ABCsforDiagnosing UrinaryTractInfection inLongTermCare

ResidentName:Date/Time:

Nurse:MD/NP/PA:

DiagnosisofUrinaryTract Infection(UTI) inlong termcareresidentrequiresclinicalsignsandsymptomsof

UTIandapositiveculture.

Assessment:ClinicalSignsandSymptomsofUTI1

CHECKHEREIFCRITERIAAREMETFORSIGNSORSYMPTOMS

Residentwithout indwellingcatheter*

Residentwithindwellingcatheter

AcutedysuriaaloneOR

Fever+atleastoneofthesymptomsbelow

(neworincreased) OR

Ifnofever,atleasttwoofthesymptoms below (neworincreased)

Urgency Frequency Suprapubicpain Grosshematuria

Costovertebralangletenderness

Urinaryincontinence

Atleastoneofthesymptomsbelow

(neworincreased)

Fever

Costovertebralangle(CVA)tenderness

Rigors (shakingchills) Delirium

Flankpain(back, sidepain)

pelvicdiscomfort

Acutehematuria

Malaiseorlethargywithnoothercause

*Mentalstatuschangesalonearenotspecificenoughtoidentifysymptomaticurinary tractinfection.Seereversesideforalternativecauses.

BloodPressurePulseTemperatureRespiratoryRate

Fever (oral100°Foranysite2°Fabove baseline orrepeatedoral99°F/rectal>99.5°F)

Bacteria(Orderurinalysisandculturesensitivityifabovecriteriaaremet)

Collect cleanvoidedspecimenifpossible;inandout catheterifnecessary. Forresidentswithchronicindwelling

Foley catheter,change catheter;sendurine obtainedfromnewcatheter.

Consider CBC,BMPifclinicallyindicated(e.g.,lethargy,fever)

Cultureandsensitivity

Pyuria10WBCurinalysis

Positiveurine culture:

Cleancatchspecimen:105cfu/mLwith2organisms

Catheterizedspecimen(straightcath ornewlyplaced indwellingcath):103cfu/mLwith1organism

Negativeurine culture

CarePlan

Criteriamet forUTIsymptomsAND

positiveurine culture

Criterianot met forUTIsymptoms (withorwithoutapositiveurine culture)

Review fortreatmentwithantibiotics

Monitorvital signs

Monitorfluid intakeandincrease ifindicated

Review foralternatediagnosis

Monitorvital signsandsymptoms

Monitorfluid intakeandincrease ifindicated

Re-evaluateifabovecriteriaforsymptomatic

UTIemerge

ATANYPOINT,re-evaluateandreview withMD/NP/PA,ifsymptomsprogressorifresidentappearsclinically unstable(e.g.,fever102°F,heartrate100,RR30,BP90 systolic,fingerstickglucose60 or400,

residentunabletoeatordrink).

Priortotreatmentconsiderreview:

Advancedirectivesforlimitingtreatment(especiallyantibiotics): / NO / YES
MedicationAllergies: / NO / YES
Theresidentisonwarfarin(Coumadin) / NO / YES

Possiblecausesformental statuschangesinclude:

•Constipation

•Pain

•Dehydration

•Medicationordosechange

•Hypoxia

•Infectionssuchaspneumonia

•Hypo/hyperglycemia

•Urinaryretention

•Environmentaltriggers

NOTES

1CID2010;50:625-663 (IDSAguidelines CA-UTI):ID2009;48:149-171 (IDSAguidelines LTCF):ICHE2001;22:120-124 (Loebcriteria)CID2005;40:643-54 (IDSAguidelinesASB)