Urinary Tract Infections (UTIs)

What Is Urinary Tract Infection?

 Urinary Tract Infection is an infection in any part of your urinary system.
 This can include your kidneys, ureters, bladder, and urethra.
 Most infections involve the lower part of the urinary tract—the bladder and the urethra.
 In one research study, more than half of the antibiotic prescriptions for Urinary Tract Infections
were for residents who didn’t have symptoms.

Assessment:

Signs and Symptoms of Urinary Tract Infection

 What are the signs and symptoms of Urinary Tract Infection?

 Signs and symptoms of Urinary Tract Infection may vary and are different depending on
whether the resident has an indwelling catheter.
 A lot of research has been done to identify the symptoms that indicate Urinary Tract
Infection in nursing home residents.
 The key symptoms of urinary tract infections are:
— Dysuria or acute pain when urinating
— Fever with another symptom
— Back or flank pain
— Frequent urination
— Incontinence
— A strong, persistent urge to urinate
— Suprapubic pain
— Gross hematuria
— New or dramatic change in mental status for residents with an indwelling catheter

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 — Hypotension
 Even when there seem to be signs or symptoms of a Urinary Tract Infection, sometimes they could
be related to some other issue or problem. It may not be a Urinary Tract Infection.
 When a resident has a suspected Urinary Tract Infection, the nursing staff can communicate with
the physician, Nurse Practitioner, or Physician Assistant about symptoms and the resident’s
condition. This information is essential to making a decision about whether to start antibiotics or
take other actions first.

Common Myths About Urinary Tract Infections

There are at least three common myths about urinary tract infections:

1. Change in mental status

 The first myth is that any change in mental status by itself indicates that a resident without an
indwelling catheter has a UTI.
 However, if the resident has an indwelling catheter, then a new and dramatic change in mental
status alone is reason to suspect a UTI.
— What are some reasons that a person without an indwelling catheter may have a change in
mental status?
— Possible reasons for a change in mental status: Dehydration; being tired;
medication side effects; vascular problems; head trauma; dementia; hearing or other
sensory deficiencies; infection; or many other possible causes
 Even though a change in mental status can be related to an infection, it does not necessarily mean
that someone has a UTI.
 It may be better to wait and assess the resident frequently for other symptoms of infection.

2. Foul smelling and/or dark urine

 The second myth is that dark and/or foul smelling urine means that someone has a UTI.
— What are some reasons that a person may have dark urine?
— Possible reasons for dark-colored urine: The color of urine comes from a
pigment called urochrome. If urine is darker, then it is more concentrated; this may
indicate that a person is dehydrated and needs additional fluids.
— What are some reasons that a person may have foul-smelling urine?
— Possible reasons for foul-smelling urine: The smell of urine has to do with the
amount and concentration of substances that are excreted by the kidneys. Urine that is
more concentrated may smell more like ammonia. Dehydration, some foods,
vitamins, and health conditions can affect the smell of urine.

3. Urinalysis with positive findings

 The third myth is that finding bacteria, nitrites, and/or white blood cells (or leukocytes) in a
urinalysis means that the resident has a UTI even if the resident shows no other signs of infection.
— What are some reasons that people may have positive results with a urinalysis?
— Possible reasons for positive results of a urinalysis:
 It’s not easy to get a clean catch or midstream catch urine specimen, especially
among persons who may have cognitive issues or mobility problems.
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  There can be problems with contamination. False positives and false negatives
can occur with dipstick urinalysis.
 White blood cells in the urine can be related to use of a catheter, stones, tumors,
or infections.
— Bacteria in the urine does not mean that there is an infection if the resident shows no
other signs or symptoms of a UTI.

When to Order a Urine Culture?

2 or more symptoms/signs
of other infection?
YES NO

Do not order Order urine culture if you observe 1 or

urine culture more:

• New onset burning urination (dysuria)

• Urinary catheter

• New or worsening:

o Urgency

o Frequency

o Flank pain

o Gross hematuria

o Urinary incontinence

o Suprapubic pain

Urinary catheter?

