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Datta R, Kiwak E, Fried TR, Benjamin A, Iannone L, Krein SL, Carter W, Cohen AB. Diagnostic uncertainty and decision-making in home-based primary care: A qualitative study of antibiotic prescribing. J Am Geriatr Soc 2024; 72:1468-1475. [PMID: 38241465 PMCID: PMC11090732 DOI: 10.1111/jgs.18778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/19/2023] [Accepted: 12/23/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Evaluating infection in home-based primary care is challenging, and these challenges may impact antibiotic prescribing. A refined understanding of antibiotic decision-making in this setting can inform strategies to promote antibiotic stewardship. This study investigated antibiotic decision-making by exploring the perspectives of clinicians in home-based primary care. METHODS Clinicians from the Department of Veterans Affairs Home-Based Primary Care Program were recruited. Semi-structured interviews were conducted from June 2022 through September 2022 using a discussion guide. Transcripts were analyzed using grounded theory. The constant comparative method was used to develop a coding structure and to identify themes. RESULTS Theoretical saturation was reached after 22 clinicians (physicians, n = 7; physician assistants, n = 2, advanced practice registered nurses, n = 13) from 19 programs were interviewed. Mean age was 48.5 ± 9.3 years, 91% were female, and 59% had ≥6 years of experience in home-based primary care. Participants reported uncertainty about the diagnosis of infection due to the characteristics of homebound patients (atypical presentations of disease, presence of multiple chronic conditions, presence of cognitive impairment) and the challenges of delivering medical care in the home (limited access to diagnostic testing, suboptimal quality of microbiological specimens, barriers to establishing remote access to the electronic health record). When faced with diagnostic uncertainty about infection, participants described many factors that influenced the decision to prescribe antibiotics, including those that promoted prescribing (desire to avoid hospitalization, pressure from caregivers, unreliable plans for follow-up) and those that inhibited prescribing (perceptions of antibiotic-associated harms, willingness to trial non-pharmacological interventions first, presence of caregivers who were trusted by clinicians to monitor symptoms). CONCLUSIONS Clinicians face the difficult task of balancing diagnostic uncertainty with many competing considerations during the treatment of infection in home-based primary care. Recognizing these issues provides insight into strategies to promote antibiotic stewardship in home care settings.
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Affiliation(s)
- Rupak Datta
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Eliza Kiwak
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Terri R. Fried
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Andrea Benjamin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Lynne Iannone
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sarah L. Krein
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Warren Carter
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Andrew B. Cohen
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Smith M, Crnich C, Donskey C, Evans CT, Evans M, Goto M, Guerrero B, Gupta K, Harris A, Hicks N, Khader K, Kralovic S, McKinley L, Rubin M, Safdar N, Schweizer ML, Tovar S, Wilson G, Zabarsky T, Perencevich EN. Research agenda for transmission prevention within the Veterans Health Administration, 2024-2028. Infect Control Hosp Epidemiol 2024:1-10. [PMID: 38600795 DOI: 10.1017/ice.2024.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Matthew Smith
- Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Chris Crnich
- William. S. Middleton Memorial VA Hospital, Madison, WI, USA
| | - Curtis Donskey
- Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Charlesnika T Evans
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA
- Department of Preventive Medicine and Center for Health Services and Outcomes Research, Northwestern University of Feinberg School of Medicine, Chicago, IL, USA
| | - Martin Evans
- MRSA/MDRO Division, VHA National Infectious Diseases Service, Patient Care Services, VA Central Office and the Lexington VA Health Care System, Lexington, KY, USA
| | - Michihiko Goto
- Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Bernardino Guerrero
- Environmental Programs Service (EPS), Veterans Affairs Central Office, Washington, DC, USA
| | - Kalpana Gupta
- VA Boston Healthcare System and Boston University School of Medicine, Boston, MA, USA
| | - Anthony Harris
- Department of Epidemiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Natalie Hicks
- National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Karim Khader
- DEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Stephen Kralovic
- Veterans Health Administration National Infectious Diseases Service, Washington, DC, USA
- Cincinnati VA Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Linda McKinley
- William. S. Middleton Memorial VA Hospital, Madison, WI, USA
| | - Michael Rubin
- DEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Nasia Safdar
- William. S. Middleton Memorial VA Hospital, Madison, WI, USA
| | - Marin L Schweizer
- William. S. Middleton Memorial VA Hospital, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, and William S. Middleton Hospital, Madison, WI, USA
| | - Suzanne Tovar
- National Infectious Diseases Service (NIDS), Veterans Affairs Central Office, Washington, DC, USA
| | - Geneva Wilson
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines Jr. Veterans Affairs Hospital, Hines, IL, USA
- Department of Preventive Medicine, Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Trina Zabarsky
- Environmental Programs Service (EPS), Veterans Affairs Central Office, Washington, DC, USA
| | - Eli N Perencevich
- Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Song J, Min SH, Chae S, Bowles KH, McDonald MV, Hobensack M, Barrón Y, Sridharan S, Davoudi A, Oh S, Evans L, Topaz M. Uncovering hidden trends: identifying time trajectories in risk factors documented in clinical notes and predicting hospitalizations and emergency department visits during home health care. J Am Med Inform Assoc 2023; 30:1801-1810. [PMID: 37339524 PMCID: PMC10586044 DOI: 10.1093/jamia/ocad101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/04/2023] [Accepted: 06/02/2023] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVE This study aimed to identify temporal risk factor patterns documented in home health care (HHC) clinical notes and examine their association with hospitalizations or emergency department (ED) visits. MATERIALS AND METHODS Data for 73 350 episodes of care from one large HHC organization were analyzed using dynamic time warping and hierarchical clustering analysis to identify the temporal patterns of risk factors documented in clinical notes. The Omaha System nursing terminology represented risk factors. First, clinical characteristics were compared between clusters. Next, multivariate logistic regression was used to examine the association between clusters and risk for hospitalizations or ED visits. Omaha System domains corresponding to risk factors were analyzed and described in each cluster. RESULTS Six temporal clusters emerged, showing different patterns in how risk factors were documented over time. Patients with a steep increase in documented risk factors over time had a 3 times higher likelihood of hospitalization or ED visit than patients with no documented risk factors. Most risk factors belonged to the physiological domain, and only a few were in the environmental domain. DISCUSSION An analysis of risk factor trajectories reflects a patient's evolving health status during a HHC episode. Using standardized nursing terminology, this study provided new insights into the complex temporal dynamics of HHC, which may lead to improved patient outcomes through better treatment and management plans. CONCLUSION Incorporating temporal patterns in documented risk factors and their clusters into early warning systems may activate interventions to prevent hospitalizations or ED visits in HHC.
