Background
Urinary tract infection (UTI) is the most diagnosed infection in older people living in care homes.
Objective
To identify interventions for recognising and preventing UTI in older people living in care homes in the UK and explain the mechanisms by which they work, for whom and under what circumstances.
Methods
A realist synthesis of evidence was
undertaken to develop programme theory underlying strategies to recognise and prevent UTI. A generic topic based search of bibliographic databases was completed with further purposive searches to test and refine the
programme theory in consultation with stakeholders.
Results
56 articles were included in the review. Nine context–mechanism–outcome configurations were
developed and arranged across three theory areas:
(1) Strategies to support accurate recognition of UTI,
(2) care strategies for residents to prevent UTI and (3)
making best practice happen. Our programme theory
explains how care staff can be enabled to recognise and
prevent UTI when this is incorporated into care routines
and activities that meet the fundamental care needs
and preferences of residents. This is facilitated through
active and visible leadership by care home managers and
education that is contextualised to the work and role of
care staff.
Conclusions
Care home staff have a vital role in
preventing and recognising UTI in care home residents. Incorporating this into the fundamental care they
provide can help them to adopt a proactive approach to preventing infection and avoiding unnecessary antibiotic use. This requires a context of care with a culture of
personalisation and safety, promoted by commissioners,
regulators and providers, where leadership and resources
are committed to support preventative action by
knowledgeable care staff.