Hydration in Care Homes - (In development)

Low-intake dehydration is associated with an increased risk of death, disability, hospital admission and longer hospital stays.  Treatment for Urinary Tract Infections can often involve lengthy hospital stays which can be highly distressful to the person and often requires anti-biotic prescribing.  As UTIs are one of the most common reasons that antibiotics are prescribed, there is the potential for antibiotic resistance.  There are preventative measures we can put into place that people to stay hydrated and keep people happy and healthy in our care.

Very Brief Intervention

Ask

Do you know who is at risk of a UTI?

  • Elderly
  • Cognitive Impairment
  • People who are catheterised
  • Diabetics
  • Previous UTIs

Did you know that there are many reasons why older adults are most susceptible to dehydration, would you like some further information on this?

  • They have naturally less water in their bodies.
  • Elderly people may be taking medication which flushes water from their system.
  • They can be less sensitive to the feeling of thirst.
  • If an older person is concerned about continence or needs help to get to the toilet, they often choose to drink less, thereby increasing their risk of low-intake dehydration

Did you know that Urinary Tract Infection's (UTI's) are a common cause for hospital admissions?

  • UTIs is an Ambulatory care sensitive condition (ACSC) which is a conditions where effective community care and case management can help prevent the need for hospital admission.
  • UTI was the ACSC with the highest emergency admissions rate in 2012/13.
  • The average cost of a UTI hospital admission is £1331.

Urinary Tract Infections and Blood-Stream Infections

  • E.coli is a bacteria commonly found in the gastro-intestinal tract, and is the most common cause of UTI.
  • Surveillance of Escherichia coli bloodstream infection (BSI) in England identified the urinary tract as the most commonly reported source of infection (51.2%).
  • The chances of developing these serious bloodstream infections can be reduced by prevention, early recognition and appropriate treatment of UTIs.

One in four nursing home patients admitted to hospital are dehydrated. Dehydration increases the risk of Urinary Tract Infections (UTIs) which can lead to multiple complications including confusion, falls, Acute Kidney Injury (AKI) and hospital admission.

Assist

Do you know what the recommended daily fluid intake is?

  • The recommended daily minimum is 6 to 8 glasses of fluid a day.

Would you like some information about the benefits of good hydration

  • Improved hydration has been shown to reduce UTIs requiring antibiotics by 58% and UTIs requiring hospital admissions reduced by 36% in one study.
  • Hydration also helps prevent falls, constipation, pressure ulcers, confusion and kidney stones. .

How confident are you in recognising mild dehydration symptoms, would you like some further information on this?

  • Headache
  • Tiredness
  • Poor oral hygiene/Dry mouth
  • Confusion
  • Dark urine
  • Small volumes of urine
  • Constipation

Act

Would you like some information on how you can promote good hydration for people you care for?

  • Introducing protected drinks times. This encourages people to drink there drinks and ensures people who need assistance drinking will get the help they need.
  • Increasing the number of opportunities for a drink e.g. before and after a meal.
  • Identify people’s drinks preferences.
  • Provide people with a drinks menu which allows them to choose what they would like to drink.
  • Provide cups that hold a large volume of fluid.
  • Identify if a person has a preference of cup e.g. larger handle. Some people may prefer to drink through a straw.
  • Be aware of those that need assistance when eating and drinking.
  • Offer people Ice pops and fruit.
  • Create accessible hydration stations allowing people to pour themselves a drink when they would like.
  • Remember if someone is suffering from diarrhoea and vomiting they require more fluid to prevent dehydration.

Here are some tips about how you could monitor hydration.

  • Provide people with charts recoding how many cups they have drank that day.
  • Look for the signs of dehydration described above.

Here is how you can help reduce antibiotic resistance

  • Help reduce the rates of urinary infections by using the tips in this tool.
  • Follow the link below and become an antibiotic guardian.Choose one simple pledge about how you’ll make better use of antibiotics and help save these vital medicines from becoming obsolete.
  • Antibiotic Guardian Website: https://antibioticguardian.com/

Information Services

Antimicrobial Resistance

  • Antimicrobial resistance (AMR) is the ability of a microorganism (like bacteria, viruses, and some parasites) to stop an antimicrobial (such as antibiotics, antivirals and antimalarials) from working against it. As a result, standard treatments become ineffective, infections persist and may spread to others.
  • This applies to UTIs. If a person is having multiple courses of antibiotics for recurrent UTIs these antibiotics may eventually start to become ineffective as the bacteria become resistant. As a result the UTIs may start to become more severe and require treatment in hospital with stronger antibiotics.
  • For more information regarding AMR visit the following website: https://www.gov.uk/government/publications/health-matters-antimicrobial-resistance/health-matters-antimicrobial-resistance

TARGET Antibiotics Tool Kit

Further Information around Dehydration and UTIs is available below: