Urinary Tract Infections (UTI) & Hydration

A urinary tract infection (UTI) is an infection in any part of your urinary system — your kidneys, ureters, bladder and urethra.

Urinary tract infections typically occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder which may go on to cause a urinary tract infection.

Urinary tract infections (UTIs) – NHS

Why do we need to improve UTI management?

• Overuse of antibiotics causes antibiotic resistance, so antibiotics no longer work
• In Wirral, we are one of the highest prescribers of antibiotics for urinary tract infections in the UK
• We have among the highest rate for admissions to hospital for UTI in England particularly in 70+ population

How to reduce the risk of UTI

Staying hydrated will help to reduce the risk of UTI. Drinking plenty of fluids make you pee more often, helping to flush bacteria out of the urinary tract.

Older Persons Care Home UTI Training

General Practice UTI Training

Preventing Dehydration

Hydration

It is recommended that you aim to drink at least eight cups per day (unless you have been advised to restrict your fluid intake for medical reasons). Any fluid, except alcohol counts including milk, water, tea, coffee and fruit juice. Other foods such as ice cream, ice-lollies, jelly, soup, yoghurt, milk puddings or water rich fruits such as melons can also count towards your fluid intake. The key is to drink regularly throughout the day to prevent dehydration.

Improving fluid intake – Hydrating fruits and vegetables

Cucumber – 96%

Pineapple – 95%

Lettuce – 95%

Celery – 95%

Tomato – 94%

Watermelon – 92%

Grapefruit – 90%

Blueberries – 85%

Pear – 84%

Resources:

Hydration information leaflet – Wirral Community Health and Care NHS Foundation Trust

Hydration Risk Assessment Tool

WCHC Hydration Poster

UTI Infection Assessment Tool

For Health Care Professionals

Urine dipping (urinalysis) should not be undertaken in those aged over 65 years and those with a urinary catheter Dipstick poster

Urine sampling

Urine samples should be sent for all adults presenting with a possible UTI who fall within the following categories:

• 65 years (greater than 65 years – men & women)
• Pregnant women 
• Catheter Associated UTI 
• Symptoms of upper UTI / pyelonephritis
• Recurrent UTI (2 episodes in 6m or 3 episodes in 12m)
• Failed treatment or non-response

Consider risk factors for resistance and send urine for culture if: 

• Abnormalities of genitourinary tract
• Renal impairment 
• Care home resident
• Hospitalisation for > 7 days in last 6m (greater than 7 days)
• Recent travel to a country with increased resistance
• Previous UTI resistant

Rationale for urine sample:

• Determine whether the person’s symptoms are caused by a UTI or are more likely to be another problem
• Make sure that the antibiotic the person is being treated with is appropriate in order to kill the bacteria
• Identify resistant bacteria

(NB: People who are 70+ years and/or live in a care home are more likely to have an                             infection caused by antibiotic resistant bacteria)

• Midstream Specimen of Urine Patient Information Leaflet

For further information:

Urinary tract infections (UTIs) – NHS

Overview | Urinary tract infection (lower): antimicrobial prescribing | Guidance | NICE

Managing Common Infections in Adults – UTI – Treatment (2021)

Pan Mersey Formulary

National infection prevention and control manual