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Affiliation(s)
- Jiyoun Song
- Columbia University School of Nursing, New York City, New York, USA
| | - Se Hee Min
- Columbia University School of Nursing, New York City, New York, USA
| | - Sena Chae
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Kathryn H Bowles
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | | | - Mollie Hobensack
- Columbia University School of Nursing, New York City, New York, USA
| | - Yolanda Barrón
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Sridevi Sridharan
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Anahita Davoudi
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Sungho Oh
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Lauren Evans
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
| | - Maxim Topaz
- Columbia University School of Nursing, New York City, New York, USA
- Center for Home Care Policy & Research, VNS Health, New York, New York, USA
- Data Science Institute, Columbia University, New York City, New York, USA
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Liljas AE, Agerholm J, Schön P, Burström B. Risk factors for infection in older adults who receive home healthcare and/or home help: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31772. [PMID: 36397381 PMCID: PMC9666220 DOI: 10.1097/md.0000000000031772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The shift towards home-based care has resulted in increased provision of home healthcare and home help to older adults. Infections acquired in older adults while receiving home care have increased too, resulting in unplanned yet avoidable hospitalizations. In recent years, several studies have reported an array of factors associated with risk of infection; however, no previous systematic review has compiled such evidence, which is important to better protect older adults. Therefore, we have outlined the work of a systematic review that aims to identify risk factors for infection in older adults receiving home healthcare and/or home help. METHODS Searches for relevant studies will be conducted in five databases [MEDLINE, EMBASE (Excerpta Medica Database), Web of Science Core Collection, Cinahl (Cumulative Index to Nursing & Allied Health Literature) and Sociological Abstracts]. All types of studies will be included. Exposures considered refer to medical, individual, social/behavioral and environmental risk factors for infection (outcome). Two researchers will independently go through the records generated. Eligible studies will be assessed for risk of biases using the Cochrane risk of bias assessment tool and an overall interpretation of the biases will be provided. If the data allow, a meta-analysis will be conducted. It is possible that both quantitative and qualitative studies will be identified and eligible. Therefore, for the analysis, the Joanna Briggs Institute Reviewers' Manual for mixed methods systematic reviews will be used as it allows for two or more single method reviews (e.g., one quantitative and one qualitative) to be conducted separately and then combined in a joint overarching synthesis. RESULTS The findings of the planned systematic review are of interest to healthcare professionals, caregivers, older adults and their families, and policy- and decisions makers in the health and social care sectors as the review will provide evidence-based data on multiple factors that influence the risk of infection among older adults receiving care in their homes. CONCLUSION The results could guide future policy on effective infection control in the home care sector.
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Affiliation(s)
- Ann E.M. Liljas
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- * Correspondence: Ann E.M. Liljas, Department of Global Public Health, Karolinska Institutet, 171 77 Stockholm, Sweden (e-mail: )
| | - Janne Agerholm
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Pär Schön
- Institution for Social Work, Stockholm University, Stockholm, Sweden
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Datta R, Fried T, O’Leary JR, Zullo AR, Allore H, Han L, Juthani-Mehta M, Cohen A. National Cohort Study of Homebound Persons Living With Dementia: Antibiotic Prescribing Trends and Opportunities for Antibiotic Stewardship. Open Forum Infect Dis 2022; 9:ofac453. [PMID: 36147594 PMCID: PMC9487603 DOI: 10.1093/ofid/ofac453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/01/2022] [Indexed: 11/14/2022] Open
Abstract
Background Over 7 million older Americans are homebound. Managing infections in homebound persons presents unique challenges that are magnified among persons living with dementia (PLWD). This work sought to characterize antibiotic use in a national cohort of PLWD who received home-based primary care (HBPC) through the Veterans Health Administration. Methods Administrative data identified veterans aged ≥65 years with ≥2 physician home visits in a year between 2014 and 2018 and a dementia diagnosis 3 years before through 1 year after their initial HBPC visit. Antibiotics prescribed orally, intravenously, intramuscularly, or by enema within 3 days of an HBPC visit were assessed from the initial HBPC visit to death or December 31, 2018. Prescription fills and days of therapy (DOT) per 1000 days of home care (DOHC) were calculated. Results Among 39 861 PLWD, the median age (interquartile range [IQR]) was 85 (78-90) years, and 15.0% were Black. Overall, 16 956 (42.5%) PLWD received 45 122 prescription fills. The antibiotic use rate was 20.7 DOT per 1000 DOHC. Telephone visits and advanced practice provider visits were associated with 30.9% and 42.0% of fills, respectively. Sixty-seven percent of fills were associated with diagnoses for conditions where antibiotics are not indicated. Quinolones were the most prescribed class (24.3% of fills). The overall median length of therapy (IQR) was 7 (7-10) days. Antibiotic use rates varied across regions. Within regions, the median annual antibiotic use rate decreased from 2014 to 2018. Conclusions Antibiotic prescriptions were prevalent in HBPC. The scope, appropriateness, and harms of antibiotic use in homebound PLWD need further investigation.
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Affiliation(s)
- Rupak Datta
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Terri Fried
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - John R O’Leary
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
| | - Heather Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ling Han
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Manisha Juthani-Mehta
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Andrew Cohen
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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6
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Harrison JM, Dick AW, Madigan EA, Furuya EY, Chastain AM, Shang J. Urinary catheter policies in home healthcare agencies and hospital transfers due to urinary tract infection. Am J Infect Control 2022; 50:743-748. [PMID: 34890702 DOI: 10.1016/j.ajic.2021.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Urinary tract infections (UTIs) are a frequent cause of hospital transfer for home healthcare (HHC) patients, particularly among patients with urinary catheters. METHODS We conducted a cross-sectional, nationally representative HHC agency-level survey (2018-2019) and combined it with patient-level data from the Outcome and Assessment Information Set (OASIS) and Medicare inpatient data (2016-2018) to evaluate the association between HHC agencies' urinary catheter policies and hospital transfers due to UTI. Our sample included 28,205 patients with urinary catheters who received HHC from 473 Medicare-certified agencies between 2016-2018. Our survey assessed whether agencies had written policies in place for (1) replacement of indwelling catheters at fixed intervals, and (2) emptying the drainage bag. We used adjusted logistic regression to estimate the association of these policies with probability of hospital transfer due to UTI during a 60-day HHC episode. RESULTS Probability of hospital transfer due to UTI during a HHC episode ranged from 5.62% among agencies with neither urinary catheter policy to 4.43% among agencies with both policies. Relative to agencies with neither policy, having both policies was associated with 21% lower probability of hospital transfer due to UTI (P < .05). CONCLUSION Our findings suggest implementation of policies in HHC to promote best practices for care of patients with urinary catheters may be an effective strategy to prevent hospital transfers due to UTI.
