Long-Term Care / Geriatrics

AHRQ-aligned work on catheter-associated urinary tract infection (CAUTI) prevention centers on a simple fact: catheter days drive infections. The most effective interventions limit indwelling urinary catheter use, insert only for appropriate indications, maintain a closed drainage system, and remove the catheter the moment it is no longer needed.

The strongest, most nurse-controlled lever is the nurse-driven removal protocol, which lets nurses remove a catheter that no longer meets criteria without waiting for a separate order. Daily review of necessity — paired with securement, hand hygiene, and keeping the bag below bladder level — is what brings rates down.

CDC hand-hygiene guidance reaffirms that consistent hand hygiene at the recommended moments remains one of the most effective ways to prevent healthcare-associated infections. The guidance covers when to use alcohol-based hand rub versus soap and water (for example, with certain spore-forming organisms or visibly soiled hands).

The clinical point is reliability at the key moments — before patient contact, before a clean/aseptic task, after body-fluid exposure risk, after patient contact, and after contact with patient surroundings. Adherence tends to slip during busy periods, which is exactly when transmission risk rises.

Guidance on the behavioral and psychological symptoms of dementia (BPSD) — agitation, wandering, resistance to care — continues to recommend nonpharmacologic, person-centered strategies as first-line, reserving antipsychotics for situations where there is risk of harm, because those medications carry serious risks in older adults with dementia.

The practical message is to look for the trigger behind a behavior: pain, a full bladder, hunger, overstimulation, fear, or an unmet need. Structured routines, calm environments, validation rather than correction, and addressing physical needs often de-escalate symptoms without medication.

AHRQ's fall-prevention resources emphasize that effective programs are multifactorial and individualized: a risk assessment that actually drives a tailored care plan, rather than a universal label applied to 'high-risk' patients without matching interventions.

The guidance highlights addressing the specific contributors a patient has — medications that increase fall risk, mobility limits, toileting needs, delirium, and environmental hazards — and pairing them with targeted actions like scheduled toileting, mobility assistance, medication review, and a safe room setup. Post-fall huddles help teams learn from each event.

Guideline guidance on pressure injury (pressure ulcer) prevention emphasizes structured risk assessment on admission and at regular intervals, paired with individualized prevention: repositioning, pressure-redistributing surfaces, skin inspection, and moisture and nutrition management.

The guidance stresses that prevention is ongoing and tailored to risk — higher-risk patients need more frequent repositioning and skin assessment, and early-stage skin changes should trigger escalation before they progress. Heels, the sacrum, and medical-device sites are common, watch-closely locations.