YES NO

Order urine culture if Order urine culture if you observe 2 or

you observe 1 or more: more:

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 • New CVA tenderness • New onset burning urination (dysuria)

• Shaking chills (rigors) • New or worsening:

• New onset of delirium o Urgency

o Frequency

o Flank pain

o Gross hematuria

o Urinary incontinence

o Suprapubic pain

Diagnostics:

Centers for Disease Control and Prevention criteria for

Urinary Tract Infection:
Definitions:

Healthcare-associated infections (HAI):

UTI Urinary tract infections (UTI) are defined using Symptomatic Urinary Tract Infection (SUTI) criteria,
Asymptomatic Bacteremic UTI (ABUTI), or Urinary System Infection (USI) criteria.

Refer to the charts below (pages 7-10).

Date of event (DOE): For a UTI, the date of event is the date when the first element used to meet the
UTI infection criterion occurred for the first time within the 7-day Infection Window Period.

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Indwelling catheter: A drainage tube that is inserted into the urinary bladder through the urethra, is left
in place, and is connected to a drainage bag (including leg bags). These devices are also called Foley
catheters. Condom or straight in-and-out catheters are not included nor are nephrostomy tubes,
ileoconduits, or suprapubic catheters unless a Foley catheter is also present. Indwelling urethral
catheters that are used for intermittent or continuous irrigation are included in CAUTI surveillance.

Catheter-associated UTI (CAUTI): A UTI where an indwelling urinary catheter was in place for >2
calendar days on the date of event, with day of device placement being Day 1,

AND an indwelling urinary catheter was in place on the date of event or the day before. If an indwelling
urinary catheter was in place for > 2 calendar days and then removed, the date of event for the UTI must
be the day of discontinuation or the next day for the UTI to be catheter-associated.

Example of Associating Catheter Use to UTI: A patient in an inpatient unit has a Foley catheter inserted
and the following day is the date of event for a UTI. Because the catheter has not been in place >2
calendar days on the date of event, this is not a CAUTI. However, depending on the date of admission,
this may be a healthcare-associated UTI.

Notes:

 Indwelling urinary catheters that are removed and reinserted: If, after indwelling urinary catheter
removal, the patient is without an indwelling urinary catheter for at least 1 full calendar day (NOT to be
read as 24 hours), then the urinary catheter day count will start anew. If instead, a new indwelling
urinary catheter is inserted before a full calendar day has passed without an indwelling urinary catheter
being present, the urinary catheter day count will continue.

Infection Window Period:

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The National Healthcare Safety Network (NHSN) Infection Window Period is defined as the 7-days during
which all site-specific infection criteria must be met. It includes the day the first positive diagnostic test
that is used as an element of the site-specific infection criterion, was obtained, the 3 calendar days
before and the 3 calendar days after. For purposes of defining the Infection Window Period the
following are considered diagnostic tests:

• laboratory specimen collection

• imaging test 2-3 January 2016 Identifying Healthcare-associated Infections

• procedure or exam

• physician diagnosis

• initiation of treatment

For site-specific infection criteria that do not include a diagnostic test, the first documented localized
sign or symptom that is used as an element of NHSN infection criterion should be used to define the
window (e.g., diarrhea, site specific pain, purulent exudate).

Infection Window Period:

Infection Window

3 days before
Period

First positive diagnostic test OR First documented

localized sign and/or symptom in the absence of a
diagnostic test
3 days after

Centers for Disease Control and Prevention criteria for

Urinary Tract Infection:

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 Criteria for Defining UTI
Symptomatic UTI (SUTI) Must meet at least one
of the following criteria:
SUTI 1a Patient must meet 1, 2, and 3 below:
Catheter associated Urinary Tract Infection
(CAUTI) 1. Patient had an indwelling urinary catheter that
had been in place for > 2 days on the date of
event (day of device placement = Day 1) AND was
either:
 Present for any portion of the calendar day on
the date of event†, OR
 Removed the day before the date of event‡