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Song J, Zolnoori M, Scharp D, Vergez S, McDonald MV, Sridharan S, Kostic Z, Topaz M. Do nurses document all discussions of patient problems and nursing interventions in the electronic health record? A pilot study in home healthcare. JAMIA Open 2022; 5:ooac034. [PMID: 35663115 PMCID: PMC9154272 DOI: 10.1093/jamiaopen/ooac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/23/2022] [Accepted: 05/04/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the overlap of information between electronic health record (EHR) and patient–nurse verbal communication in home healthcare (HHC). Methods Patient–nurse verbal communications during home visits were recorded between February 16, 2021 and September 2, 2021 with patients being served in an organization located in the Northeast United States. Twenty-two audio recordings for 15 patients were transcribed. To compare overlap of information, manual annotations of problems and interventions were made on transcriptions as well as information from EHR including structured data and clinical notes corresponding to HHC visits. Results About 30% (1534/5118) of utterances (ie, spoken language preceding/following silence or a change of speaker) were identified as including problems or interventions. A total of 216 problems and 492 interventions were identified through verbal communication among all the patients in the study. Approximately 50.5% of the problems and 20.8% of the interventions discussed during the verbal communication were not documented in the EHR. Preliminary results showed that statistical differences between racial groups were observed in a comparison of problems and interventions. Discussion This study was the first to investigate the extent that problems and interventions were mentioned in patient–nurse verbal communication during HHC visits and whether this information was documented in EHR. Our analysis identified gaps in information overlap and possible racial disparities. Conclusion Our results highlight the value of analyzing communications between HHC patients and nurses. Future studies should explore ways to capture information in verbal communication using automated speech recognition.
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Affiliation(s)
- Jiyoun Song
- Columbia University School of Nursing, New York, New York, USA
| | - Maryam Zolnoori
- Columbia University School of Nursing, New York, New York, USA
| | - Danielle Scharp
- Columbia University School of Nursing, New York, New York, USA
| | - Sasha Vergez
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, New York, USA
| | - Margaret V McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, New York, USA
| | - Sridevi Sridharan
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, New York, USA
| | - Zoran Kostic
- Fu Foundation School of Engineering and Applied Science, Department of Electrical Engineering, Columbia University, New York, New York, USA
| | - Maxim Topaz
- Columbia University School of Nursing, New York, New York, USA.,Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, New York, USA.,Data Science Institute, Columbia University, New York, New York, USA
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Song J, Hobensack M, Bowles KH, McDonald MV, Cato K, Rossetti SC, Chae S, Kennedy E, Barrón Y, Sridharan S, Topaz M. Clinical notes: An untapped opportunity for improving risk prediction for hospitalization and emergency department visit during home health care. J Biomed Inform 2022; 128:104039. [PMID: 35231649 PMCID: PMC9825202 DOI: 10.1016/j.jbi.2022.104039] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND/OBJECTIVE Between 10 and 25% patients are hospitalized or visit emergency department (ED) during home healthcare (HHC). Given that up to 40% of these negative clinical outcomes are preventable, early and accurate prediction of hospitalization risk can be one strategy to prevent them. In recent years, machine learning-based predictive modeling has become widely used for building risk models. This study aimed to compare the predictive performance of four risk models built with various data sources for hospitalization and ED visits in HHC. METHODS Four risk models were built using different variables from two data sources: structured data (i.e., Outcome and Assessment Information Set (OASIS) and other assessment items from the electronic health record (EHR)) and unstructured narrative-free text clinical notes for patients who received HHC services from the largest non-profit HHC organization in New York between 2015 and 2017. Then, five machine learning algorithms (logistic regression, Random Forest, Bayesian network, support vector machine (SVM), and Naïve Bayes) were used on each risk model. Risk model performance was evaluated using the F-score and Precision-Recall Curve (PRC) area metrics. RESULTS During the study period, 8373/86,823 (9.6%) HHC episodes resulted in hospitalization or ED visits. Among five machine learning algorithms on each model, the SVM showed the highest F-score (0.82), while the Random Forest showed the highest PRC area (0.864). Adding information extracted from clinical notes significantly improved the risk prediction ability by up to 16.6% in F-score and 17.8% in PRC. CONCLUSION All models showed relatively good hospitalization or ED visit risk predictive performance in HHC. Information from clinical notes integrated with the structured data improved the ability to identify patients at risk for these emergent care events.
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Affiliation(s)
- Jiyoun Song
- Columbia University School of Nursing, New York City, NY, USA,Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York City, NY, USA,Corresponding author at: Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, USA. (J. Song)
| | | | - Kathryn H. Bowles
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York City, NY, USA,University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, PA, USA
| | - Margaret V. McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York City, NY, USA
| | - Kenrick Cato
- Columbia University School of Nursing, New York City, NY, USA,Emergency Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Sarah Collins Rossetti
- Columbia University School of Nursing, New York City, NY, USA,Columbia University, Department of Biomedical Informatics, New York City, NY, USA
| | - Sena Chae
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Erin Kennedy
- University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, PA, USA
| | - Yolanda Barrón
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York City, NY, USA
| | - Sridevi Sridharan
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York City, NY, USA
| | - Maxim Topaz
- Columbia University School of Nursing, New York City, NY, USA,Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York City, NY, USA,Data Science Institute, Columbia University, New York City, NY, USA
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Shang J, Harrison JM, Chastain AM, Stone PW, Perera UGE, Madigan EA, Pogorzelska-Maziarz M, Dick AW. Influenza vaccination of home health care staff and the impact on patient hospitalizations. Am J Infect Control 2022; 50:369-374. [PMID: 35369936 PMCID: PMC9052587 DOI: 10.1016/j.ajic.2021.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Influenza is associated with significant morbidity and mortality for adults aged 65 years and older. Influenza vaccination of health care workers is recommended. There is limited evidence regarding influenza vaccinations among health care workers in the home health care (HHC) setting and their impact on HHC patient outcomes. METHODS A national survey of HHC agencies was conducted in 2018-2019 and linked with patient data from the Centers for Medicare and Medicaid Services. Adjusted logistic regression models were used to estimate the association between hospital transfers due to respiratory infection during a 60 day HHC episode and staff vaccination policies. RESULTS Only 26.2% of HHC agencies had staff vaccination requirements and 71.2% agencies had staff vaccination rates higher than 75%. Agency policies for staff influenza vaccination were associated with reduced hospital transfers due to respiratory infection among HHC patients. DISCUSSION Influenza vaccination rates among HHC staff were low during the 2017-2018 influenza season. Policymakers may consider vaccination mandates to improve health care worker vaccination rates and protect patient safety. CONCLUSIONS This study sheds light on the potential impact of COVID-19 vaccination among HHC workers on patient outcomes. COVID-19 vaccination mandates could prove to be a vital tool in the fight against COVID-19 variants and infection outbreaks.
