The NHS and UK Health Security Agency (UKHSA) are raising awareness of urinary tract infections (UTIs), as new data shows they have led to more than 800,000 admissions to hospitals across the country over the past five years.
While UTIs are a year-round concern, ahead of what is expected to be another busy winter in the NHS, clinical leaders are reminding people – particularly those aged 65 and older, and carers – of the steps they can take to reduce their risk of getting a harmful infection.
Some of the symptoms of UTI include needing to pee more frequently or urgently than usual, pain or a burning sensation when peeing, new pain in the lower tummy, kidney pain or pain in the lower back, blood in the pee, and for older people can include changes in behaviour such as acting agitated or confused.
A range of resources, including posters, have been developed for local NHS areas to share with all their services, including GP practices. They will also be shared with charities, royal colleges, care homes, and other relevant groups in the health and care sector to ensure as many older people and their carers have access to the information as possible.
The campaign also highlights the importance of keeping hydrated by regularly drinking enough fluids, going to the toilet as soon as possible when you need to, and washing or showering regularly to make sure the genital area is kept clean and dry.
Older adults are more prone to UTIs – making up almost three fifths of admissions for UTIs over the past five years.
New data, published today, shows there were over 1.8 million hospital admissions involving UTIs between 2018-19 and 2022-23 – the majority of which involved patients aged 65 and older. This includes admissions because of UTIs as well as those for another reason where the patient also had a UTI.
Last year (2022/23), of the 147,285 admissions with a primary diagnosis of UTI, 56% (82,392) were people over 65 years old, with the highest number in the 80-84 age group (17,280 admissions).
Additionally, UTIs are one of the leading causes of life-threatening E. coli bloodstream infections in England, and are a major contributor to the burden of antibiotic resistant infections in this country. A quarter of urine samples analysed in the first half of 2023 had bacteria resistant to a common type of antibiotic used in treatment.
If left unmanaged UTIs can lead to severe infection, sepsis, and in the most serious cases death.
Professor Sir Stephen Powis, NHS national medical director, said: “As we get closer to what is likely to be another challenging winter in the health service, it is a good opportunity to remind people of the range of services available in the NHS and the best way to get the right care for their needs, which can help avoid unnecessary trips to A&E – these include using NHS 111, speaking to a pharmacist or GP, or visiting an urgent care walk-in centre.
“And this joint campaign with UKHSA is a timely reminder for older people and carers of the importance of keeping hydrated year-round – not just during warmer months – going to the toilet when you need to, and regular washing, which can all help avoid preventable infections like UTIs, that if left untreated can become serious infections and can lead to admission to hospital.
“So if you or someone you care for has any symptoms like pain when peeing, a high temperature, lower tummy pain, or changes in behaviour, please seek advice as soon as possible from your GP, a walk-in centre, community pharmacist, or by calling NHS 111, as the quicker a UTI is detected, the faster and easier it is to treat.”
The campaign comes ahead of Infection Prevention Control week, and as the NHS has been busy preparing for what is expected to be another winter of pressure in the health service, following last winter’s record demand for emergency care, the significant number of people being treated in hospital for respiratory illnesses like flu and covid, and high bed occupancy.
A key aim of the urgent and emergency care recovery plan, published earlier this year, is the expansion of out-of-hospital care so patients can be treated and recover in the comfort of their own homes.
One of the plan’s initiatives has been to increase referrals into urgent community response teams, which respond to calls normally requiring an ambulance crew, and allow people to get care and treatment at home within two hours, avoiding a trip to A&E when clinically appropriate. Since April last year, these have been available across England.
Patients who would require inpatient care can also receive hospital-level treatment through a virtual ward, and UCR teams – and other healthcare professionals, including GPs – can refer a patient to a virtual ward if a longer period of treatment is needed to manage their condition.
Virtual wards – or “hospital at home” services – mean patients with acute medical problems including UTIs and dehydration can be seen by clinical teams, who deliver the same level of high-quality patient care and have access to the same investigations and treatment they would receive in hospital. Patients are closely monitored which enables clinicians to recognise early deterioration and adjust treatment if needed.
Dr Colin Brown, Deputy Director for Antimicrobial Resistance at UKHSA, said: “Urinary Tract Infections are incredibly common and while most people can manage their infection at home with painkillers and plenty of fluids, some do go on to develop much more serious complications, such as kidney or bloodstream infections that need hospital treatment.
“These more serious consequences are more common in people over the age of 65 so we are reminding this group in particular to be aware of the ways they can help reduce their risk of getting poorly. Drinking enough fluids is so important, as well as avoiding holding onto pee. Regular washing and keeping dry can also help reduce the risk of infections.”
Professor Adam Gordon, President of the British Geriatrics Society, said: “Most urinary tract infections can be managed at home if they’re spotted in time. But they can be serious, and lead to hospitalisation, if they continue without treatment. We would encourage people to be vigilant for signs of urinary infection, and to seek help if they’re worried about this. People with dementia may not be able to report symptoms, and so it’s important that carers are on the lookout for sudden changes in toileting habits, or other behaviours, that might indicate infection. We support the NHS and UKHSA in raising awareness about this important issue”.
To prevent getting a UTI, the NHS and UKHSA are reminding older adults to:
- drink enough fluids regularly
- avoid holding pee- instead, go to the toilet as soon as possible when you need to
- wash, or shower daily where possible especially if you suffer from incontinence
- keep the genital area clean and dry and check and change leakage of urine pads often
- wash genitals before and after sex.
Older adults, particularly people 65 years and older are more prone to UTIs and while both sexes can get a UTI, UTIs are more common in women than men. Women have a shorter urethra than men and bacteria are therefore more likely to reach the bladder or kidneys and cause an infection.
Symptoms of UTIs can include:
- pain or a burning sensation when peeing (dysuria)
- needing to pee more often than usual
- needing to pee more often than usual during the night (nocturia)
- needing to pee suddenly or more urgently than usual
- pee that looks cloudy
- blood in your pee
- lower tummy pain or pain in your back, just under the ribs
- a high temperature, or feeling hot and shivery
- a very low temperature below 36C.
In older, frail people who have problems with memory, learning and concentration (such as dementia), and people with a urinary catheter, symptoms of a UTI may also include:
- changes in behaviour, such as acting agitated or confused (delirium)
- wetting themselves (incontinence) that is worse than usual
- new shivering or shaking (rigors).
More information can be found at www.nhs.uk/conditions/urinary-tract-infections-utis