Infection Risks in Home Health Care
Each year, an estimated 12 million Americans receive care from more than 33,000 home health providers in the U.S., where the annual tab for home health services exceeds $72 billion. Patients depend on home health care services to recover from surgeries and hospital stays, as well as to manage daily life with chronic conditions. All too often, however, proven practices for preventing infections aren’t followed when care is provided at home. This lapse leaves patients vulnerable to serious and potentially fatal complications, according to a study done by researchers at Columbia University School of Nursing and published in May 2014 in the American Journal of Infection Control. The team found that unsterile living conditions and untrained caregivers contribute to infections in home health settings, with patients at greater risk when they have tubes to provide nutrition or help with urination.
A release from the university quotes lead study author Jingjing Shang PhD as saying, “Patients shouldn’t have to choose between safety and receiving care in the comfort of their own homes. The stakes are already high, and they’re getting higher all the time, as our population keeps aging and more and more patients receive care outside of an institutional setting.”
The research team conducted a systematic review of studies evaluating infection prevalence and risk factors among adult patients who received home health care. Infection rates found in the analysis varied widely, ranging from about five percent to more than 80 percent.
The highest infection rates were among patients who received nutrients through an intravenous catheter, a process known as total parenteral nutrition, the review found. Patients may lose the ability to swallow or eat on their own due to a stroke, dementia, or advanced illness. Some patients may receive nutrition through a catheter inserted into a central vein if it isn’t possible to insert a feeding tube into the nose or mouth or directly into the small intestine. These central venous catheters often stay in place for long periods of time, and infections can easily develop when caregivers and family members who assist with care don’t keep the catheter or injection site clean.
Catheter-associated urinary tract infections (CAUTIs) are also a recurring problem for many home health patients. These infections can develop when urinary catheters are left in for long periods of time, and repeated use of antibiotics to treat these infections can leave patients susceptible to antibiotic-resistant strains of bacteria. Caregivers in the home can help prevent CAUTI by washing hands with soap and water or using an alcohol-based sanitizer before touching the catheter or emptying the urine bag. Infections can also be averted by keeping the catheter secure, keeping the urine bag lower than the bladder, emptying the urine bag into a clean container, and keeping the tube unobstructed.
In addition, catheter-related blood stream infections (CLABSI) are common in home health. Catheters deliver life-saving medicines and nutrients to some of the most vulnerable patients receiving home health care. But without proper insertion, utilization, and maintenance, catheters can also transmit deadly infections to the bloodstream.
“The infection risk for patients receiving care at home is high because they often aren’t being looked after by individuals with the same infection control experience that would occur in a hospital setting,” says Shang. “Nurses who care for patients in their homes need to teach patients and their families how to prevent infections, and nurses need to make sure that they tailor this education to a level that’s easy for people without formal medical training to understand.”