How to modify the risk of complications such as urinary tract infections (UTIs) and post-stroke bronchial aspiration in the long term?

From the Guidelines

To modify the risk of complications like urinary tract infections (UTIs) and post-stroke bronchial aspiration long-term, implement a comprehensive prevention strategy that prioritizes early removal of indwelling catheters, proper hygiene, and intermittent catheterization when necessary, as recommended by the Canadian Stroke Best Practice Recommendations (1). For UTIs, ensure adequate hydration with 2-3 liters of water daily and practice proper hygiene to minimize the risk of infections (1). Avoid indwelling catheters when possible, using intermittent catheterization instead if necessary, as indwelling catheters should be removed as soon as possible to minimize the risk of urinary tract infections (1). Consider implementing a bladder-training program, including timed and prompted toileting on a consistent schedule, to help manage urinary incontinence (1). For post-stroke bronchial aspiration, implement proper positioning during meals (upright at 90 degrees), modify food textures based on swallowing ability, and perform regular swallowing evaluations (1). Speech therapy with exercises like the Mendelsohn maneuver and effortful swallow can strengthen swallowing muscles (1). Early mobilization after stroke reduces aspiration risk, while oral hygiene with chlorhexidine 0.12% mouthwash twice daily decreases oral bacteria that could cause pneumonia if aspirated (1). Regular neurological follow-ups every 3-6 months help monitor progress and adjust interventions (1). These approaches work by addressing the underlying mechanisms of these complications—maintaining urinary flow and reducing bacterial colonization for UTIs, while strengthening swallowing coordination and reducing aspiration risk through positioning and texture modifications. Key aspects of management also include assessing bladder function, considering the use of silver alloy–coated urinary catheters if a catheter is required, and managing bowel function to prevent constipation and fecal impaction (1). By prioritizing these evidence-based strategies, healthcare providers can effectively reduce the risk of UTIs and post-stroke bronchial aspiration, ultimately improving patient outcomes and quality of life (1).

From the Research

Modifying the Risk of Complications

To modify the risk of complications such as urinary tract infections (UTIs) and post-stroke bronchial aspiration in the long term, several strategies can be considered:

• Reducing the use of indwelling urinary catheters, as they are a significant risk factor for UTIs 2, 3, 4
• Implementing quality improvement interventions to reduce inappropriate catheterization 2
• Using antiseptic-impregnated catheters or other types of catheters that may reduce the risk of UTIs 2, 5
• Developing effective approaches to decrease UTIs in the stroke population, as patients with stroke have different risks and consequences of UTIs compared to other hospitalized patients 2

Preventing Urinary Tract Infections

Preventing UTIs is crucial to reducing the risk of complications in stroke patients. Some strategies that can be used include:

• Identifying and addressing risk factors for UTIs, such as biological sex, age, menopause status, and diabetes mellitus 6
• Using prophylactic antibiotics or other prophylactic strategies, such as estrogen hormone therapy or dietary supplements, to prevent recurrent UTIs 6
• Implementing effective UTI diagnostic platforms to quickly and accurately diagnose UTIs 6
• Reducing the use of Foley catheters, as they are associated with an increased risk of UTIs 4

Reducing the Risk of Post-Stroke Bronchial Aspiration

While the provided studies do not directly address the risk of post-stroke bronchial aspiration, reducing the risk of complications such as UTIs can also help reduce the risk of other complications, including post-stroke bronchial aspiration. Additionally, strategies such as reducing the use of indwelling urinary catheters and implementing quality improvement interventions can help reduce the risk of other healthcare-associated infections, including those that can lead to post-stroke bronchial aspiration.