Preventing urinary tract infection in older people living in care homes: the ‘StOP UTI’ realist synthesis
Preventing urinary tract infection in older people living in care homes: the ‘StOP UTI’ realist synthesis
Background: urinary tract infection (UTI) is the most diagnosed infection in older people living in care homes.
Objective: to identify interventions for recognising and preventing UTI in older people living in care homes in the UK and explain the mechanisms by which they work, for whom and under what circumstances.
Methods: a realist synthesis of evidence was undertaken to develop programme theory underlying strategies to recognise and prevent UTI. A generic topic-based search of bibliographic databases was completed with further purposive searches to test and refine the programme theory in consultation with stakeholders.
Results 56 articles were included in the review. Nine context–mechanism–outcome configurations were developed and arranged across three theory areas: (1) Strategies to support accurate recognition of UTI, (2) care strategies for residents to prevent UTI and (3) making best practice happen. Our programme theory explains how care staff can be enabled to recognise and prevent UTI when this is incorporated into care routines and activities that meet the fundamental care needs and preferences of residents. This is facilitated through active and visible leadership by care home managers and education that is contextualised to the work and role of care staff.
Conclusions : care home staff have a vital role in preventing and recognising UTI in care home residents.
Incorporating this into the fundamental care they provide can help them to adopt a proactive approach to preventing infection and avoiding unnecessary antibiotic use. This requires a context of care with a culture of personalisation and safety, promoted by commissioners, regulators and providers, where leadership and resources are committed to support preventative action by knowledgeable care staff.
Leadership, Nursing homes, Adverse events, epidemiology and detection, Infection control, Safety culture
Prieto, Jacqui
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Wilson, Jennie
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Tingle, Alison
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Cooper, Emily
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Handley, Melanie
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Rycroft-Malone, Jo
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Bostock, Jennifer
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Loveday, Heather
16f46dc2-e4c0-4544-87a0-e631b04ea2b6
Prieto, Jacqui
47dd42cd-35d5-4ece-8fc6-fdb8fe1f01cc
Wilson, Jennie
7f6ed51b-a3ad-42e2-8e9b-240aaff10220
Tingle, Alison
e60a2895-4f3c-4c5c-be96-1a9b78e30283
Cooper, Emily
d6cc4db6-6df1-464d-b5e3-ee8bd0d04404
Handley, Melanie
9a2946df-34ca-4498-8f8f-6f6292390db6
Rycroft-Malone, Jo
110a6ffe-40fe-4039-bf74-b50cddbda937
Bostock, Jennifer
89fdc85d-6103-4091-9cfa-9b3f4e74c8a9
Loveday, Heather
16f46dc2-e4c0-4544-87a0-e631b04ea2b6
Prieto, Jacqui, Wilson, Jennie, Tingle, Alison, Cooper, Emily, Handley, Melanie, Rycroft-Malone, Jo, Bostock, Jennifer and Loveday, Heather
(2024)
Preventing urinary tract infection in older people living in care homes: the ‘StOP UTI’ realist synthesis.
BMJ Quality and Safety.
(doi:10.1136/ bmjqs-2023-016967).
Abstract
Background: urinary tract infection (UTI) is the most diagnosed infection in older people living in care homes.
Objective: to identify interventions for recognising and preventing UTI in older people living in care homes in the UK and explain the mechanisms by which they work, for whom and under what circumstances.
Methods: a realist synthesis of evidence was undertaken to develop programme theory underlying strategies to recognise and prevent UTI. A generic topic-based search of bibliographic databases was completed with further purposive searches to test and refine the programme theory in consultation with stakeholders.
Results 56 articles were included in the review. Nine context–mechanism–outcome configurations were developed and arranged across three theory areas: (1) Strategies to support accurate recognition of UTI, (2) care strategies for residents to prevent UTI and (3) making best practice happen. Our programme theory explains how care staff can be enabled to recognise and prevent UTI when this is incorporated into care routines and activities that meet the fundamental care needs and preferences of residents. This is facilitated through active and visible leadership by care home managers and education that is contextualised to the work and role of care staff.
Conclusions : care home staff have a vital role in preventing and recognising UTI in care home residents.
Incorporating this into the fundamental care they provide can help them to adopt a proactive approach to preventing infection and avoiding unnecessary antibiotic use. This requires a context of care with a culture of personalisation and safety, promoted by commissioners, regulators and providers, where leadership and resources are committed to support preventative action by knowledgeable care staff.
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bmjqs-2023-016967.full
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Accepted/In Press date: 1 August 2024
e-pub ahead of print date: 8 August 2024
Keywords:
Leadership, Nursing homes, Adverse events, epidemiology and detection, Infection control, Safety culture
Identifiers
Local EPrints ID: 493506
URI: http://eprints.soton.ac.uk/id/eprint/493506
ISSN: 2044-5415
PURE UUID: 9501044d-e09f-4d2f-bb65-7cb295800740
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Date deposited: 04 Sep 2024 16:40
Last modified: 05 Sep 2024 01:38
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Contributors
Author:
Jennie Wilson
Author:
Alison Tingle
Author:
Emily Cooper
Author:
Melanie Handley
Author:
Jo Rycroft-Malone
Author:
Jennifer Bostock
Author:
Heather Loveday
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