Date of Award

Fall 1995

Document Type

Thesis - Restricted

Degree Name

Master of Science (MS)

Department

Nursing

First Advisor

Fehring, Richard J.

Second Advisor

Schank, Mary Jane

Third Advisor

Miller, Judith A.

Abstract

Criteria for defining a urinary tract infection (UTI) have been developed for acute care and long term care facilities. Standardized criteria are used for surveillance. There are no known standard criteria for defining a UTI in a physical medicine and rehabilitation (PM&R) setting. The primary purpose of this study was to describe the relationship between nursing observations, level of functioning, and functional gains with the growth of microorganisms in urine specimens. The secondary purpose was to describe those differences in nursing observations of patients grouped by the presence or absence of an indwelling catheter. A previous study with 126 subjects was done to determine the prevalence of UTI in a PM&R setting. This study involved a secondary analysis of data obtained from the previous study and the retrieval of more data from clinical records. The previous study used data collected concurrently which included laboratory reports, admission interviews, daily reports by nursing, and a review of the clinical record. Functional level was measured by an intradisciplinary team with the Team Conference Flow Sheet (TCFS) designed by Sacred Heart Rehabilitation Hospital. The current study found that 42 of the 126 (33.3%) patients had a UTI on admission. Positive predictive accuracy values for the following nursing observations in patients without an indwelling catheter were determined to be foul urine (78.6% ), muscle spasms (71.4%), fever (25.0%), and cloudy urine (55.6%). Positive predictive accuracy values for the following nursing observations in patients with an indwelling catheter were determined to be elevated body temperature (100.0%), foul urine (100.0%), cloudy urine (86.4%), fever (80.0%), and muscle spasms (80.0%). The mean TCFS scores were significantly lower in the group of patients with UTI's. The mean value of the difference between the admission score on the TCFS and the first team conference score was significantly lower in the group with UTI's. A surveillance tool needs to be developed for the PM&R setting. Cloudy urine, foul aroma of the urine, elevated body temperature, muscle spasms, and failure to progress or a slow rate of progress in the level of functioning during rehabilitation should be considered as criteria for defining a UTI in patients regardless of the presence of an indwelling catheter. Dysuria and frequent voiding in small amounts should also be considered as criteria for defining UTI in patients without an indwelling catheter. Impaired bowel function and impaired mobility should be considered as criteria for defining a UTI in patients with an indwelling catheter. The results of this study can serve as a basis for the development of a surveillance tool used to identify nosocomial UTI's in a PM&R setting.

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