Abstract
Background:
This project was carried out in a district general hospital, it included multiple teams working under the supervision of the same clinical lead, between 2019 and 2021.
Introduction
Asymptomatic bacteriuria is commonplace among patients above 75 years of age (Manisha Juthani-Mehta MD, Volume 23, Issue 3, August 2007, Pages 585-594). Local guidelines informed by the Scottish Intercollegiate Guidelines Network on UTI management July 2012, therefore advise the importance of sending urine for culture only in cases, where minimum clinical diagnostic criteria are met.
Methodology
The initial baseline measurements was a retrospective study. It looked at 17 patients over the age of 65 years, who had admissions for urinary tract infections. During the 2nd cycle, we designed a prospective study. It looked at all the patients considered to have a UTI in the first 72h of admission, during a 4-week period.
Results
The initial measurements showed that 53% of patients met the clinical diagnostic criteria. A teaching on the topic was organised for the medical team in the hospital and the learning points were disseminated further to senior ward staff. In the second cycle I found that 75% of the patients met the minimum clinical criteria for diagnosis. As a further intervention I designed warning cards containing a summary of local guidelines for diagnosis which were distributed across all medical inpatient wards.
Conclusion
Our QIP showed that in our trust even with initial intervention having been implemented, compliance with local guidelines was not 100%. Important discussion for the next cycle would be weather the local guidelines need to be updated as there have been recent updated in NICE guidelines for diagnosis of UTI’s in patients over 65 years of age.