1. Cranberry Tablets to Decrease UTI Rates Essay.
Cranberry Tablets to Decrease UTI Rates Essay. Nursing Capstone projectSubmit EBP
project with Implementation Plan and Evaluation Plan. Note EBP plan should resemble plan
on page 248 of the Melnyx text. Sources no more than 5 years old. PICOT Question: In adults
65 years old orolder does daily administration of cranberry tablets compared to no
cranberry tablet decrease new UTI rates?Cranberry Tablets to Decrease UTI Rates
Essay.ORDER A PLAGIARISM-FREE PAPER HEREThe paper should include all topics below
and while your paper will be in APA format an example to emulate is on page 248 of your
Melynk text.IntroductionThe Spirit of Inquiry IgnitedThe PICOT Question
FormulatedSearch Strategy ConductedCritical Appraisal of the Evidence
PerformedEvidence Integrated with Clinical Expertise and Patient Preferences to Inform a
Decision and Practice Change ImplementedOutcome EvaluatedProject
DisseminationConclusionAmong the elderly, asymptomatic bacteriuria and UTIs are very
common. Urinary Tract Infections involve the upper, lower or both urinary tracts. In long-
term care institutions, urinary tract infections account for more than one third of infections
amongst elderly residents. Generally in the United States, urinary tract infections have been
revealed as the most common urological condition whose annual management cost is
approximately $3.5 billion.Cranberry Tablets to Decrease UTI Rates Essay. Within a 20-year
period, the approximated costs of diagnosis and treatment have exceeded $ 25billion (Lim
et al., 2014). Up to 50% of the older population experiences more than a single UTI when
elderly. Besides, 25-35% of those who suffer from a UTI have more than one recurrent UTI
episode in the subsequent years. Although UTIs are prevalent among older people,
according to the statistics provided by the World Health Organization, they are more
common among elderly women as compared to men. This has been attributed to the fact
that women have shorter urethras which permit bacteria to ascend to the bladder.
Generally, the high prevalence and related costs makes them to be of public health
significanceCurrently, the management of UTIs includes the use of antibiotics have proven
to very efficient. Antibiotics have also been used as prophylaxis. However, due to their
repetitive use, antibiotics have largely contributed to the development of multidrug
resistance bacteria, fungal super infections and infections of the GIT (Lim et al., 2014).
Therefore, the numerous factors which make the prevention and reduction of UTIs a major
goal among the elderly include: their recurrent nature, associated medical costs and
increasing antimicrobial resistance. Based on the continuous increase in the ageing
population, the burden of urinary tract infections in the elderly is also expected to grow.
2. This reveals how critical it is to improve strategies in diagnosis management and
prevention with an aim of improving the health status of the elderly. More importantly, the
identification and implementation of highly effective non-antibiotic strategies to reduce the
incidence of UTIs among the elderly is of great significance.Cranberry Tablets to Decrease
UTI Rates Essay.The Spirit of Inquiry IgnitedAccording to the Centers for Disease Control,
UTIs account for approximately 7.2million office visits, 1.1 million emergency room visits
and 102,000 admissions annually (Lim et al., 2014). This accounts for 30% of all infections
among geriatric patients. Most healthcare providers tend to confuse asymptomatic
bacteriuria with UTIs and this is what majorly contributes to antimicrobial resistance
(Ikram et al., 2015). The prevalence is even higher among the elderly in long term care
facilities and nursing homes since they have a poor immune status. In this organization, the
overall incidence of UTIs in elderly women and men ranges within 1 infection per 10-20
person-years. This data is however based on administrative data which is limited by
variations in what is considered as a UTI by medical practitioners.Cranberry Tablets to
Decrease UTI Rates Essay.As a long-term care facility that primarily deals with geriatric
patients, advanced age is by itself a risk factor for UTIs. The fact that there are elderly
patients with urinary catheters, urine retention and incontinence, admissions and
suppressed immune systems also increases the incidences of UTIs. As supported by
Venkatesh et al., (2016), other factors which contribute to the development of UTIs in the
elderly are associated with changes in the immune status, numerous underlying morbidities
and exposure to hospital pathogens due to frequent hospitalizations.Cranberry Tablets to
Decrease UTI Rates Essay.The demand to reduce the rates of UTIs among elderly patients
with an aim of containing the costs of operation and achieving good patient outcomes in this
organization has been made a priority. The fact that the majority of the population served
by this facility is elderly patients worsens the situation and can potentially contribute to the
hospitals poor performance. UTIs also account for congestion, prolonged hospital stays and
frequent re-admissions witnessed in the geriatric wards. Therefore, in order to address this
issue, the primary purpose of this project is to establish whether the daily administration of
cranberry tablets is an effective way of reducing new rates of UTIs. Clinical studies have
revealed that cranberry tablets and supplements can reduce the occurrence of UTIs since
they suppress the inflammatory cascade as well as interfere with bacteria adhesion to the
epithelial cells of the urinary tract.Cranberry Tablets to Decrease UTI Rates Essay.PICOT
QuestionResearch reveals that there are numerous approaches to reduce the rates of UTIs
in the elderly such as antibiotic stewardship. The most effective strategies are however
those that are take a non-pharmacological approach. For instance, evidence-based meta-
analyses and systematic reviews have evaluated cranberries and UTIs. Cranberries
comprise of 10% carbohydrates and more than 80% water (Ledda et al., 2016).They also
contain organic acids, anthocyanins, catechins and very small amounts of ascorbic acid.
Despite the fact that some of these reviews have produced conflicting conclusion, others
have provided a lot of clarity on how efficacious cranberries are for the reduction and
prevention of UTIs (Nicolle, 2016).Cranberry Tablets to Decrease UTI Rates
Essay.Cranberries were initially used by Native Americans for its medicinal properties in
the management of fever, blood disorders and liver problems. Their mode of action has
3. greatly been linked to the adherence of pathogens such as Escherichia coli to the epithelial
cells, which is the initial step in the pathology of UTI’s. Based on the findings of other
studies, the actions of cranberries have been associated with suppressing the inflammatory
cascade and attenuating the reservoir of the pathogens in the GIT system (Ledda et al.,
2016). In elderly individuals, cranberries have been evidenced to reduce bacteriuria. This
explains how cranberries, its supplements and products are a potential non-antibiotic
alternative in reducing or preventing UTIs thus reducing the overall amount of the
antibiotics prescribed for UTIs for public health importance. This therefore leads to the
following PICOT question:In adults 65 years old older does daily administration of
cranberry tablets compared to no cranberry tablet decrease new UTI rates?Population
adults aged 65 years or olderIntervention daily administration of cranberry
tabletsComparison no cranberry tabletOutcome decrease new UTI ratesSearch
StrategySearch MethodsAn initial literature search was conducted using the EBSCOHost
search engine in the databases of PubMed, CINAHL, the National Guideline Clearing House
and CINAHL since the author was well informed on what was to be searched. This search
used the following key-terms: reduced urinary tract infections, elderly, geriatric and
cranberry tablets. The inclusion criteria was as follows: articles in English that were
published within the last five years, articles that discussed the reduction of UTIs using
cranberry tablets/supplements, articles which included adults, elderly men, women or both
aged 65 years or older, systematic reviews, meta-analyses and peer-reviewed articles. The
exclusion criterion was as follows: articles published before 2014, articles with young or
children participants, articles containing other non-pharmacological strategies to reduce
UTIs other than cranberry tablets/supplements and articles in other languages other than
English. In order to obtain a more discrete search and exclude articles which didn’t apply,
the following Boolean search operators were used: AND, OR and NOT.Cranberry Tablets to
Decrease UTI Rates Essay.Summary of Search ResultsBased on the initial search, 20 articles
directly related to the subject were found. This search was narrowed to 10 articles after a
preliminary review after which the exclusion criterion was applied to the articles that
remained thereafter. Articles that were published before 2014, those in other languages
apart from English, articles that included adults and young participants were all excluded.
The final search and review revealed that only 5 articles were effective and had met the
inclusion criteria and were included in the critical appraisal.Cranberry Tablets to Decrease
UTI Rates Essay.Critical Appraisal of the EvidenceJuthani-Mehta et al., (2016) in their study
purposed to determine the effect of two cranberry capsules administered once daily on
pyuria and bacteriuria among women who dwelled in nursing homes. The study was a
randomized double-bind placebo controlled trial that included 21 nursing homes with a
minimum of 90 beds in New Haven. The participants included 185 female residents from
nursing homes aged 65 years and older who spoke English with or without pyuria and
bacteriuria (Juthani-Mehta et al., 2016). The intervention involved the oral administration
of two cranberry capsules once daily to participants in 93 control and 92 treatment groups.