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Abstract
At the heart of infection prevention in the home care setting is aseptic technique, a generic term for the clinical competency of ensuring asepsis during invasive clinical procedures and the maintenance of invasive medical devices. Variable terminology has resulted in confused education and clinical practice. Ambiguity has played out in all care environments, but especially in the home, where the challenge of providing effective aseptic technique is complicated by unique environmental and logistical factors. This has led some to conclude that aseptic technique is not possible in the home, or that it is not required at all in certain situations. This article challenges these assumptions and outlines the Aseptic Non Touch Technique (ANTT®) Clinical Practice Framework, that is used widely internationally. Through a thematic analysis of focus group discussions with home care nurses (n = 107) in the United Kingdom and the United States, opinions about aseptic practice in the home care setting were examined. Three main polarizing themes were identified and used to discuss theory and practice applications of aseptic technique for home healthcare nurses. Specific challenges in performing aseptic technique in home-based settings are exacerbated by ambiguity between what constitutes "clean," "aseptic," or so-called "sterile" technique, and are perpetuated by a lack of competency-based training that doesn't reflect the critical importance of aseptic technique to patient safety. Rather than continuing an endless debate about the definition of aseptic technique, ANTT has redefined aseptic technique education and clinical practice, with a comprehensive clinical practice framework and associated clinical governance better supporting patient safety.
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11
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Hoeppchen I, Walter C, Berger S, Brandauer A, Freywald N, Kutschar P, Lex KM, Strobl A, Gnass I. Hygiene management for long-term ventilated persons in the home health care setting: a scoping review. BMC Health Serv Res 2022; 22:244. [PMID: 35197063 PMCID: PMC8864850 DOI: 10.1186/s12913-022-07643-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 02/11/2022] [Indexed: 12/15/2022] Open
Abstract
Background Evidence and recommendations for hygiene management in home mechanical ventilation (HMV) are rare. In Germany, few regionally limited studies show poor hygiene management or a lack of its implementation. This scoping review of international literature identified the evidence in hygiene management for ventilated patients in the home care setting which has to be implemented for infection prevention and control. Methods A review of international literature was conducted in CINAHL, PubMed and Web of Science. The search focused on four key domains: HMV, hygiene management, home care setting, and methicillin-resistant Staphylococcus aureus (MRSA). Data of included studies were extracted using a data charting sheet. Extracted data were assigned to the categories (1) study description, (2) setting and participants, and (3) hygiene management. Results From 1,718 reviewed articles, n = 8 studies met inclusion criteria. All included studies had a quantitative study design. The approaches were heterogeneous due to different settings, study populations and types of ventilation performed. Regarding aspects of hygiene management, most evidence was found for infectious critical activities (n = 5), quality management for hygiene (n = 4), and training and education (n = 4). This review identified research gaps concerning kitchen hygiene, relatives and visitors of HMV patients, and waste management (n = 0). Discussion Overall evidence was rather scarce. Consequently, this review could not answer all underlying research questions. No evidence was found for measures in hygiene management relating to ventilated patients’ relatives. Evidence for kitchen hygiene, waste management and interaction with relatives is available for inpatient care settings. However, this may not be transferable to outpatient care. Binding legal requirements and audits may help regulate the implementation of HMV hygiene measures. Conclusion Infection control programmes included qualified personnel, hygiene plans, and standards for MRSA and multidrug-resistant organisms (MDRO). The appropriateness of hygiene management measures for outpatient care is the basis for their application in practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07643-w.
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Affiliation(s)
- Isabel Hoeppchen
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| | - Carola Walter
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria.
| | - Stefanie Berger
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| | - Anna Brandauer
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| | - Nicole Freywald
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| | - Patrick Kutschar
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| | - Katharina Maria Lex
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| | - Annemarie Strobl
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
| | - Irmela Gnass
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria
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Inoue Y, Nishi K, Mayumi T, Sasaki J. Factors in Avoidable Emergency Visits for Ambulatory Care-sensitive Conditions among Older Patients Receiving Home Care in Japan: A Retrospective Study. Intern Med 2022; 61:177-183. [PMID: 35034933 PMCID: PMC8851167 DOI: 10.2169/internalmedicine.7136-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Older adults have many health conditions that do not require hospitalization, such as cognitive decline and progression of frailty, so it is necessary to prevent avoidable emergency visits for ambulatory care-sensitive conditions (ACSCs) in this population. We therefore examine Freund's classification of reasons for hospitalization owing to ACSCs to identify factors involved in elderly patients visiting emergency departments in Japan. Methods This retrospective case-control study included patients who received emergency transport for medical treatment at Yushoukai Home Care Clinic Shinagawa in Japan between January 1, 2016, and April 30, 2019. We examined patients' medical records and categorized the reasons for emergency visit by ambulance in accordance with Freund's categories (physician related level, medical causes, patient level, and social level). In addition, we classified and compared patients who lived at home (Group A) with those living in a care facility for older adults (Group B). Results A total of 365 patients visited the emergency department (298 in Group A and 67 in Group B). Among these, we determined that emergency visits were potentially avoidable in 135 patients from Group A and 28 from Group B. The patient and social level categories accounted for 81% of potentially avoidable emergency visits. Confirmed advanced care planning (ACP) was significantly associated with avoidable emergency visit by ambulance in multivariate analyses. Conclusion To prevent emergency visits for ACSCs among older people, ACP should be encouraged.
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Affiliation(s)
- Yoshie Inoue
- Yushoukai Medical Corporation Association, Yushoukai Home Care Clinic Shinagawa, Japan
| | - Kazuo Nishi
- Yushoukai Medical Corporation Association, Yushoukai Home Care Clinic Shinagawa, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Jun Sasaki
- Yushoukai Medical Corporation Association, Japan
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Wendt B, Huisman-de Waal G, Bakker-Jacobs A, Hautvast JLA, Huis A. Exploring infection prevention practices in home-based nursing care: A qualitative observational study. Int J Nurs Stud 2021; 125:104130. [PMID: 34839222 DOI: 10.1016/j.ijnurstu.2021.104130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Home-based nursing care continues to expand, delivering care to increasingly older clients with multiple, chronic and complex conditions that require the use of additional and more numerous invasive medical devices. Therefore, the prevention of infections poses a challenge for nurses, professional caregivers and clients. OBJECTIVE This article explores infection prevention practices and related behavioural factors in both nurses and clients to identify barriers and facilitators of infection prevention practices in home-based nursing care. DESIGN A qualitative, exploratory design. SETTING Four healthcare organisations providing home-based nursing care in the Netherlands. METHODS Participant observations were used as the main source of data collection complemented with focus group discussions and semi-structured interviews. PARTICIPANTS Participant observations: 16 nurses, three professional caregivers and 80 clients. Semi-structured interviews: 11 clients. Focus group discussions: 15 nurses and four professional caregivers. RESULTS A total of 87 unique care delivery situations were observed for 55 h, complemented with three focus group discussions and 11 individual semi-structured client interviews. Infection prevention practices in home-based nursing care appeared to be challenged by 1. The specific context or environment in which the care occurred, which is more autonomous, less structured, less controlled and less predictable than other care settings; 2. Suboptimal and considerable variation in professional performance concerning the application of hand hygiene and the proper use of personal protective equipment such as face masks, barrier gowns and disposable gloves; 3. Extensive use in and outside the client's surroundings of communication devices that are irregularly cleaned and tend to interrupt nursing procedures; and 4. Inadequate organisational support in the implementation and evaluation of new information or policy changes and fragmentation, variation and conflicting information regarding professional guidelines and protocols. CONCLUSIONS From a first-hand observational viewpoint, this study showed that the daily practice of infection prevention in home-based nursing care appears to be suboptimal. Furthermore, this research revealed considerable variation in the work environment, the application of hand hygiene, the proper use of personal protective equipment, the handling of communication devices and organisational policies, procedures and support. Finally, the study identified a number of important barriers and facilitators of infection prevention practices in the work environment, professional and team performance, clients and organisations.
