The prevalence of infections and patient risk factors in home health care: A systematic review

Abstract

Background Home health care (HHC) has been the fastest growing health care sector for the past 3 decades. The uncontrolled home environment, increased use of indwelling devices, and the complexity of illnesses among HHC patients lead to increased risk for infections. Methods A systematic review of studies evaluating infection prevalence and risk factors among adult patients who received HHC services was conducted and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Literature was searched using Medline, PubMed, and the Cumulative Index to Nursing and Allied Health as well as hand searching. Two reviewers independently assessed study quality using validated quality assessment checklists. Results Twenty-five studies met the inclusion criteria and were reviewed. The infection rates and identified risk factors for infections varied dramatically between studies. In general, patients receiving home parental nutrition treatments had higher infection rates than patients receiving home infusion therapy. The identified risk factors were limited by small sample sizes and other methodologic flaws. Conclusions Establishing a surveillance system for HHC infections, identifying patients at high risk for infections, tailoring HHC and patient education based on patient living conditions, and facilitating communication between different health care facilities will enhance infection control in HHC settings. Future studies should use a nationally representative sample and multivariate analysis for the identification of risk factors for infections.

Theoretical-practical acquisition of topics relevant to patient safety: dilemmas in the training of nurses

“…15 The traditional "invisibility" given to community-acquired infection results from difficulties in conceptualizing the term, listing risk factors and prevention and control measures, as shown in studies conducted in Brazil 15,16 and abroad. 17 Strategies for prevention and control of infections must be expanded to all healthcare areas, and this primarily occurs through the training of professionals. 10,16 One of the major difficulties in the prevention of healthcare-associated infections refers to the education and training of human resources sensitive to the problem, aware of and responsible for the maintenance of a biologically safe environment, which is crucial to providing safe care.…”

Representações sociais da infecção comunitária por profissionais da atenção primária

“…(11,13) The implementation of infection prevention and control strategies, including education and training of staff, with an emphasis on correct hand hygiene, maintenance of aseptic techniques, and the following of standard precautions and effective methods for dealing with environmental factors, have proven to be effective. (5,14) Once familiar with these measures, the health team is able to empower the local population through health education strategies and placing greater importance on health promotion, which make preventive measures and the fight against disease more effective. (15)(16)(17) Concerns and care in the community are important, and health professionals should properly assess the environment where care is provided.…”

“…(8,9) A study conducted in the United States noted a significant increase in the incidence of communi-ty-acquired infections, particularly those caused by multidrug-resistant microorganisms. (5) The fact that a community is a closed environment can facilitate the spread of infection. In addition, there are increasing numbers of older people with chronic diseases, who are more vulnerable and also prone to have indwelling devices.…”

“…(10,11) Among the risk factors, the primary ones were those involving the domestic environment, such as lack of basic sanitation, patients with acute illnesses and complex medical conditions, difficulties in performing self-care, increased use of medical devices in the home, and patients' social and/or economic factors. (11) In Brazil, the Hospital Infection Control Program was implemented in 1998, (10) which defined the conceptual bases of hospital-acquired and community-acquired infection, in addition to regulating the implementation of Hospital Infection Control Committees throughout Brazil. However, this ordinance does not include prevention of community-acquired infections, since it does not specify the need for creating a management body in the community.…”

“…Furthermore, Brazil does not have a surveillance system for community-acquired infection, which makes it difficult to ascertain the real status of the problem at a national level. (5) Primary care plays an important role in the prevention and control of infections in the community. This care model is composed of a university-or high school-educated multidisciplinary team, which is essential for creating and strengthening infection prevention and control practices.…”