A shared approach to managing urinary tract infections in nursing homes improved perceived care quality, workload, and collaboration - a qualitative study.

Abstract

Background: In 2019, around 4.95 million global deaths were linked to bacterial antimicrobial resistance (AMR). Managing urinary tract infections (UTIs) in nursing homes involves prevention, diagnosis, and treatment. This is often complex and cause excessive antibiotic use, increasing AMR. Infection prevention and antimicrobial stewardship (AMS) are complementary strategies for reducing AMR. Studies show that nursing home staff can safely reduce antibiotic prescriptions for UTIs using these strategies and that cross-sectoral collaboration with general practice is important in UTI management. However, the impact of combining infection prevention with AMS and general practice is unknown.

Objective: To explore the perceived impact of a new cross-sectorial intervention combining prevention and AMS on UTI management in nursing homes.

Methods: The intervention included a 3-h seminar for general practice and nursing home staff, and a reflection sheet to assess residents. We held 9 seminars in the Capital Region of Denmark in 2022 and conducted 15 semi-structured online and phone interviews with participants.

Results: Our findings indicate that the intervention clarified workflows, encouraged nursing staff to adhere to agreements, and increased trust and respect between nursing homes and general practice. A reflection sheet was essential in linking planned changes to actual implementation. The sheet helped restructure UTI management, leading to perceived improved patient assessment and fewer UTI-related inquiries to general practice.

Conclusion: Our findings suggest that the intervention had a positive impact on experienced care quality, workload, and cross-sector collaboration. However, physical attendance at the seminar limits the large-scale implementation of the intervention.