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Affiliation(s)
- Benjamin Wendt
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, PO box 9101 (114), 6500 HB, Nijmegen, the Netherlands.
| | - Getty Huisman-de Waal
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, PO box 9101 (114), 6500 HB, Nijmegen, the Netherlands.
| | - Annick Bakker-Jacobs
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, PO box 9101 (114), 6500 HB, Nijmegen, the Netherlands.
| | - Jeannine L A Hautvast
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, PO box 9101 (149), 6500 HB, Nijmegen, the Netherlands.
| | - Anita Huis
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, PO box 9101 (114), 6500 HB, Nijmegen, the Netherlands.
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Byon HD, Ahn S, Yan G, Crandall M, LeBaron V. Association of a Substance Use Disorder with Infectious Diseases among Adult Home Healthcare Patients with a Venous Access Device. Home Healthc Now 2021; 39:320-326. [PMID: 34738967 DOI: 10.1097/nhh.0000000000001009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Substance use disorders (SUDs) and high incidence of infectious diseases are both critical public health issues. Among patients who use a venous access device (VAD) in home care settings, SUDs may play a role in increasing their risk of having a concurrent infectious disease. This study examined the association of SUD with infectious diseases among adult home healthcare patients with a VAD. We identified adult patients with an existing VAD who were admitted to a home healthcare agency August 1, 2017-July 31, 2018 from the electronic health records of a large Medicare-certified agency. Four serious infectious diseases (endocarditis, epidural abscess, septic arthritis, and osteomyelitis) and SUD related to injectable drugs were identified using relevant ICD-10 codes. Multiple logistic regression was performed to examine the association. Of 416 patients with a VAD, 12% (n = 50) had at least one diagnosis of a serious infectious disease. The percentage of patients who had a serious infectious disease was 40% among those with SUDs, compared with only 11% among those without SUDs. After adjusting for age and sex, the odds of having a serious infectious disease was 3.52 times greater for those with SUDs compared with those without (odds ratio [95% confidence interval], 4.52 [1.48-13.79], n = .008). Our findings suggest that home healthcare patients with a VAD and a documented SUD diagnosis may have an increased risk of having a concurrent serious infectious disease. Therefore, patients with an SUD and a VAD would need more attention from home healthcare providers to prevent a serious infectious disease. Further research is suggested on modalities of care for individuals with an SUD and VAD to reduce the incidence of infectious diseases so that care can be delivered safely and efficiently in a home healthcare setting.
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Cordeiro JFC, Menegueti MG, Laus AM, Tipple AFV, Santana RC, Canini SRMDS. Hand hygiene by the nursing team in home care: a cross-sectional study. Rev Esc Enferm USP 2021; 55:e20210104. [PMID: 34605536 DOI: 10.1590/1980-220x-reeusp-2021-0104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/29/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE to identify whether nursing professionals carry out hand hygiene, how they do it, and what resources are available for this practice during home visits. METHOD cross-sectional study conducted in a public Home Care service. The World Health Organization instrument was used to observe the hand hygiene technique, the time of performance, and the product used. RESULTS a total of 940 hand hygiene opportunities taking place in 231 home visits were observed. Overall adherence was 14.4%, with the practice of hand hygiene being higher after contact with the patient (53.7%). Before aseptic procedures, after risk/exposure to body fluids, after contact with the patient's environment, and before contact with the patient, adherence was 0.4%. Regarding the quality of the technique, in none of the 135 practices the recommended steps were followed. As for the structure available in the households, 35 (15.2%) had accessible sinks and none had liquid soap and alcohol-based formulation. CONCLUSION adherence to hand hygiene by nursing professionals in home care was low, the technique was not performed, and households did not have resources for the practice.
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Affiliation(s)
| | | | - Ana Maria Laus
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | | | - Rodrigo Carvalho Santana
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Ribeirão Preto, SP, Brazil
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Ma C, McDonald MV, Feldman PH, Miner S, Jones S, Squires A. Continuity of Nursing Care in Home Health: Impact on Rehospitalization Among Older Adults With Dementia. Med Care 2021; 59:913-920. [PMID: 34166269 PMCID: PMC8446319 DOI: 10.1097/mlr.0000000000001599] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Home health care (HHC) is a leading form of home and community-based services for persons with dementia (PWD). Nurses are the primary providers of HHC; however, little is known of nursing care delivery and quality. OBJECTIVE The objective of this study was to examine the association between continuity of nursing care in HHC and rehospitalization among PWD. RESEARCH DESIGN This is a retrospective cohort study using multiple years (2010-2015) of HHC assessment, administrative, and human resources data from a large urban not-for-profit home health agency. SUBJECTS This study included 23,886 PWD receiving HHC following a hospitalization. MEASURES Continuity of nursing care was calculated using the Bice and Boxerman method, which considered the number of total visits, nurses, and visits from each nurse during an HHC episode. The outcome was all-cause rehospitalization during HHC. Risk-adjusted logistic regression was used for analysis. RESULTS Approximately 24% of PWD were rehospitalized. The mean continuity of nursing care score was 0.56 (SD=0.33). Eight percent of PWD received each nursing visit from a different nurse (no continuity), and 26% received all visits from one nurse during an HHC episode (full continuity). Compared with those receiving high continuity of nursing care (third tertile), PWD receiving low (first tertile) or moderate (second tertile) continuity of nursing care had an adjusted odds ratio of 1.33 (95% confidence interval: 1.25-1.46) and 1.30 (95% confidence interval: 1.22-1.43), respectively, for being rehospitalized. CONCLUSIONS Wide variations exist in continuity of nursing care to PWD. Consistency in nurse staff when providing HHC visits to PWD is critical for preventing rehospitalizations.
