Healthcare-associated infections in home healthcare: an extensive assessment, 2019

Abstract

Introduction The number of patients and clinical conditions treated in home healthcare (HHC) is increasing. Care in home settings presents many challenges, including healthcare-associated infections (HAI). Currently, in Belgium, data and guidelines on the topic are lacking. Aim To develop a definition of HAI in HHC and investigate associated risk factors and recommendations for infection prevention and control (IPC). Methods The study included three components: a scoping literature review, in-depth interviews with individuals involved in HHC and a two-round Delphi survey to reach consensus among key informants on the previous steps’ results. Results The literature review included 47 publications. We conducted 21 in-depth interviews. The Delphi survey’s two rounds had 21 and 23 participants, respectively. No standard definition was broadly accepted or known. Evidence on associated risk factors was impacted by methodological limitations and recommendations were inconsistent. Agreement was reached on defining HAI in HHC as any infection specifically linked with providing care that develops in a patient receiving HHC from a professional healthcare worker and occurs ≥ 48 hours after starting HHC. Risk factors were hand hygiene, untrained patients and caregivers, patients’ hygiene and presence and management of invasive devices. Agreed recommendations were to adapt and standardise existing IPC guidelines to HHC and to perform a national point prevalence study to measure the burden of HAI in HHC. Conclusions This study offers an overview of available evidence and field knowledge of HAI in HHC. It provides a framework for a prevalence study, future monitoring policies and guidelines on IPC in Belgium.

Barriers and facilitators to infection prevention practices in home healthcare: a scoping review and proposed implementation framework

“…Infection prevention and control (IPC) research and quality improvement initiatives have focused on the more structured hospital setting, and neglected the heterogeneous HHC sector [ 8 , 9 ]. The Covid-19 pandemic, however, has raised the awareness that hospital IPC recommendations cannot be easily transferred to care which is delivered in the less controlled environment of the patient's own home.…”

Global prevalence of nosocomial infection: A systematic review and meta-analysis

“…HAIs refer to a group of infections a patient does not have before admission to the hospital. HAIs do not even exist in the latency period; they occur upon arrival at the hospital or within 48-72 hours after admission to the hospital [1][2][3][4]. Nowadays, such infections are significant problems for societies and healthcare organizations.…”

Invasive Group A Streptococcus Outbreaks Associated with Home Healthcare, England, 2018–2019

“…In addition, family members who sometimes help nursing staff do not have adequate training in infection control. A recent study from Belgium highlighted the need for better data on HHC-associated infections and for developing infection control guidelines specific to this setting (19).…”