2. Patient has at least one of the following signs

or symptoms:
• fever (>38.0°C)
• suprapubic tenderness*
• costovertebral angle pain or tenderness*
• urinary urgency ^
• urinary frequency ^
• dysuria ^

3. Patient has a urine culture with no more than

two species of organisms identified, at least one
of which is a bacterium of ≥105 CFU/ml

“Mixed flora” is not available in the pathogen list

within NSHN. Therefore, it cannot be reported as
a pathogen to meet the NHSN UTI criteria.
Additionally, “mixed flora” represent at least two
species of organisms. Therefore, an additional
organism recovered from the same culture would
represent >2 species of microorganisms. Such a
specimen also cannot be used to meet the UTI
criteria.
The following excluded organisms cannot be used
to meet the UTI definition:
 Candida species or yeast not otherwise
specified
 mold
 dimorphic fungi or
 parasites

An acceptable urine specimen may include these

organisms as long as one bacterium of greater

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 than or equal to 100,000 CFU/ml is also present.
Additionally, these non-bacterial organisms
identified from blood cannot be deemed
secondary to a UTI since they are excluded as
organisms in the UTI definition.
All elements of the UTI criterion must occur
during the Infection Window Period.

Notes:  An indwelling urinary catheter in place

SUTI 1b Non-Catheterassociated Urinary Tract
Infection (NonCAUTI)
could cause patient complaints of “frequency”
“urgency” or “dysuria” and therefore these
cannot be used as symptoms when catheter is in
place.  Fever is a non-specific symptom of
infection and cannot be excluded from UTI
determination because it is clinically deemed due
to another recognized cause.
Patient must meet 1, 2, and 3 below:
1. One of the following is true:
 Patient has/had an indwelling urinary catheter
but it has/had not been in place >2 calendar days
on the date of event†
OR
 Patient did not have a urinary catheter in place
on the date of event nor the day before the date
of event †

2. Patient has at least one of the following signs

or symptoms:
• fever (>38°C) in a patient that is ≤ 65 years of
age
• suprapubic tenderness
• costovertebral angle pain or tenderness
• urinary frequency
• urinary urgency
• dysuria

3. Patient has a urine culture with no more than

two species of organisms identified, at least one
of which is a bacterium of ≥105 CFU/ml. All
elements of the SUTI criterion must occur during
the Infection Window Period.

“Mixed flora” is not available in the pathogen list

within NSHN. Therefore, it cannot be reported as
a pathogen to meet the NHSN UTI criteria.
Additionally, “mixed flora” represent at least two
species of organisms. Therefore, an additional

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 organism recovered from the same culture would
represent >2 species of microorganisms. Such a
specimen also cannot be used to meet the UTI
criteria.

The following excluded organisms cannot be used

to meet the UTI definition:
 Candida species or yeast not otherwise
specified
 mold
 dimorphic fungi or
 parasites

An acceptable urine specimen may include these

organisms as long as one bacterium of greater
than or equal to 100,000 CFU/ml is also present.
Additionally, these non-bacterial organisms
identified from blood cannot be deemed
secondary to a UTI since they are excluded as
organisms in the UTI definition.
All elements of the UTI criterion must occur
during the Infection Window Period.

Notes:
 An indwelling urinary catheter in place could
cause patient complaints of “frequency”
“urgency” or “dysuria” and therefore these
cannot be used as symptoms when catheter is in
place.
 Fever is a non-specific symptom of infection
and cannot be excluded from UTI determination
because it is clinically deemed due to another
recognized cause.

Asymptomatic Bacteremic Urinary Tract Infection (ABUTI)

Patient must meet 1, 2, and 3 below:

1. Patient with (an indwelling urinary catheter in place for >2 calendar days, with day of device
placement being Day 1, and catheter was in place on the date of event or the day before.) or without
an indwelling urinary catheter has no signs or symptoms of SUTI 1 or 2 according to age (Note:
Patients > 65 years of age with a non-catheter-associated ABUTI may have a fever and still meet the
ABUTI criterion)

2. Patient has a urine culture with no more than two species of organisms identified, at least one of
which is a bacterium of ≥105 CFU/ml.