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Affiliation(s)
- Chenjuan Ma
- New York University Rory Meyers College of Nursing, 433 First Ave., New York, NY 10010
| | - Margaret V. McDonald
- Center for Home Care Policy & Research at the Visiting Nurse Service of New York, 107 E. 70 St. New York, NY 10021
| | - Penny H. Feldman
- Center for Home Care Policy & Research at the Visiting Nurse Service of New York, 107 E. 70 St. New York, NY 10021
| | - Sarah Miner
- St. John Fisher College Wegmans School of Nursing, 3690 East Ave. Rochester, NY 14618
| | - Simon Jones
- Department of Population Health, NYU School of Medicine, 227 East 30 St., New York, NY 10016
| | - Allison Squires
- New York University Rory Meyers College of Nursing, 433 First Ave., New York, NY 10010
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Morioka N, Kashiwagi M. Infection prevention and control practice among home-care nursing agencies in Japan: Secondary analysis of a nationwide cross-sectional survey. Geriatr Gerontol Int 2021; 21:913-918. [PMID: 34470081 PMCID: PMC9292936 DOI: 10.1111/ggi.14266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/17/2021] [Accepted: 07/19/2021] [Indexed: 12/13/2022]
Abstract
Aim We describe the nationwide situation of infection prevention and control (IPC) practices among home‐visit nursing agencies and compare them by agency size to explore whether these practices are associated with the occurrence of infection. Methods We conducted a secondary analysis using data from a cross‐sectional nationwide survey inspecting patient safety and IPC practices among nationwide home‐visit nursing agencies, from March to April 2020. Among 9978 agencies, 580 responded and 370 were incorporated in the analysis. The self‐administered questionnaire inquired about the IPC policy and administrative structure, education and training, adherence to standard precautions, and employee health programs. We described the adherence to IPC practice at the agency level and compared them by agency size using chi‐squared tests. Logistic regression analysis was performed to explore the associations between IPC practices and incidence of infection. Results Adherence to IPC practices ranged from 19.2% to 92.4% and varied according to agency size. Less than 20% of agencies had instituted a committee for IPC and strictly used disposable aprons when changing patients' diapers. Instituting a committee for IPC (odds ratio 2.19, 95% confidence interval 1.11–4.34, P < 0.05) and training staff for infection prevention (odds ratio 1.67, 95% confidence interval 1.02–2.72, P < 0.01) were significantly associated with the incidence of infection, after adjusting for covariates. Conclusions There are challenges in establishing IPC policies and administrative structures and adhering to standard precautions. Well‐organized agencies were found to be more likely to detect infections occurring over the past 3 months. Geriatr Gerontol Int 2021; 21: 913–918.
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Affiliation(s)
- Noriko Morioka
- Graduate School of Healthcare Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masayo Kashiwagi
- Graduate School of Healthcare Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Mohammed S, Gorski L. Antimicrobial Resistance and Antimicrobial Stewardship in Home Healthcare. Home Healthc Now 2021; 39:238-246. [PMID: 34473111 DOI: 10.1097/nhh.0000000000001012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Antimicrobial resistance, the ability of microbes to become resistant to known antimicrobial medications, is a growing and serious global health concern. There are growing numbers of publications about efforts to educate nurses about antimicrobial resistance, and efforts to involve nurses in antimicrobial stewardship in acute and long-term care settings; however, this has not been the case in home care. Home care organizations are required to address infection control and surveillance, including patient, family, and staff education. Home care nurses play an important role in identifying infections, performing cultures, and teaching patients and families. This article provides an overview of antimicrobial resistance and antimicrobial stewardship and provides antimicrobial stewardship actions for home care nurses and agencies. In the interest of public health, home care agencies and nurses can, and should, educate themselves and patients about antimicrobial resistance and employ antimicrobial stewardship strategies.
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Mangal S, Pho A, Arcia A, Carter E. Patient and Family Engagement in Catheter-Associated Urinary Tract Infection (CAUTI) Prevention: A Systematic Review. Jt Comm J Qual Patient Saf 2021; 47:591-603. [PMID: 34215555 PMCID: PMC8506981 DOI: 10.1016/j.jcjq.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) are detrimental to health and are largely preventable with adherence to CAUTI prevention guidelines. Patient and family engagement in CAUTI prevention is often encouraged in these guidelines; however, little is known about how this engagement is operationalized in practice. A systematic review was conducted to synthesize the content, format, and outcomes of interventions that engage patients and/or families in CAUTI prevention. METHODS Two reviewers independently screened records from four databases up to March 2021 and searched reference lists of final articles. Included articles were primary research, tested an intervention, involved indwelling urinary catheters, and described at least one patient and/or family engagement method. Articles were appraised for quality using the Downs and Black checklist. RESULTS After 720 records were screened, 12 were included. Study quality ranged from good to poor, scoring lowest in internal validity. The most common formats of patient/family engagement were flyers/handouts (83.3%) and verbal education (58.3%). Common content areas were urinary catheter care and maintenance strategies. Most study outcomes (83.3%) measured CAUTI rates, and half measured patient/family-related outcomes. Improvements were seen in at least one outcome across all studies, but less than half (41.7%) showed statistically significant results. CONCLUSION The researchers found that most interventions lacked sufficient detail on the content, delivery, and/or outcome measurement of patient/family engagement, which limits transferability. More high-quality, generalizable trials are warranted in this area. Future research should focus on integrating publicly available resources into practice that can be tested for comprehension and revised based on feedback from target audiences.
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Affiliation(s)
- Sabrina Mangal
- Columbia University School of Nursing, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA (Present affiliation)
| | - Anthony Pho
- Columbia University School of Nursing, New York, NY, USA
- Stanford University School of Medicine, Stanford, CA, USA (Present affiliation)
| | - Adriana Arcia
- Columbia University School of Nursing, New York, NY, USA
| | - Eileen Carter
- Columbia University School of Nursing, New York, NY, USA
- University of Connecticut School of Nursing, Storrs, CT, USA (Present affiliation)
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Song J, Woo K, Shang J, Ojo M, Topaz M. Predictive Risk Models for Wound Infection-Related Hospitalization or ED Visits in Home Health Care Using Machine-Learning Algorithms. Adv Skin Wound Care 2021; 34:1-12. [PMID: 34260423 DOI: 10.1097/01.asw.0000755928.30524.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Wound infection is prevalent in home healthcare (HHC) and often leads to hospitalizations. However, none of the previous studies of wounds in HHC have used data from clinical notes. Therefore, the authors created a more accurate description of a patient's condition by extracting risk factors from clinical notes to build predictive models to identify a patient's risk of wound infection in HHC. METHODS The structured data (eg, standardized assessments) and unstructured information (eg, narrative-free text charting) were retrospectively reviewed for HHC patients with wounds who were served by a large HHC agency in 2014. Wound infection risk factors were identified through bivariate analysis and stepwise variable selection. Risk predictive performance of three machine learning models (logistic regression, random forest, and artificial neural network) was compared. RESULTS A total of 754 of 54,316 patients (1.39%) had a hospitalization or ED visit related to wound infection. In the bivariate logistic regression, language describing wound type in the patient's clinical notes was strongly associated with risk (odds ratio, 9.94; P < .05). The areas under the curve were 0.82 in logistic regression, 0.75 in random forest, and 0.78 in artificial neural network. Risk prediction performance of the models improved (by up to 13.2%) after adding risk factors extracted from clinical notes. CONCLUSIONS Logistic regression showed the best risk prediction performance in prediction of wound infection-related hospitalization or ED visits in HHC. The use of data extracted from clinical notes can improve the performance of risk prediction models.
