Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Feb 19;34(3):178-189.
doi: 10.1136/bmjqs-2023-016967.

Preventing urinary tract infection in older people living in care homes: the 'StOP UTI' realist synthesis

Jacqui Prieto  1 , Jennie Wilson  2 , Alison Tingle  2 , Emily Cooper  3 , Melanie Handley  4 , Jo Rycroft Malone  5 , Jennifer Bostock  6 , Heather Loveday  2
Affiliations
Review

Preventing urinary tract infection in older people living in care homes: the 'StOP UTI' realist synthesis

Jacqui Prieto et al. BMJ Qual Saf. .

Abstract

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.

Keywords: adverse events, epidemiology and detection; infection control; leadership; nursing homes; safety culture.

PubMed Disclaimer

Conflict of interest statement

Competing interests: The following committee memberships were active during the lifetime of the project: JRM: HSDR Programme Director 2015-2022, NIHR Strategy Board 2015-2022, NIHR Journals Library Editorial Board 2016-2018. JB: HSDR Funding Committee Member 2018-2020, HTA Clinical Evaluation and Trials Committee Member 2020.

Figures

Figure 1
Figure 1. Stages of the review.
Figure 2
Figure 2. Flow diagram of the scoping search process in stage 1.
Figure 3
Figure 3. Conceptual diagram of initial programme theory. GP, general practitioner; UTI, urinary tract infection.
Figure 4
Figure 4. Theory areas and related context–mechanism–outcome configurations (CMOc). CAUTI, catheter-associated UTI; UTI, urinary tract infection.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Thornley T, Ashiru-Oredope D, Normington A, et al. Antibiotic prescribing for residents in long-term-care facilities across the UK. J Antimicrob Chemother. 2019;74:1447–51. doi: 10.1093/jac/dkz008. - DOI - PMC - PubMed
    1. Genao L, Buhr GT. Urinary Tract Infections in Older Adults Residing in Long-Term Care Facilities. Ann Longterm Care. 2012;20:33–8. - PMC - PubMed
    1. Schmid A, Burchardi H, Clouth J, et al. Burden of illness imposed by severe sepsis in Germany. Eur J Health Econom . 2002;3:77–82. doi: 10.1007/s10198-002-0095-8. - DOI - PubMed
    1. Rosello A, Hayward AC, Hopkins S, et al. Impact of long-term care facility residence on the antibiotic resistance of urinary tract Escherichia coli and Klebsiella. J Antimicrob Chemother. 2017;72:1184–92. doi: 10.1093/jac/dkw555. - DOI - PubMed
    1. Abernethy J, Guy R, Sheridan EA, et al. Epidemiology of Escherichia coli bacteraemia in England: results of an enhanced sentinel surveillance programme. J Hosp Infect. 2017;95:365–75. doi: 10.1016/j.jhin.2016.12.008. - DOI - PubMed

LinkOut - more resources