Home Care Infections
Home Care Infections
Experts Encourage Surveillance Programs
As the number of patients receiving home care flourishes, so do the number of germs being spread among them.
However, few systems currently are in place to track the incidence of home care infections. Disease control experts urge home care providers to take a closer look at their surveillance programs, in the hopes of reducing the risk of infections in this setting.
The home care population reached 8.2 million in 1996, the last year for which data is available.1 Many of these patients, faced with early hospital discharge, now require the use of invasive devices and fairly sophisticated procedures, therapies and treatments at home.
“The distinction between what’s done in the hospital and in other venues is blurred,” says Michele Pearson, MD, medical epidemiologist in the Hospital Infections Program at the Centers for Disease Control and Prevention in Atlanta. The movement has “preceded our ability to have mechanisms in place to monitor it, so we’re sort of playing catch up in that way.”
The CDC addresses this shift of health care delivery in its report Addressing Emerging Infectious Diseases: A Strategy for the 21st Century. “Part of the plan for monitoring infectious diseases, whether they be ones we know about or emerging infections, involves focusing on alternate care settings such as the home,” Dr. Pearson explains.
A SURVEILLANCE MODEL
As a first step, the CDC is collaborating with the Missouri Alliance for Home Care, a Jefferson City-based umbrella organization for 86 home care agencies in several states. The CDC conducted surveys to see how prevalent infections were among home care patients and assessed infection control resources and infrastructure within the member agencies.
One of the alliance’s current projects is to collect data quarterly on bladder catheter and central venous catheter-related infections, according to Carolyn Crumley, RN, MSN, CS, CWOCN, a volunteer member of the committee for infection surveillance and control. The agencies receive a table with confidential rates broken down into hospital-based vs. freestanding facilities, size (in number of visits per year), and urban or rural location.
“You have something to benchmark against and have an idea of where your agency stands,” says Crumley, although the committee stresses that this is just a starting point. “Looking at the data has made people more aware that this is something that needs to be done.”
STANDARDS AND DEFINITIONS
One of the obstacles to setting up a surveillance program is the lack of guidelines for the professionals providing home care. “There is not a lot of information out there as far as guidelines or practices as to how care should be provided, especially as far as respiratory care,” laments Mary M. Friedman, MS, RN, CRNI, principal and home care consultant at Home Health Systems, Marietta, Ga.
To correct this problem, the Association for Professionals in Infection Control (APIC) created standardized definitions for surveillance of home care infections, with input from the CDC and Missouri Alliance. And the CDC is revising its guideline for prevention of what was formerly titled nosocomial pneumonia. The document is being expanded to address health care-associated pneumonia, addressing any setting where health care is delivered, including the home, Dr. Pearson explains.
An additional source that professionals can consult is the APIC-endorsed publication Infection Control in Home Care, a book that Friedman co-authored in 1999. The organization hopes the book will pave the way for additional research and data collection, especially for home care surveillance activities.
While surveillance statistics can present the “big picture” of an infection control problem, home care providers still must focus on educating individual patients, Crumley reminds.
Respiratory therapists should stress and model the basic principles of using proper hand washing technique, personal protective equipment, disinfectants and single dose vials. “There may be a tendency to be slightly more lax in a home care setting because you’re not surrounded by the same level of acuity that you would be in an acute care setting,” Dr. Pearson explains.
Friedman gives the example of hospital health care workers who use a new catheter each time they suction a patient. Whereas in a home care setting, the catheter could potentially be reused for a very limited time; the caregiver may boil it or soak it in hydrogen peroxide. Reusing a suction catheter is only appropriate for a patient who is not an infant, immunocompromised or otherwise at risk.
Another area patients need to be educated about is environmental exposure. For instance, patients with an indwelling central venous catheter may be swimming or showering, which they would not be allowed to do in the hospital, Dr. Pearson said. The line would be more susceptible to contamination with waterborne bacteria.
Repetition helps patients with compliance, especially if they hear it from several health care professionals. Written materials reinforce what patients learn because sometimes they’re distracted during the visit, adds Crumley, a clinical nurse specialist at John Knox Village in Lee’s Summit, Mo.
In addition, her facility administers influenza vaccines through home health, which Crumley says reduces respiratory infection rates. She also encourages her patients to keep themselves healthy with good nutrition and hydration.
Armed with surveillance mechanisms, guidelines and good teaching techniques, respiratory therapists will help to prevent infections in the ever-growing population of home care patients.
1. Centers for Disease Control and Prevention. National Center for Health Statistics. Abstract and Results from the 1996 National Home and Hospice Care Survey. Accessed via the Web at www.cdc.gov/nchs/about/major/nhhcsd/nhhcdh.htm.
Jennifer Gillespie is assistant editor of ADVANCE.