Among the 185 randomized women participants, the overall adherence was 80.1%. In the
treatment group, the presence of pyuria and bacteriuria was 25.5% (95% CI 18.6, 33.9) and
in the control group 29.5% (95% CI 22.2, 37.9) within one year. It was concluded that, in
4. older adults residing in nursing homes, the oral administration of cranberry capsules
resulted to a significant difference in pyuria and bacteriuria within 1 year (Juthani-Mehta et
al., 2016).The objective of the study by Caljouw et al., (2014) was to determine if cranberry
capsules are effective in the prevention of urinary tract infections among patients residing
in long term care facilities. The study was a Double-blind randomized placebo-controlled
multicenter trial that took place in facilities of long term care involving 707 women whose
median age was 84. Each participant took cranberry capsules twice daily for 12 months
(Caljouw et al., 2014).They were stratified based on their risk for UTIs such as DM, long-
term urinary catheterization and those who had suffered from more than one UTI in a
year. Among those at high risk of UTIs (n=516) the UTI incidence was very low with
cranberry capsules than with a placebo (62.8 vs. 84.8 per 100 person-years at risk, P=.04)
and the effect of treatment was 0.74(95% confidence interval (CI) =0.57–0.97). Among
participants who had a low risk of UTIs (n=412), there was no significant difference in the
incidence of UTIs between the placebo and cranberry. Caljouw et al., (2014) concluded that
among residents in long term care facilities who have a high risk of UTIs, the oral
administration of cranberry capsules twice daily significantly decreases the occurrence of
clinically defined UTIs. According to Luís, Domingues & Pereira (2017), prophylaxis of
UTIs with cranberries is an integral prevention strategy as evidenced through systematized
studies. Their study purposed to establish the association that exists between the intake of
cranberries and prevention of UTIs. The study was a systematic reviews that complied with
PRISMA guidelines and done as a meta-analysis of clinical trials. The findings revealed that
cranberries could potentially be used for UTIs incidence reduction as revealed by the risk
ratio (0.6750, 95% CI 0.5516-0.7965, p<0.0001). Besides, patients who were at some risk of
UTIs were highly susceptible to cranberry ingestion effects. Luís, Domingues & Pereira
(2017) concluded that primary care providers and physicians can recommend cranberry
capsules and supplements to reduce the rates of UTIs especially in elderly persons with
recurrent UTIs. This approach would also help to reduce the use of antibiotics which can
ultimately result to antimicrobial resistance.Cranberry Tablets to Decrease UTI Rates
Essay. Fu et al., (2017) acknowledge that cranberry tablets and extracts have
continuously been advocated for the management of UTIs. However, information regarding
its efficiency remains controversial. Fu et al., (2017) conducted a meta-analysis whose
purpose was to assess the effectiveness of cranberry on the recurrence and risk of UTIs
among women. The researchers therefore conducted a literature search chin Medline and
Embase databases (Fu et al., 2017). This literature included randomized controlled trials of
healthy women with a UTI history who were not pregnant above 18 years. Full-text and
abstract screening was done by two researchers and any bias risks and discrepancies were
resolved through a consensus group (Fu et al., 2017). Stata SE software version 13 was
used to perform the meta-analysis and the overall heterogeneity risk was employed using
the Mantel-Haenszel method (I2 < 50%). The findings revealed that women who were
otherwise healthy and at risk of UTIs in the studies were (n = 1498 participants). Cranberry
reduced UTI rates and risks by 26% (risk ratio: 0.74; 95% CI: 0.55, 0.98; I2 = 54%). It was
later concluded that cranberry capsules and supplements are effective in the prevention of
recurrent UTIs. However, these findings should be confirmed by higher-quality studies (Fu
5. et al., 2017).Cranberry Tablets to Decrease UTI Rates Essay. The objective of the pilot
study by Ledda et al., (2015) was to evaluate the prophylactic effects of oral supplements of
cranberry extracts among patients with recurrent urinary tract infections within 2 months.
The study was influenced by the background knowledge on the use of cranberry extracts as
nutritive supplements in the reduction and prevention of recurrent UTIs. Besides lifestyle
advice, the participants were required to take a capsule that contained cranberry extract for
sixty days (Ledda et al., 2015). A comparison was thereafter made between participants
who were given cranberry capsule extracts and those who did not receive the supplements.