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 3. Patient has organism (identified by a culture or non-culture based microbiologic testing method
which is performed for purposes of clinical diagnosis or treatment) from blood specimen with at least
one matching bacterium to the bacterium identified in the urine specimen. All elements of the ABUTI
criterion must occur during the Infection Window Period.

“Mixed flora” is not available in the pathogen list within NSHN. Therefore, it cannot be reported as a
pathogen to meet the NHSN UTI criteria. Additionally, “mixed flora” represent at least two species of
organisms. Therefore, an additional organism recovered from the same culture would represent >2
species of microorganisms. Such a specimen also cannot be used to meet the UTI criteria.

The following excluded organisms cannot be used to meet the UTI definition:
 Candida species or yeast not otherwise specified
 mold
 dimorphic fungi or
 parasites

An acceptable urine specimen may include these organisms as long as one bacterium of greater than
or equal to 100,000 CFU/ml is also present. Additionally, these non-bacterial organisms identified
from blood cannot be deemed secondary to a UTI since they are excluded as organisms in the UTI
definition.
All elements of the UTI criterion must occur during the Infection Window Period.

Notes:
 An indwelling urinary catheter in place could cause patient complaints of “frequency” “urgency” or
“dysuria” and therefore these cannot be used as symptoms when catheter is in place.
 Fever is a non-specific symptom of infection and cannot be excluded from UTI determination
because it is clinically deemed due to another recognized cause.

CDC SUTI and ABUTI Flowchart:

"Surveillance for for Urinary Tract Infections." National Healthcare Safety Network (NHSN). Centers for
Disease Control and Prevention, Jan. 2016. Web. 5 Mar. 2016.
<http://www.cdc.gov/nhsn/pdfs/pscmanual/7psccauticurrent.pdf>.Page 7-12

Minimum Criteria for Initiating Antibiotics for a Urinary

Tract Infection:

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Notes:

1. Urine cultures should not be performed on a scheduled basis (e.g., monthly).

2. Urine cultures should not be used to identify UTIs in the absence of symptoms.
3. Smelly or cloudy urine is not a symptom of a UTI.
4. Residents with an intermittent catheter or a condom catheter should be evaluated as if they are not
catheterized.
5. Urine cultures should be used to identify the most appropriate antibiotic. For residents with acute dysuria, it
may be appropriate to initiate empirical antibiotic therapy; but for all other symptoms, wait for a urine culture.

For residents that regularly run a lower temperature, use a temperature of 2°F (1°C) above the baseline as a
definition of a fever.

For residents without an indwelling catheter, initiate antibiotics if the resident meets
criteria of one of three situations:
1. Acute dysuria alone
OR

2. Fever of 100°F (37.9°C) or two repeated temperatures of 99°F (37°C) AND at least one
of the following:
New or worsening:
– Urgency, or

– Frequency, or

– Suprapubic pain, or

– Gross hematuria, or

– Costovertebral angle tenderness, or

– Urinary incontinence

OR

3. No fever, then two or more of the following:

– Urgency, or

– Frequency, or

– Suprapubic pain, or

– Gross hematuria, or

– Urinary incontinence

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For residents with a chronic indwelling catheter, initiate antibiotics if one or more
of the following criteria are met:
 Fever of 100°F (37.9°C) or two repeated temperatures of 99°F (37°C), or
 New or worsening costovertebral tenderness, or
 New onset suprapubic pain, or
 New or worsening delirium (sudden onset of confusion, disorientation, dramatic
change in mental status), or
 New or worsening rigors (shaking chills) with or without identified cause, or
 New or worsening hypotension (e.g., significant change from baseline BP or a
systolic BP <90)
Notes:
1. Urine cultures should not be performed on a scheduled basis (e.g., monthly).
2. Urine cultures should not be used to identify UTIs in the absence of symptoms.
3. Smelly or cloudy urine is not a symptom of a UTI.
4. Residents with an intermittent catheter or a condom catheter should be evaluated as if
they are not catheterized.
5. Urine cultures should be used to identify the most appropriate antibiotic. For residents
with acute dysuria, it may be appropriate to initiate empirical antibiotic therapy; but for
all other symptoms, wait for a urine culture.
6. For residents that regularly run a lower temperature, use a temperature of 2°F (1°C)
above the baseline as a definition of a fever.

