Running head: PREVENTION OF URINARY TRACT INFECTIONS

Executive Summary: Whatcom County Health Department

Prevention of Urinary Tract Infections in Skilled Nursing Facilities
Dani Woodley, Debra Bevens, Nicole Marslya
Western Washington University

PREVENTION OF URINARY TRACT INFECTIONS

The organization that our group collaborated with this quarter was the Whatcom County
Health Department (WCHD) infection prevention division. According to the WCHDs website,
their mission and vision is to lead the community in promoting health and preventing disease,
and that all people in our community have the opportunities they need to thrive in a safe and
healthy environment. The health department oversees almost all areas of health and prevention
in our county. Some of the many aspects that they manage are disease outbreaks, environmental
health, child and family health, immunization coverage, food recalls, emergency preparedness,
and birth and death certificates. Our practical experience (PE) project was focused toward
infection prevention in Whatcom County, mainly skilled nursing facilities (SNFs).
During our first meeting, our WCHD Infection Prevention mentor, Lela Riherd, RN,
BSN, presented us with two options that our group could choose to proceed forward with. We
were introduced to the Center of Disease and Preventions (CDC) Antimicrobial Stewardship
Program, and Lelas manager, Joni Hensley, RN, BSN, covered that the WCHD would be
hosting an Infection Prevention conference on June 2nd for local healthcare providers. Joni
implored our group to complete a poster to present at this conference that will provide the local
community with more information regarding infection prevention strategies in Whatcom County
SNFs. We decided that this was an area we wanted to explore further, and chose to proceed down
this path. We then began to define our vulnerable population, and narrowed it to SNF residents
that were at risk of infection. Next, our group began to research common infections in SNFs, the
CDCs Antimicrobial Stewardship Program, and infection prevention interventions in SNFs.
After a thorough evidence-based research of our population, we chose to focus on prevention of
urinary tract infections (UTIs) in Whatcom County SNFs. Research indicated that UTIs were at
the top of all infections in SNFs, one of the most preventable, and highly over prescribed for

PREVENTION OF URINARY TRACT INFECTIONS

antibiotics. Our group confirmed these same findings by conducting informal interviews with
local Whatcom County SNFs.
With our vulnerable population well defined, our group developed three interventions for
the prevention of UTIs, and the proper use of antibiotics in Whatcom County SNFs. The poster
that we designed for the Infection Prevention conference was geared toward the staff of local
SNFs and is our groups deliverable project. The poster covers information on the high rates of
UTIs and the overuse of antibiotics, preventative interventions, risks factors, signs and
symptoms, Antibiotic Stewardship Program for SNFs, CDC recommendations, resources and
references. Our second intervention we suggest is to develop an online training module that
could be accessed by SNFs to train employees on UTI prevention and proper use of antibiotics.
We suggest that this intervention be an annual mandatory module for all SNF employees that
care for residents. We also recommend that the module be reviewed and updated annually for
the best evidence-based information on UTI prevention. Our final intervention recommendation
is a pamphlet on UTI prevention and proper antibiotic use. This pamphlet would be given to all
SNF residents and their families. It is our long term goal for continual advancement in resident
and family education, leading to increased community awareness of proper antibiotic use and
infection prevention.
After our community assessment and interventions were complete, our group evaluated
WCHD and local SNFs readiness for change. Using Lewins Force Field Analysis, we
determined the forces for and against the change of proper antibiotic usage and prevention of
UTIs in SNFs. Since the WCHD nurses suggested our poster be our deliverable, and organized
the Infection Prevention conference, we concluded that they were forces for the change. The
SNF employees, prescribing doctors, residents, and families may be forces against change due to

PREVENTION OF URINARY TRACT INFECTIONS

long-term habits of prescribing antibiotics immediately upon any signs and symptoms of a UTI.
The driving force of a determined family member wanting antibiotics prescribed can be difficult
to content with, and many times physicians will prescribe an antibiotic because of this. With our
poster, and the plan for the poster to travel from SNF to SNF in Whatcom County our hope is
that our intervention will take hold and become sustainable.
It is our recommendation that future RN to BSN students, at Western Washington
University (WWU), develop and implement the training module and the resident and familys
informational pamphlet. Our interventions were approved and highly recommended by two
representatives from Washington State Department of Health (WA DOH) that we had the
opportunity to meet during our last PE day. Patricia Montgomery, RN, who directs the Infection
Control Assessment and Response Program (ICAR) for WA DOH and Kelly Kauber, MPH, who
is the Antimicrobial Stewardship Coordinator for WA DOH gave us confirmation that we were in
line with the CDCs and WA DOHs recommendations for infection prevention and antibiotic
stewardship. With the relationship developed with Patricia and Kelly, at the state level, and our
great partnership with the WCHD, future RN to BSN cohorts should have success implementing
our recommended interventions.