The results revealed that 22 participants in each of the groups took part in the study. In the
intervention group, the frequency of UTIs during the period of study as compared to the
initial two months before the study was 73.3% (p< 0.05).In the control group, it was 15.4%
p (p< 0.05;p= 0. 012) (Ledda et al., 2015). Besides, seven patients in the intervention group
(31.8%) were free of symptoms while no subjects in the control group were symptom free
(p< 0.05). In the cranberry/intervention group, 20 of 22 participants (90.9%) had a
negative urine evaluation and 11 participants in the control group (50.0%, p< 0.05). Ledda
et al., (2015) concluded that cranberry extracts are safe and effective in the reduction and
prevention of recurrent UTIs (Ledda et al., 2015).Cranberry Tablets to Decrease UTI Rates
Essay.Integrating Evidence to Clinical PracticeThe results from this project highly
recommend the use of cranberries as an alternative non-pharmacological approach to
reduce and prevent UTIs. The high efficacy has been attributed to the concentration of
polyphenols in interfering with the adhesion of bacteria along the urinary tract. After
consuming cranberry, pathogens are prevented from adhering to the cell receptors of the
bladder. This hinders their growth and ability to cause infection. At minimum, the daily
recommended dosage is 36mg. Therefore, in clinica settings, it is advisable that primary
care providers and physicians administer oral cranberry capsules and supplements to
prevent and reduce the occurrence of recurrent UTIs among healthy individuals and those
in long term care facilities. Cranberry Tablets to Decrease UTI Rates Essay.Outcome
EvaluatedThe outcomes will be evaluated through quarterly staff meetings where the data
obtained from the new infection reduction strategy (cranberry tablets) will be discussed. A
database with metrics and graphics for caregivers to see will be maintained by the nursing
officer. The monthly metrics will be as follows: percentage of elderly individuals
hospitalized due to recurrent UTIs, those who received cranberry tablets, those who did not
receive cranberry tablets and the number of new UTIs during hospitalization. Quarterly,
after caregivers have received the necessary training on the administration of cranberry
tablets and its significance, they will be re-surveyed to gauge their understanding on the
subject and this knowledge compared with clinical outcomes to inform decision making on
areas that need improvement.Cranberry Tablets to Decrease UTI Rates Essay.Project
DisseminationThe findings of this project will be disseminated through bronchures, CMEs
and routine staff meetings. The bronchures will specifically be designed for patients and
their respective families. They will have relevant images and use simple language that can
easily be understood. Routine staff meetings and CMEs will be scheduled and
communicated prior for all nurses to attend based on their work schedules. The trainings
and CMEs will provide a platform for nurses to share additional knowledge obtained
6. through research with colleagues and ask relevant questions for better understanding and
application in the clinical setting.Cranberry Tablets to Decrease UTI Rates Essay.The
transtheoretical model for change will be used as the model of change for this project. This
model basically tests how ready a person is to act on a new approach to care and pinpoints
the approaches of change which guide an individual. This takes place in 5 key stages
namely: precontemplation, contemplation, preparation, action and maintenance. In this
project, the new idea which is to be adopted is that, through the daily administration of
cranberry tablets to individuals aged 65 years or older, the rates of UTIs will significantly be
prevented. Central to this change of this new approach to care is that the education of
primary care providers and nurses will contribute significantly to the adoption of this
change. This is a daily routine that both nurses and elderly individuals aged 65 years or
older with the help of family members will be expected to adopt. As a change adoption
process, it is expected that some may easily accept and embrace the change faster than
others.Cranberry Tablets to Decrease UTI Rates Essay.Conclusion Evidence-based
research is one of the most appropriate and surest way to ascertain that the proposed
project will help to attain desired outcomes. Besides, evidence-based research is an integral
aspect in the decision making process concerning the continuation or discontinuation of the
proposed evidence-based strategy. This project has clearly revealed how UTIs are of public
health significance among the elderly aged 65 years or older. Based on WHO reports, UTIs
account for approximately $3.5 annually. In the United States, statistics provided by the CDC
reveal that UTIs are responsible for approximately 7.2million office visits, 1.1 million
emergency room visits and 102,000 admissions annually, which is 30% of all infections
among geriatric patients. The associated mortalities, morbidities, high medical costs and
poor health outcomes ignited the spirit of inquiry to undertake this project.Cranberry
Tablets to Decrease UTI Rates Essay.Based on the search strategy, inclusion and exclusion
criteria, a total of five articles were found suitable and were included in the project’s critical
appraisal. Numerous alternative approaches that reduce the rates of UTIs in the elderly
such as antibiotic stewardship have been researched. However, this project focused on the
use of cranberries which have undoubtedly proven to be very effective in reducing the rates
of UTIs in the elderly. Cranberries do so by preventing the adherence of pathogens such as
Escherichia coli to the epithelial cells, suppressing the inflammatory cascade and reducing
bacteriuria. These findings informed the decision to give patients cranberry tablets in the
clinical setting based on routine schedules with an aim of reducing the rates of UTIs. The
project findings will be disseminated through bronchures, CMEs and ongoing trainings and
outcomes evaluated through the use mortality and morbidity data, administrative data,
incidence and prevalence data from the hospital’s database six weeks after
implementation.Cranberry Tablets to Decrease UTI Rates Essay.
