Purple Urine Bag Syndrome in Geriatric Wards: Two Faces of a Coin?

Abstract

falls are a major health problem, and efforts to lower the risk of falling in the community setting are needed, 1 but a fall is also one of the most serious iatrogenic events that an elderly person requiring hospitalization might experience. Approximately 5% to 10% of community-dwelling elderly people who fall sustain a significant injury. 2 It is likely that a greater percentage of falls results in such an injury if the elderly person is acutely ill and unable to protect herself during the fall. Multiple factors, including poor vision, delirium, pharmaceuticals, a hazardous environment, and chronic dementing illness may contribute to a greater risk of falling. 3 One program, the Hospital Elder Life Program, designed to decrease the incidence of delirium in the hospital setting, has been shown to decrease the risk of falls. 4 Notwithstanding such efforts, falls in the hospital setting remain a matter of considerable concern to patients, their families, their physicians, and hospital administrators.To address this, a video monitoring system was put in place at Hackensack University Medical Center on a 33-bed unit that serves the older population almost exclusively. Eight individuals deemed to be at high risk of falling were located in adjoining rooms, and video cameras were directed at their beds. To protect the privacy of the individuals when nursing care was being provided, the monitors were located in such a way that the patient in the bed could not be seen if the curtains were fully drawn.Individuals selected to occupy these beds were aged 70 and older and acutely ill. In addition, they had a diagnosis of delirium or dementia and a history of a fall in the recent past. Initially, a nursing assistant observed all eight beds continuously during the night shift on a single video screen. Each attendant received an educational program targeted to fall prevention. If a patient appeared to be about to fall, the nursing assistant intervened immediately.During the first full year of this program, 72 falls occurred on the 33-bed unit, with more than 50% of them happening at night, but not a single individual in a monitored bed fell at night during the year. Because of its initial success, the monitoring program has been expanded to be in place throughout the 24-hour period. The only fall by a monitored individual during this period occurred when two patients were observed to be ready to fall at the same time, and the assistant was unable to reach the second elder in time.Although no data are available at this time, it seems likely that this video-monitoring program would not only improve outcomes, but would also save money directly, lower legal costs, and improve patient satisfaction. In addition, in the near future, Medicare might not pay for the acute care of an individual who sustains an iatrogenic event, such as a fall-related injury, that occurred during hospitalization.

Purple diaper syndrome self remitted without antibiotic treatment

“…There is no definite strategy for how to deal with PDS. In the case of PUBS, some clinicians emphasize that this discoloration should be treated by antibiotics, because it is supposed to be related to urinary tract infection or even sepsis, 7,8 but other researchers have advocated it is unnecessary to treat it aggressively 9,10 . In the present case, we didn't manage the patient with antibiotics, because she was not severely ill and laboratory data were not suggestive of infection.…”

Purple Urine Bag Syndrome in Rehabilitation

“…The prevalence of PUBS in acute inpatient rehabilitation units appears low. As noted previously, elderly women are more prone to this disorder, likely related to anatomic considerations, increased rate of chronic catheterization compared with men, and the association of vaginal discharge and urinary infections [15‐18]. The reason for the low frequency of PUBS overall may be attributable to the intense bladder and bowel programs offered in the rehabilitation facilities upon admission, including regular changing or discontinuation of indwelling urinary catheters to prevent urinary tract infections and bowel regimens to prevent constipation.…”

An update on purple urine bag syndrome

“…However, some reports suggest a prevalence of 8.3%–16.7% in patients with long-term urinary catheterization 2–4. In one study, 27% of elderly patients with dementia in a geriatric hospital who required urinary catheterization developed PUBS 8. Thus, PUBS seems to be associated with dementia and is not considered so rare by geriatric physicians 9.…”