Urinary Tract Infection (UTI) Program

We have developed the Urinary Tract Infection (UTI) program to respond to concerns about the overuse of antibiotics for presumed UTIs in residents in long term care homes (LTCHs) and the associated antibiotic-related harms. The UTI Program supports LTCHs to improve the management of UTIs for non-catheterized residents in their homes and helps them implement the organizational and individual practice changes required. For more information contact your Regional Support Team or email us at ipac@oahpp.ca.

PHO's Urinary Tract Infection (UTI) Program

An overview of our UTI program. We explain the rationale and evidence behind this program and how you can implement it in your home.

Duration: 2 min

Why was the UTI Program Developed?

  • It is common to find bacteria in the urine of the elderly – but it does not always mean that they have a UTI.
  • Older people are often given antibiotics for what health care providers and other caregivers assume to be UTIs.  
  • It can be harmful to treat somebody with antibiotics when they don’t need them. 
  • Antibiotic use can increase the risk of antibiotic resistance, which can make it more difficult to treat future infections.

For more information on the overuse of antibiotics in long term care homes, see infographic.

What are the Five Key Practice Changes of the UTI Program?

1

Obtain urine cultures only when residents have the indicated clinical signs and symptoms of a UTI.

2

Obtain and store urine cultures properly.

3

Prescribe antibiotics only when specified criteria have been met, and reassess once urine culture and susceptibility results have been received.

4

Do not use dipsticks to diagnose a UTI.

5

Discontinue routine annual urine screening and screening at admission if residents do not have indicated clinical signs and symptoms of a UTI.

Implementing the UTI Program

The three phases of the UTI Program (assess, plan, implement) are designed to help LTCHs adopt and sustain best practices for managing and treating UTIs. Each phase is supported by tools and resources that have been developed based on current evidence in infection prevention and control, antimicrobial stewardship and clinical practice. The resources are listed in the pages that follow.

The Implementation Guide includes additional background information and details about the UTI Program’s activities and implementation strategies. We recommend downloading and/or printing the Implementation Guide for reference as you work through each of the implementation phases.

Understanding and Managing UTIs

PHO developed several resources to be used in the course of implementing the UTI Program. However, some LTCHs may wish to use the resources below without adopting the full program.

Understanding UTIs:

Assessing UTIs in your Residents and Organization:

Obtaining Urine Cultures:

What do we need to change and are we ready to make those changes?

During this phase, long term care homes (LTCHs) look at the practice changes and assess both their need for the program and what they should focus on in addition to making sure they are ready to get started. At the end of this phase, LTCHs will have a good understanding of whether they are ready to move forward with implementing the Program.

Use the two worksheets below to help assess for need and fit of the program, and whether your LTCH is ready to implement. Once you have confirmed your readiness, you will then move on to establishing the implementation team that will support the implementation of the program.

Complete Practice Change Questionnaire

This questionnaire asks LTCHs to identify their current practices related to UTI management and treatment. These questions help to establish your readiness for the program and identify the objectives you will need to include in your implementation plan.

Go to Questionnaire

Review the Considerations for Readiness

These tips will help you reflect on the context within which your LTCH will implement the UTI Program and assess whether now is the right time to start.

Go to Questions

Get the Implementation Team Together

This resource identifies considerations for who should be on your implementation team and how the team will function to support implementing the UTI Program in your LTCH.

Go to Implementation Team Checklist

In the Plan phase, you will examine existing barriers to practice change and plan to address them using several implementation strategies. All activities, implementation steps, and implementation strategies are listed and linked below. More detailed information can be found in the implementation guide.

Examine Barriers to Practice Change

This tool lists barriers to practice change for UTI management and treatment that have been identified by LTCHs across Ontario and asks you to indicate whether it is a barrier in your LTCH.

Go to the Worksheet

Review Core Strategies

This is a checklist of the core implementation strategies included in the program. More information about each of these strategies is listed below.

Go to the Checklist

Create action plan

This worksheet includes questions related to each of the UTI Program’s strategies. The worksheet will help to document the implementation team’s decisions and the plans for implementing the program within your LTCH.

Go to the Worksheet

Strategies to address barriers and implement new practices

Increase buy-in and support

There are four strategies to help you increase buy-in for the UTI Program and the practice changes you will be making in your LTCH.

Strategy A: Involve local influencers

  • Local influencers are well-respected and trustworthy individuals that can support practice change by sharing information about the program or helping to deliver education to staff.

Strategy B: Generate buy-in 

  • Involving staff in discussions about the problem of antibiotic-related harms can increase acceptance and adoption of the key practice changes and engagement in the program overall.

Strategy C: Align policy and procedures to reflect practice changes

Strategy D: Review how resident symptoms are documented and communicated

  • This strategy will help LTCHs understand how the LTCH is doing as the Program is implemented. By tracking information and monitoring for changes, LTCHs may identify areas that require further education/
    reminders or supports and create an action plan to improve practice.
  • Resources:

Increase knowledge and develop skills

Changing key practices related to UTI management and treatment requires education for front-line staff, as well as residents and their families.

Strategy E: Deliver classroom education to staff

Strategy F: Provide information and education to residents and families

Strategy G: Use coaching to reinforce practices and support staff

  • Coaches provide one-on-one education, supervision, assessment, feedback, and emotional support to front-line staff as they adopt the key practice changes in the UTI Program.
  • Resources:

Monitor practice and give feedback to staff

Once your LTCH has adopted the key practice changes for UTI management and treatment, the UTI Program includes two strategies to support the integration of these practices into day-to-day activities and to ensure sustainability.

Strategy H: Keep track of how your home is doing and provide feedback to staff

  • Once your LTCH has been monitoring for practice changes, it is important to share these results back with staff to demonstrate how well they are adhering to the practice changes. LTCHs can choose the way they prefer to share this type of feedback with their staff. Some ways that this has been accomplished include:
    • Via email
    • Sharing results at staff meetings
    • Huddles with staff
    • 1:1 feedback
    • Creating one-page reports or posters or memos
    • Share at meetings where this topic would be of interest, such as Professional Advisory Committees (PAC), IPAC Committee, or during Quality Improvement Planning (QIP).

Strategy I: Continue to remind staff of key practice changes

  • Reminders are useful when staff and facilities are adopting practice changes.

After completing the Assess and Plan phases, you are ready to implement the UTI Program. Below is a listing of all the resources you need for the Program. The action plan you created (in the Plan phase) will help you move through each of the steps.

The UTI Program has been designed to support practice change to reduce the number of inappropriate urine culture submissions and inappropriate treatment of asymptomatic bacteriuria for residents in LTCHs. By participating in this program, LTCHs could potentially see:

  • fewer total urine cultures being sent out for laboratory analysis
  • reduced costs related to testing and treatment for asymptomatic bacteriuria
  • reduced risk that residents will experience antibiotic harms

We have designed the UTI Program to be implemented by going through each of these three phases in order. If you have not yet completed the Assess and Plan phases, we recommend that you return to complete those steps.

If your organization is not able to take on the full program at this time, the resources below can also be used individually to support practice change as you see fit.

UTI Program Checklist

This checklist can be used to help your implementation team to monitor your progress and ensure that each step in the implementation guide has been addressed.

Go to Checklist

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Contact the Department

Infection Prevention and Control

ipac@oahpp.ca

Updated 8 April 2019