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Affiliation(s)
- Jiyoun Song
- Jiyoun Song, PhD, RN, AGACNP-BC, is Postdoctoral Fellow, Columbia University School of Nursing, New York, NY. Kyungmi Woo, PhD, RN, is Assistant Professor, The Research Institute of Nursing Science, Seoul National University College of Nursing, Republic of Korea. Jingjing Shang, PhD, RN, is Associate Professor, Columbia University School of Nursing, New York, NY. Marietta Ojo, MPH, is Research Assistant, Columbia University Mailman School of Public Health, New York, NY. Maxim Topaz, PhD, RN, is Associate Professor, Columbia University School of Nursing, New York, NY. Acknowledgments: This study is funded by the Eugenie and Joseph Doyle Research Partnership Fund from Visiting Nurses Service of New York and the Intramural Pilot Grant from Columbia University School of Nursing. At the time of data analysis and manuscript development, Jiyoun Song was supported in part by the Agency for Healthcare Research and Quality (R01HS024915), Nursing Intensity of Patient Care Needs and Rates of Healthcare-Associated Infections, and The Jonas Center for Nursing and Veterans Healthcare. Kyungmi Woo was supported by the Comparative and Cost-Effectiveness Research (T32 NR014205) grant through the National Institute of Nursing Research. The authors have disclosed no other financial relationships related to this article. Submitted August 28, 2020; accepted in revised form December 8, 2020
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Schultz TJ, Thomas A, Georgiou P, Juaton MS, Cusack L, Simon L, Naidoo K, Webb K, Karnon J, Ravindran J. Home infusions of natalizumab for people with multiple sclerosis: a pilot randomised crossover trial. Ann Clin Transl Neurol 2021; 8:1610-1621. [PMID: 34288591 PMCID: PMC8351394 DOI: 10.1002/acn3.51410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/27/2021] [Accepted: 05/30/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The delivery of healthcare at home has expanded to intravenous infusions of monoclonal antibodies. A recently developed model of care for home infusions of natalizumab for people with relapsing-remitting multiple sclerosis was evaluated. This pilot study of home infusions of natalizumab and usual care (attendance in a hospital out-patients' clinic) compared safety, feasibility, patient satisfaction, effectiveness and costs. METHODS In this randomised AB/BA crossover trial, 37 adults were randomised to usual care (n = 19) or home infusions (n = 18). After three infusions, patients crossed over to the alternate treatment for another three infusions. Patient safety outcomes and adherence, satisfaction, quality of life, disability and costs were compared. RESULTS No adverse events were recorded from 207 infusions from 35 patients across both home and clinic infusions. There was no difference in adherence (p = 0.71) and infection rates (p = 0.84) between home and clinic settings. Satisfaction with "convenience" of home infusions was significantly greater (p = 0.008) but there were no differences in quality of life measures. Excluding pharmacy, costs were A$74 lower per infusion at home, including A$16 of patients" out-of-pocket costs. INTERPRETATION There were no differences in safety and effectiveness between clinic and home infusions of natalizumab. The home infusions were shown to be feasible, more convenient and less expensive than usual care. Larger scale studies are required to verify these preliminary findings, particularly around safety and management of hypersensitivity adverse events in the home setting and for equivalence of clinical outcomes.
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Affiliation(s)
- Timothy J. Schultz
- Adelaide Nursing SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Present address:
Flinders Health and Medical Research InstituteFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Anne Thomas
- Post Op Care at Home (Pty Ltd)AdelaideSouth AustraliaAustralia
| | - Paul Georgiou
- Medical Day Treatment UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Mahasen S. Juaton
- Adelaide Nursing SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Lynette Cusack
- Adelaide Nursing SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Lorraine Simon
- Medical Day Treatment UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Kerisha Naidoo
- Biogen Australia and New ZealandSydneyNew South WalesAustralia
| | - Kevin Webb
- Neurology & Stroke UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Jonathan Karnon
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Janakan Ravindran
- Neurology & Stroke UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
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Woo K, Song J, Adams V, Block LJ, Currie LM, Shang J, Topaz M. Exploring prevalence of wound infections and related patient characteristics in homecare using natural language processing. Int Wound J 2021; 19:211-221. [PMID: 34105873 PMCID: PMC8684883 DOI: 10.1111/iwj.13623] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 12/13/2022] Open
Abstract
We aimed to create and validate a natural language processing algorithm to extract wound infection-related information from nursing notes. We also estimated wound infection prevalence in homecare settings and described related patient characteristics. In this retrospective cohort study, a natural language processing algorithm was developed and validated against a gold standard testing set. Cases with wound infection were identified using the algorithm and linked to Outcome and Assessment Information Set data to identify related patient characteristics. The final version of the natural language processing vocabulary contained 3914 terms and expressions related to the presence of wound infection. The natural language processing algorithm achieved overall good performance (F-measure = 0.88). The presence of wound infection was documented for 1.03% (n = 602) of patients without wounds, for 5.95% (n = 3232) of patients with wounds, and 19.19% (n = 152) of patients with wound-related hospitalisation or emergency department visits. Diabetes, peripheral vascular disease, and skin ulcer were significantly associated with wound infection among homecare patients. Our findings suggest that nurses frequently document wound infection-related information. The use of natural language processing demonstrated that valuable information can be extracted from nursing notes which can be used to improve our understanding of the care needs of people receiving homecare. By linking findings from clinical nursing notes with additional structured data, we can analyse related patients' characteristics and use them to develop a tailored intervention that may potentially lead to reduced wound infection-related hospitalizations.
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Affiliation(s)
- Kyungmi Woo
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Jiyoun Song
- School of Nursing, Columbia University, New York City, New York, USA
| | - Victoria Adams
- Visiting Nurse Service of New York, New York City, New York, USA
| | - Lorraine J Block
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leanne M Currie
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jingjing Shang
- School of Nursing, Columbia University, New York City, New York, USA
| | - Maxim Topaz
- School of Nursing, Columbia University, New York City, New York, USA.,Visiting Nurse Service of New York, New York City, New York, USA.,Data Science Institute, Columbia University, New York City, New York, USA
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Adams V, Song J, Shang J, McDonald M, Dowding D, Ojo M, Russell D. Infection prevention and control practices in the home environment: Examining enablers and barriers to adherence among home health care nurses. Am J Infect Control 2021; 49:721-726. [PMID: 33157183 DOI: 10.1016/j.ajic.2020.10.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Infection Prevention and Control (IPC) practices have been established in home health care. Adherence to IPC practices has been suboptimal with limited available evidence. The study aim was to examine the impact of individual, home environment, and organizational factors on IPC practices using human factors model. METHODS Three hundred and fifty-three nurses were surveyed across two large home care agencies to examine the relationship between IPC adherence and individual, home environment, and organizational factors. RESULTS Nurses reported multiple barriers to IPC practices in patients' homes (mean = 4.34, standard deviation = 2.53). Frequent barriers included clutter (reported by 74.5% of nurses) and a dirty environment (70.3%). Nurses also reported limited availability of some IPC supplies (mean = 7.76, standard deviation = 2.44), including personal protective equipment. Home environment factors were significant barriers, and availability of IPC supplies were significant enablers of IPC adherence. Agency-provided training and decision-making resources were not significant factors for IPC adherence in the presence of home environment barriers and IPC supplies. CONCLUSIONS This study findings suggest that IPC adherence strategies point to addressing barriers in the home environment and increasing availability of IPC supplies. The relationship between the patient's home environment, organizational factors, and IPC practices among home health care nurses warrants further study.