If none of the minimum criteria are met, consider initiating the following:

Note: Refer to your facility’s protocol or Doctor’s order to determine dosages, frequency, and
appropriate instructions.
 Encourage _____ ounces of liquid intake ____ daily until urine is light yellow in
color.
 Record fluid intake every ______ hours for ______ hours.
 Assess vital signs, including temp, every ______ hours for ______ hours.
 Request notification if symptoms worsen or if unresolved in ______ hours.

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 Plans:

 Monitor, Assess, And Follow up.

 Break The Chain of Infection.

 Determine whether to treat

 Help clinicians choose the right antibiotic

 Educate and Engage Residents and Family Member

 Monitor Antibiotic Use

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Implementation:

 Monitor, Assess, And Follow up:

Gather data through constant monitoring. Then chart the appropriate signs and
symptoms through proper assessment. Next, follow up with a healthcare team to
provide continuity of care and ultimately address and solve the problem.

Infection Window Period:

The National Healthcare Safety Network (NHSN) Infection Window Period is defined as the 7-days during
which all site-specific infection criteria must be met. It includes the day the first positive diagnostic test
that is used as an element of the site-specific infection criterion, was obtained, the 3 calendar days
before and the 3 calendar days after. For purposes of defining the Infection Window Period the
following are considered diagnostic tests:

• laboratory specimen collection

• imaging test 2-3 January 2016 Identifying Healthcare-associated Infections

• procedure or exam

• physician diagnosis

• initiation of treatment

For site-specific infection criteria that do not include a diagnostic test, the first documented localized
sign or symptom that is used as an element of NHSN infection criterion should be used to define the
window (e.g., diarrhea, site specific pain, purulent exudate).

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Infection Window Period:
Infection Window

3 days before
Period

First positive diagnostic test OR First documented

localized sign and/or symptom in the absence of a
diagnostic test
3 days after

Repeat Infection Timeframe (RIT):

The RIT is a 14-day timeframe during which no new infections of the same type are reported. The date
of event is Day 1 of the 14-day RIT. If criteria for the same type of infection are met within the 14 day
RIT, a new event is not identified or reported. Additional pathogens recovered during the RIT from the
same type of infection are added to the event.

Refer to for more information:

"Surveillance for for Urinary Tract Infections." National Healthcare Safety Network (NHSN).
Centers for Disease Control and Prevention, Jan. 2016. Web. 5 Mar. 2016.
<http://www.cdc.gov/nhsn/PDFs/pscManual/2PSC_IdentifyingHAIs_NHSNcurrent.pdf>.

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  Break the chain of infection:

The six links of the chain of infection are:

 Infectious disease (any microorganism such as a bacterium or virus that can cause

disease)

 Reservoir (place where an infectious disease lives, thrives, and reproduces)

 Portal of exit (place where the organism leaves the reservoir)

 Mode of transmission (how an infectious disease transfers from one person or object

to another person)

 Portal of entry (place where the infectious disease enters the body of a susceptible
host)

 Susceptible host (a person at risk for developing an infection)

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  Determine whether to treat:
UTI SBAR toolkit

The Suspected UTI SBAR toolkit helps nursing home staff and prescribing clinicians communicate
about suspected UTIs and facilitates appropriate antibiotic prescribing. The primary tool in this toolkit is
the Suspected UTI SBAR form. This form consists of questions that help nurses collect the most relevant
information about a resident with a suspected UTI for the prescribing clinician, who then uses the
information to assess the need for an antibiotic prescription.

What is the UTI SBAR form? What does it include?

• The Suspected Urinary Tract Infection (UTI) Situation, Background, Assessment, and Recommendation
form (the UTI SBAR form) is intended to guide communication between nursing home staff and
prescribing clinicians about the potential need for antibiotics for nursing home residents.

