Investigating the impact of an online hydration intervention in care homes using the COM-B model: a mixed methods study

Abstract

Background Antimicrobial resistance is a serious threat to public health. To reduce antimicrobial resistance, interventions to reduce gram-negative infections, specifically urinary tract infections, are vital. Early evidence suggests increased fluid intake is linked with a reduction in UTIs and subsequently has potential to reduce antibiotic usage. Care homes have a high prevalence of UTIs and provide an opportunity in a closed setting to deliver an intervention focused on increasing fluid intake, where it is support and monitored by health care workers. We aimed to evaluate the impact of a staff focused intervention to increase the hydration of care home residents and the possible impact on the number of residents who have UTIs. Methods The study was a pre and post intervention with a sequential explanatory mixed methods design. The intervention was delivered online in 3 care homes and contained 3 main components underpinned by the COM-B model including hydration training, 7 structured drinks rounds and a hydration champion to change behaviour of care home staff. A pre and post questionnaire assessed the impact of the intervention on staff and data was collected on fluid intake, drinks rounds delivered to residents, UTIs, antibiotic used to treat UTIs, falls and hospitalisation. Descriptive statistics including counts, percentages and the median summarised and assessed the impact of the study. Focus groups with care home staff provided qualitative data which was thematically analysed. Results Staff had an increase in knowledge across the six components of hydration care. 59% of residents had an increase in median fluid intake post intervention. During the time of the intervention, a 13% decrease in UTIs and antibiotic usage to treat UTIs across the 3 care homes was recorded, however falls and hospitalisations increased. Staff mostly found the intervention enjoyable and useful, with 90% reporting they would make a change to their daily practice. Conclusions This study demonstrates that a brief, low cost, online multi-component intervention focused on care home staff can increase the fluid intake of residents. A reduction in UTIs and antibiotic consumption was observed overall. Empowering care home staff could be a way of reducing the burden of infection in this setting.