102UROSEPSIS WITH GRAM-NEGATIVE BACTERAEMIA AUDIT: DEVELOPING A URINARY TRACT INFECTION PREVENTION CHECKLIST

Abstract

Background: Urinary tract infections (UTIs) are common in older adults and can result in life-threatening urosepsis with Gram-negative bacteraemia (UGNB). Responding to the Department of Health target to halve Gram-negative bacteraemias by 2021, we undertook a Quality Improvement Project (QIP) to characterise our UGNBs and developed a UTI prevention checklist for audit and intervention purposes. Method: A literature review of risk factors for UTIs identified 6 domains for our checklist: 1) appropriateness of urinary catheters; 2) bladder scan for post void residual volume (PVRV); 3) per rectum (PR) examination for constipation; 4) men: prostate assessment, women: perineum assessment for vaginal prolapse or atrophic vaginitis; 5) continence assessment; 6) medication review for drugs that cause urinary obstruction or constipation. The checklist was refined by small focus groups of nurses and doctors using Plan-Do-Study-Act (PDSA) methodology. Data were prospectively collected for all UGNBs during a 4 month period and also retrospectively for emergency hospital attendances in the preceding year. We proactively intervened to complete all checklist domains where usual care had failed to do so. Results: There were 49 cases of UGNB, 24 (49%) were >65 years old and 28 (57%) were female. 12 patients (25%) had a catheter associated UGNB; 3 (25%) of these were avoidable (catheter not indicated/not removed promptly). 15% had a documented PVRV; 12% had a PR; 30% of men and 5% of women had their prostate or perineum assessed respectively; 2% had a continence assessment; 0% had a medication review. 30% of patients with UGNB had attended hospital with a UTI in the preceding year. Intervention: We performed medication reviews on all patients, treated constipation, removed 3 catheters, and referred 5 patients to other specialties (Urology, Gynaecology and Psychiatry) Conclusion: These data show a high prevalence of UTI preceding UGNB and introduces a tool to modify UTI risk factors to reduce UGNBs as per national targets.