• The UTI SBAR form is based on the Situation, Background, Assessment, and Recommendation form of
communication, or SBAR. The SBAR communication style promotes better communication and
performance by addressing the specific types of information that clinicians are likely to need for decision
making.

• The UTI SBAR form is based on criteria developed by an expert consensus panel and modified clinical
practice guidelines for infections in older adults in long-term care facilities.

• The UTI SBAR form can be faxed to or used when speaking with a prescribing clinician. It takes only
minutes to fill in and can be used as part of the resident’s medical record.

Why use the UTI SBAR form?

• The UTI SBAR form helps to reduce the unnecessary use of antibiotics. A recent study in 12 Texas
nursing homes found that using the UTI SBAR form reduced the use of antibiotics for asymptomatic
bacteriuria by about one-third. This is important given the consistent finding that treating residents for
bacteria in the urine without localized symptoms is not beneficial.

• The UTI SBAR form facilitates communication between nursing staff and prescribing clinicians.
Prescribing clinicians need specific information about the resident to make a prescribing decision. The
UTI SBAR form is an easy-to-use way of collecting all of the information a prescribing clinician might
want to make a decision. Forms like these have proven effective in improving care. A landmark 2006
study of hospitals in Michigan demonstrated that evidence-based interventions using standardized
protocols led to a significant reduction in catheter-related bloodstream infections.

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  Help clinicians choose the right antibiotic

Antibiogram:

Laboratories can use culture results from the nursing home to create a
specialized annual report called an antibiogram. The antibiogram report shows the
organisms present in specimens from nursing home residents who are suspected of
having an infection along with the percent susceptibility of each organism to
various antibiotics. Referring to an antibiogram report helps prescribing clinicians
make better, empirically-based decisions by avoiding antibiotics with high rates of
resistance found in the nursing home. Because antibiograms provide information
on local susceptibility patterns, they may help to improve the selection of
antibiotics to treat infections from organisms with high resistance rates.

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  Educate and Engage Residents and Family Member

Educate residents and family members about:

 What are antibiotics?
 Antibiotics are medicines that fight infections caused by bacteria. Antibiotics work by
targeting and killing harmful bacteria.
 How do people get bacterial infections?
 Normally, your immune system helps control the bacteria you have. But, sometimes
bacteria grow so quickly that your immune system can’t keep up and then you may develop
an infection that needs to be treated.
 When are antibiotics used to treat urinary tract infections (UTIs)?
 A urinary tract infection (UTI) is an infection involving any party of the urinary system,
including urethra, bladder, and kidney. If you are experiencing symptoms of an infection and
bacteria are found, you will typically be prescribed an antibiotic.
 Antibiotics do not help when there are no UTI symptoms. In fact, taking antibiotics when
they are not needed may cause health problems.
 If you do not have any symptoms, but your urine sample shows some bacteria, it may be
better to wait and drink extra water or other beverages. Nurses may check on you and ask
you to drink more for a few days.
 When are antibiotics used to treat lower respiratory tract infections or LRTI?
 There are many different kinds of respiratory tract infections, such as colds and coughs,
the flu, pneumonia, and bronchitis. Not all respiratory tract infections need to be treated with
an antibiotic.
 Doctors often use antibiotics to treat some lower respiratory tract infections like
pneumonia and bronchitis.
 The most common symptoms of a respiratory infection needing an antibiotic are a fever
with a bad cough. A cough alone is typically not treated with an antibiotic.
 If you are only experiencing a cough, it is often better to wait. Your doctor will request
that nurses check on you often to see how you are feeling, take your temperature, and ask if
you are experiencing any other symptoms. They may give you acetaminophen (Tylenol)
and/or a cough suppressant to make you feel better. They may also ask you to drink more
fluids and raise you head with pillows. Nurses may check on you more and provide
acetaminophen for a few days.

