SKIP THE DIP for UTI in over 65s is a quality improvement initiative in HSE older persons residential care facilities (RCFs) led by HSE Community Antimicrobial Pharmacists and the HSE Quality and Patient Safety Office, in collaboration with the national AMRIC team. Commencing in September 2023, this new initiative aims to reduce the levels of inappropriate prescribing for urinary tract infections (UTIs) in people aged 65 years and older.
UTIs are the most common reason for antibiotic prescribing in older persons RCFs. The diagnosis and management of UTI can be challenging in older persons. Asymptomatic bacteriuria (ASB) is the presence of bacteria in the urine without symptoms of a UTI. It can be present at any age but is particularly common in those aged over 65 years and is very common in those persons with an indwelling urinary catheter. Urine dipstick tests are not a useful marker to assess for evidence of UTI in older people as they do not distinguish between ASB and UTI. ASB can lead to positive results for markers of UTI in urine dipstick tests, even in those without a UTI.
Inappropriate use of urine dipstick tests can lead to unnecessary antibiotic prescribing. This does not benefit the resident and may cause considerable harm including adverse effects, drug interactions and antimicrobial resistance. The diagnosis of a UTI should be based on clinical signs and symptoms of UTI in those aged 65 and older, not a urine dipstick test result. Antibiotics should be prescribed in line with national guidance available at www.antibioticprescribing.ie
The following resources are available to support the SKIP THE DIP for UTI in over 65s quality improvement initiative:
