Urinary Tract Infections

To raise awareness of UTI prevention in older adults and provide guidance for care home staff in Powys on safe diagnosis and management practices.

Further information: Preventing Infection Workbook - Page 53

A UTI occurs when bacteria infect the urinary tract.
Diagnosis is difficult in older adults because they often have asymptomatic bacteriuria (bacteria in urine without symptoms).
Important: Asymptomatic bacteriuria does not require antibiotics. Unnecessary treatment increases risk of:
Clostridioides difficile (C. diff) infection.
Antibiotic resistance.

1. Hydration

Dehydration increases UTI risk and can worsen behaviour in residents with dementia.
Encourage 6-8 glasses (1.5-2 litres) per day, unless fluid restricted.
Aim for pale yellow urine to help flush bacteria.

2. Personal Hygiene

Daily washing or bathing is essential.
Female residents: wipe front to back, dispose of toilet paper after each wipe.
Wash genital area with mild soap and warm water; use clean cloths for each wipe.

3. Prompt Toileting

Avoid holding a full bladder for long periods; emptying regularly reduces infection risk.

Clear to pale yellow - Normal, well hydrated - No action required

Light / transparent yellow - Suggests ideal level of hydration - Maintain current fluid intake

Darker yellow / pale honey - May need to hydrate soon - Encourage fluids

Yellow and cloudy - Resident is ready for a drink - Encourage fluids

Darker yellow - Starting to become dehydrated - Increase fluid intake and monitor

Amber coloured - The resident requires more fluid (all fluids count) - Encourage fluids and monitor closely

Orange / yellow - Suggests the resident is becoming severely dehydrated - Increase fluids urgently and monitor

Very dark, red or brown - May not be due to dehydration - Seek advice from the GP and consider sending a specimen

Consider sending a sample if:

How to collect:

Midstream/clean catch specimen.
For catheterised residents, collect from the sample port (never from drainage bag).
Use aseptic non-touch technique (ANTT).

Send sample before starting antibiotics.

Use a container with boric acid (red top), filled to the line; preserves bacteria for up to 72 hours.

Important Notes on Dipsticks

Why dipsticks should not be used in older adults

Older adults (>65) may have asymptomatic bacteriuria (bacteria in urine without infection), which does not require antibiotics.
Unnecessary antibiotics increase the risk of Clostridium difficile(C-diff) infection and future antibiotic resistance.
Diagnosis should be based on symptoms and clinical assessment rather than dipstick testing.
for GP/Microbiology Laboratory.

Hydration Monitoring - WEE Challenge