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  What are the risks—or harms—of antibiotics?
 Antibiotics are important for treating you when you definitely have an infection, but
unneeded antibiotics can do more harm than good.
 Before taking an antibiotic, it is important to understand how antibiotics could harm or
hurt you. There are five potential health problems that occur as a result of taking an
antibiotic.
1. Allergic reactions, like a rash or swelling.
2. Side effects, such as a stomach upset.
3. Drug interactions.
4. An infection called Clostridium difficile or C. diff.
5. Antibiotic resistance.

 What is our nursing home doing to decrease the chance of these risks?
 Improving the way, we use antibiotics for our residents is one way we can protect your
health and ensure the safety of your care.
 Our nursing home is taking action in two ways to make sure that you and other residents
get the right care at the right time.
– First, we share information and help you understand the risks of antibiotics.

– Second, we have a program to—

 Make sure you get antibiotics only when absolutely necessary—when you
have a bacterial infection.
 Make sure that you get the right antibiotic, at the right time, for the right
length of time.
 What can you do to get the best care for yourself?
 Ask your doctor or a nurse about the benefits and risks of taking an antibiotic.
 Tell someone, including myself or another nurse, if you want more information—or have
concerns—about antibiotics and their risks.
 When you take an antibiotic, you may experience several side effects such as a rash,
diarrhea, nausea, vomiting, and headaches. If you are (or think you may be) experiencing any
of these side effects—or just feel different—let a nurse know immediately.

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  Monitor Antibiotic Use

Monitoring antibiotic use helps a nursing home assess progress in utilizing the right antibiotics and
avoiding unnecessary Monitoring antibiotic use helps a nursing home assess progress in utilizing the
right antibiotics and avoiding unnecessary antibiotics. Communicating the results to staff, residents, and
prescribing clinicians is helpful to show progress and as a reminder that stewardship is an ongoing effort.
antibiotics. Communicating the results to staff, residents, and prescribing clinicians is helpful to show
progress and as a reminder that stewardship is an ongoing effort.

Antibiotic Use Tracking Sheet:

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References:

American Institutes for Research, Texas A & M University Health Science Center, University of
Wisconsin, TMF Health Quality Institute, Trivedi Consults, LLC, University of Pittsburgh, and
David Mehr. "Toolkit 2: Monitor and Sustain Stewardship." Nursing Home Antimicrobial
Stewardship Guide. Agency for Healthcare Research and Quality, Aug. 2012. Web.
http://nhguide.airprojects.org/LinkClick.aspx?
fileticket=weUCGwdEHPo=&tabid=107&portalid=0&mid=491

American Institutes for Research, Texas A & M University Health Science Center, University of
Wisconsin, TMF Health Quality Institute, Trivedi Consults, LLC, University of Pittsburgh, and
David Mehr. "Toolkit to Educate and Engage Residents and Family Members." Nursing Home
Antimicrobial Stewardship Guide. Agency for Healthcare Research and Quality, Aug. 2012.
Web. 5 Mar. 2016. http://nhguide.airprojects.org/Educate-Engage-Residents-Family

American Institutes for Research, Texas A & M University Health Science Center, University of
Wisconsin, TMF Health Quality Institute,, Trivedi Consults, LLC, University of Pittsburgh, and
David Mehr. "Toolkit 1. Working With Your Lab to Improve Antibiotic Prescribing." Nursing
Home Antimicrobial Stewardship Guide. Agency for Healthcare Research and Quality, Aug.
2012. Web. 5 Mar. 2016. http://nhguide.airprojects.org/LinkClick.aspx?
fileticket=Yu7IPjWqHqA=&tabid=107&portalid=0&mid=491

American Institutes for Research., Texas A & M University Health Science Center., University
of Wisconsin., TMF Health Quality Institute., Trivedi Consults., LLC., University of Pittsburgh.,
and David Mehr. "Toolkit 1. Suspected UTI SBAR Toolkit." Nursing Home Antimicrobial
Stewardship Guide. Agency for Healthcare Research and Quality, Aug. 2012. Web. 5 Mar. 2016.
http://nhguide.airprojects.org/LinkClick.aspx?
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