1. THE UTI MODULE LECTURE

2. To outline the aims of the UTI module To describe the questionnaires LECTURE OBJECTIVES

3. WHY DO THE UTI MODULE? Not just collect data to collect data

4. QUESTIONNAIRES In addition to the point prevalence survey 3 questionnaires: 1.National survey To be completed by national study coordinator 2.Institutional questionnaire on UTI To be completed by the local surveyor on the day of the PPS or on the day before or after the PPS 3.UTI resident questionnaire To be completed by the local surveyor on the day of the PPS

5. UTI INSTITUTIONAL Q. 4 page questionnaires A – UTI Surveillance & Diagnosis a. Surveillance b. Diagnosis c. UTI management d. Urine sampling B – Catheter care C – Incontinence care Same LTCF study number as PPS !!!

6. UTI RESIDENT Q. 3 page questionnaires A – Additional resident data B – Antimicrobial use for UTI C – Signs/symptoms of UTI Same LTCF study number Same resident study number as PPS

7. UTI RESIDENT Q.: WHEN? A UTI resident questionnaire has to be completed for each LTCF resident who is: Receiving one or more systemic antimicrobials for an indication related to the urinary tract on PPS day (1) AND/OR Presenting signs/symptoms of an active urinary tract infection on the day of the survey (2)

8. UTI RESIDENT Q.: WHEN? (1) Original resident questionnaire (Part B) A UTI resident questionnaire should be completed each time “urinary tract” is ticked for an antimicrobial treatment, irrespective of the type of treatment (prophylactic or therapeutic) Transfer to the UTI resident questionnaire

9. UTI RESIDENT Q.: WHEN? (2) Original resident questionnaire (Part C) A UTI resident questionnaire should also be completed if there is suspicion of a UTI i.e. if at least one sign/symptom is checked in the algorithm Signs/symptoms should be transferred to the UTI resident questionnaire

10. UTI RESIDENT Q. Additional resident data Definitions in UTI protocol

11. UTI RESIDENT Q. Additional resident data Definitions in UTI protocol

12. UTI RESIDENT Q. Antimicrobial use for UTI Day of the first and last antimicrobial intake Prescribed dose (one intake) ≠ daily intake Number of intakes per day Copy from original questionnaire ATC to be complete by NR afterwards

13. UTI RESIDENT Q. Antimicrobial use for UTI Prophylactic: To prevent the occurrence of an infection Empirical: To treat an infection, treatment initiated before the cause (e.g. organism) is known Documented: To treat an infection, choice based on the microbiological result of a culture The antimicrobial course is repeated after a certain number of days/weeks/months to treat or prevent the same infection

14. UTI RESIDENT Q. Antimicrobial use for UTI Dipstick test for nitrite: to detect the presence of Gram negative uropathogens that are capable of reducing dietary nitrates to nitrite. Dipstick leukocyte esterase test: to detect leukocyte esterase that might suggest the presence of white blood cell in the urine Recurrent UTI: Two or more proven UTI episodes within 6 months or ≥ 3 episodes in one year

15. UTI RESIDENT Q. Signs/symptoms of a UTI Signs/symptoms of a UTI to copy from original questionnaire to UTI resident questionnaire  Only infection confirmation in software Active UTI: UTI is active when signs and symptoms of the infection are present on the survey date or signs and symptoms were present in the past and the resident is (still) receiving treatment for that infection on the survey date. The presence of symptoms and signs should be verified until at least one week before the PPS day.

16. DATA DELIVERY All questionnaires should be collected, check for completeness and send back to the national study coordinator via regular mail The national study coordinator will collect the forms of all participating long-term care facilities and send them to the HALT-2 management team for data analysis