Publisher URL https://doi.org/10.1016/j.jhin.2018.10.013
Additional Information Additional Information : This is the author's accepted manuscript. The final published version is available here: https://doi.org/10.1016/j.jhin.2018.10.013.

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