In a system where chronic conditions such as chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and diabetes are often the primary focus of care management, the idea of preventing urinary tract infections (UTIs) may seem like a footnote in the narrative.
But these statistics tell a different story:1
- UTIs are the fourth-most-common hospital-acquired infection
- UTIs rank in the top five of the most common infections
- UTIs are responsible for over 8 million doctor visits each year
- UTIs cost over $1 billion annually to treat
- UTIs are among the most common bacterial infections among long term care/nursing home residents
In fact, besides being painful, these largely preventable infections also tend to kick off a chain reaction among older adults, contributing to cognitive decline, falls, increased caregiver burden and a diminished quality of life.
Health expert Martie L. Moore, MAOM, RN, CPHQ, has held the role of nurse, patient, leader and caregiver in treating urinary tract infections, so she understands the value of prevention from various viewpoints.
"There's a high cost in lives and dollars," says Moore.
By preventing and more effectively treating UTIs, we're not only disrupting the cycle of falls and cognitive decline, but we're also reducing hospitalizations, readmissions and the high risk of urosepsis, Moore explains.
According to Chris Tiemann, national sales director, post-acute care for Avadim Health, more people died of sepsis in the past year than from COVID-19.2
"We have to do better. We have to do things differently," Moore says.
Check out Martie Moore's recent webinar, Urinary health: Excellence in healthcare practices for health & well-being, hosted by McKesson.
Reframing UTIs to reduce the rate of readmissions
A population health approach to actively preventing, diagnosing and treating UTIs is valuable across the age spectrum. But for the Medicare population, there's tremendous value in reducing readmissions by improving urinary tract health — because the impact of this revolving door is felt by patients/residents and their caregivers — as well as the healthcare system.
Tiemann explains that when a nursing home resident leaves the facility for a hospital stay and returns for readmission within 30 days, the hospital pays for that resident's care. In this scenario, the hospital discharge planner would likely not send the resident back to the same skilled nursing facility (SNF) following the readmission. So now the facility has lost time on both the resident's hospitalization — and the resident.
This situation affects the SNF's census, value-based payments and Centers for Medicare & Medicaid Services (CMS) star rating/performance indicators. And because these ratings are a primary source of referrals, the census takes a hit from another side.3
But here's the good news: For the big problem of UTIs and readmissions, there's a simple solution, says Tiemann. And the secret is in the skin.
You can help reduce hospital readmissions by placing emphasis on continuity of care. The McKesson Readmissions Resource™ includes helpful information and product recommendations to help reduce readmissions caused by common disease states, including UTIs. Urinary tract infection management >
Why preventing UTIs in the elderly starts with skin health
Though the right antibiotics are very effective in treating UTIs, how to prevent them naturally comes down to what Moore believes is the unrecognized weapon in urinary health: the skin's permeability barrier.
To preserve the skin's integrity and strengthen its pathogen-blocking structures, we need to look more closely at what Moore calls nature's "magic sauce" — our pH levels.
"Healthy skin (mucosa) thrives in an optimal low pH environment. It competes successfully for nutrition and space on the skin surface, protecting against invasion by pathogens and resulting infections," she explains. "When pH rises, the normal, healthy microbiome suffers, and pathogenic bacteria capitalize on the change in pH."
Moore breaks down the risk factors that disrupt an individual's pH balance (the optimal level is between 5 and 5.5, neutral is 7), making them more susceptible to a UTI.
- Individuals who are either urine or fecal incontinent — or both — create substances that have a dramatic pH-elevating impact on the skin's surface
- Urine byproducts, such as urea and ammonia, are high in pH — up to 9.5% fecal material contains proteases, which are extremely active in a high pH environment. These proteases become digestive to human skin
- Both incontinent conditions can quickly lead to a decrease in skin quality, incontinence-associated dermatitis and eventually, aggressive skin breakdown, ulceration and open wounds
And as the process above illustrates, you're not only maintaining the skin through a healthy pH as a means of preventing UTIs, you're also providing an extra layer of protection to prevent other conditions (prevalent among older adults) that cause unnecessary pain, discomfort, hospitalizations, diminished quality of life and increased caregiver burden.
How to prevent UTIs: A patient/resident & caregiver checklist
So what if your patients/residents knew how to prevent UTIs themselves? Here are five talking points to review with your patients/residents to help them keep pathogens out of their bladder and urinary tract — and stay out of the hospital.
1 | Know your risk
Who is most at risk for a UTI? Post-menopausal women, anyone who wears incontinence products regularly, individuals whose health condition requires a catheter (whether indwelling or intermittent) and finally, anyone under stress is high-risk.
Though you can't alter the course of menopause or reverse conditions warranting catheter use, lifestyle changes and behavior modifications may help reduce the effects of stress — through exercise, diet or sleep, for example.
2 | Flush your system out with proper hydration
People of all ages benefit from increasing their water intake. Dehydration is widespread among older adults and is often the catalyst for UTIs, contributing to rapid onset cognitive decline. Disrupting this cycle by pushing clear liquids is a simple way to keep those pathogens moving downstream.
3 | Optimize your skin
Keep pathogens out of the urethra and bladder by preventing skin breakdown. This fact is crucial if you or a loved one wears incontinence products. According to Moore, an incontinence brief's pH level is typically around eight or higher, which changes the "environment" and upsets the pH balance — diminishing the skin's ability to block those infection-causing pathogens.
4 | Restore pH levels
Both Tiemann and Moore emphasize the high value of maintaining pH.
"If your skin's pH level is right, there are 40 antimicrobial peptides unleashed on any pathogen," says Tiemann. Without that optimal pH level, there's no protection in place — which is essentially a "dinner bell inviting infections and pathogens to the table," he explains.
5 | Leverage helpful products
Staying adequately hydrated and keeping that optimal pH level through skin hygiene are healthy habits that provide prevention pathways. And along that pathway, integrating certain beneficial products is valuable too.
But all the cranberry juice in the world won't prevent a UTI. Tiemann says there's not much clinical evidence to support the benefits of cranberry juice in preventing these common infections. However, some supplements with cranberry may help when in tandem with things like Theraworx cleansing wipes, soaps and similar items. Some people may find that probiotics are helpful too.
But beware, Moore says the hygiene practice of soap usage in showers and baths strips pH and natural emollients, decreasing the body's natural method of fighting the possible introduction of pathogens. Furthermore, her doctor recommends voiding after taking a bath to assure none of the bathwater remains in the urinary tract. "Restoring the pH after bathing is critical," she concludes.
Shop our these product categories to help protect your patients and residents from UTIs & their side effects:
Urological products • Incontinence products & accessories • Skin care products • Pharmaceuticals
Be advised that information contained herein is intended to serve as a useful reference for informational purposes only and is not complete clinical information. This information is intended for use only by competent healthcare professionals exercising judgment in providing care. McKesson cannot be held responsible for the continued currency of or for any errors or omissions in the information.
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