Enhancing quality practice for prevention and diagnosis of urinary tract infection during inpatient spinal cord rehabilitation

The Journal of Spinal Cord Medicine, 2017 · DOI: 10.1080/10790268.2017.1369216 · Published: January 1, 2017

Spinal Cord Injury Immunology Rehabilitation

Simple Explanation

Urinary Tract Infections (UTI) are a common secondary health complication following Spinal Cord Injury (SCI), leading to service interruptions during inpatient rehabilitation and morbidity among individuals with chronic SCI. The study aimed to improve UTI prevention and diagnosis in subacute SCI individuals admitted for tertiary inpatient rehabilitation using a quality improvement team and data collection. The study found that the concurrent presence of cloudy and foul smelling urine is predictive of UTI diagnosis in SCI inpatients, particularly those learning Clean Intermittent Catheterization (CIC) technique from nurses.

Study Duration

5 Months

Participants

55 inpatients with subacute SCI

Evidence Level

Not specified

Key Findings

1
Foul smelling urine had the highest sensitivity (0.50, 95% CI: 0.31-0.69) for UTI diagnosis.
2
New incontinence had the highest specificity (0.88, 95% CI: 0.69-0.97) for UTI diagnosis.
3
The combination of cloudy and foul smelling urine increased the PPV to 78% (95% CI: (0.40-0.97).

Research Summary

This quality improvement project aimed to reduce the incidence of UTI in individuals with subacute SCI admitted for tertiary inpatient rehabilitation. The study analyzed data from 55 inpatients with subacute SCI and found that the most frequent symptoms were foul smelling urine (41%), change in urine color (31%), and incontinence (25%), and the most common sign was fever (34%). The study concluded that the concurrent presence of cloudy and foul smelling urine is predictive of UTI diagnosis in SCI inpatients and that SCI inpatients are susceptible to UTI when learning CIC technique from nurses.

Practical Implications

Improved Diagnostic Accuracy

Assessing urine appearance and odour is crucial to confirm suspicion of UTI.

Optimized Bladder Drainage

Bladder drainage strategies should reduce dependence on indwelling catheters.

Enhanced Training

Training in CIC techniques and efforts to improve hand hygiene may reduce UTI occurrence.

Study Limitations

1
PPV, NPV, and LRs apply to the tertiary inpatient setting for individuals with subacute SCI and not to the outpatient setting.
2
Nonspecific symptoms and chronic bacteriuria are common and confound UTI diagnosis in the outpatient setting.
3
The hand washing prompting system is a prototype in our centre, which may become commercially available in the future but is not widely available.

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