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Affiliation(s)
- Victoria Adams
- Infection Prevention and Control, Visiting Nurse Service of New York, New York, NY.
| | - Jiyoun Song
- Columbia University School of Nursing, New York, NY
| | | | - Margaret McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Marietta Ojo
- Columbia University School of Nursing, New York, NY
| | - David Russell
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY; Department of Sociology, Appalachian State University, Boone, NC
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25
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Russell D, Dowding D, Trifilio M, McDonald MV, Song J, Adams V, Ojo MI, Perry EK, Shang J. Individual, social, and environmental factors for infection risk among home healthcare patients: A multi-method study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:780-788. [PMID: 33606903 PMCID: PMC8084932 DOI: 10.1111/hsc.13321] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
There has been limited research into the individual, social, and environmental factors for infection risk among patients in the home healthcare (HHC) setting, where the infection is a leading cause of hospitalisation. The aims of this study were to (1) explore nurse perceptions of individual, social, and environmental factors for infection risk among HHC patients; and (2) identify the frequency of environmental barriers to infection prevention and control in HHC. Data were collected in 2017-2018 and included qualitative interviews with HHC nurses (n = 50) and structured observations of nurse visits to patients' homes (n = 400). Thematic analyses of interviews with nurses suggested they perceived infection risk among patients as being influenced by knowledge of and attitudes towards infection prevention and engagement in hygiene practices, receipt of support from informal caregivers and nurse interventions aimed at cultivating infection control knowledge and practices, and the home environment. Statistical analyses of observation checklists revealed nurses encountered an average of 1.7 environmental barriers upon each home visit. Frequent environmental barriers observed during visits to HHC patients included clutter (39.5%), poor lighting (38.8%), dirtiness (28.5%), and pets (17.2%). Additional research is needed to clarify inter-relationships among these factors and identify strategies for addressing each as part of a comprehensive infection control program in HHC.
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Affiliation(s)
- David Russell
- Department of Sociology, Appalachian State University, Boone, NC, USA
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Dawn Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Marygrace Trifilio
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Margaret V. McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Jiyoun Song
- Columbia University School of Nursing, New York, NY, USA
| | | | - Marietta I. Ojo
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Eun K. Perry
- Department of Sociology, Appalachian State University, Boone, NC, USA
| | - Jingjing Shang
- Columbia University School of Nursing, New York, NY, USA
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26
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Noguchi K, Ochiai R, Imazu Y, Tokunaga-Nakawatase Y, Watabe S. Incidence and Prevalence of Infectious Diseases and Their Risk Factors among Patients Who Use Visiting Nursing Services in Japan. J Community Health Nurs 2021; 37:115-128. [PMID: 32820980 DOI: 10.1080/07370016.2020.1780047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study aimed to clarify the incidence of infectious diseases and the associated risk factors among patients who use visiting nursing services in Japan. We conducted a one-year follow up cohort study with 419 participants. The incidence and period prevalence rate of infectious diseases were 0.63 and 15.0%, respectively. In the multiple logistic regression analysis, the presence of chronic respiratory failure, Parkinson's disease, dermatosis other than pressure ulcers, and the inability to perform oral self-care were significantly related to the contraction of an infectious disease.
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Affiliation(s)
- Kyoko Noguchi
- Infection Control Nursing, Department of Nursing, Graduate School of Medicine, Yokohama City University , Yokohama, Japan
| | - Ryota Ochiai
- Nursing Course, School of Medicine, Yokohama City University , Yokohama, Japan
| | - Yoko Imazu
- Nursing Course, School of Medicine, Yokohama City University , Yokohama, Japan
| | | | - Setsuko Watabe
- Nursing Course, School of Medicine, Yokohama City University , Yokohama, Japan
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27
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Shang J, Chastain AM, Perera UGE, Dick AW, Fu CJ, Madigan EA, Pogorzelska-Maziarz M, Stone PW. The state of infection prevention and control at home health agencies in the United States prior to COVID-19: A cross-sectional study. Int J Nurs Stud 2021; 115:103841. [PMID: 33483100 PMCID: PMC7940586 DOI: 10.1016/j.ijnurstu.2020.103841] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/07/2020] [Accepted: 11/13/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Home health care is a rapidly growing healthcare sector worldwide. Home health professionals face unique challenges related to preventing and controlling infections, which are likely to amplify during an infectious disease outbreak (e.g. SARS-CoV-2). Little is known about the current state of infection prevention and control-related policies and outbreak preparedness at U.S. home health agencies. OBJECTIVES In this study, we conducted a national survey to assess infection prevention and control-related policies, infrastructure, and procedures prior to the SARS-CoV-2 pandemic. DESIGN Cross-sectional study. SETTING/PARTICIPANTS Using a stratified random sample of 1506 U.S. home health agencies, we conducted a 61-item survey (paper and online) from November 9, 2018 to December 31, 2019. METHODS Survey data were linked to publicly-available data on the quality of patient care, patient satisfaction, and other agency characteristics. Probability weights were developed to account for sample design and nonresponse; Pearson's χ2, Fisher's exact, t-tests or linear regression were used to compare the universe of agencies/respondents and urban/rural agencies. RESULTS 35.6% of agencies responded (n = 536). Most home health personnel in charge of infection prevention and control have other responsibilities; one-third have no formal infection prevention and control training. Rural agencies are more likely to not have anyone in charge of infection prevention and control compared to those in urban areas. About 22% of agencies implement recommended guidelines when administering antibiotics. Less than a third (26.4%) report that their staff vaccination rates were higher than 95% during the last flu season. Only 48.1% of agencies accept patients requiring ventilation, and of those, 40.9% located in rural areas do not have specific infection prevention and control policies for ventilated patients, compared to 20.8% in urban areas (p < 0.001). Only 39.7% of agencies provide N95 respirators to their clinical staff; rural agencies are significantly more likely to provide those supplies than urban agencies (50.7% vs. 37.7%, p = 0.004). Lastly, agencies report their greatest challenges with infection prevention and control are collecting/reporting infection data and adherence to/monitoring of nursing bag technique. CONCLUSIONS Prior to the SARS-CoV-2 pandemic, we found that infection prevention and control was suboptimal among U.S. home health care agencies. Consequently, most agencies have limited capacity to respond to infectious disease outbreaks. Staff and personal protective equipment shortages remain major concerns, and agencies will need to quickly adjust their existing infection prevention and control policies and potentially create new ones. In the long-term, agencies also need to improve influenza vaccination coverage among their staff. Tweetable abstract: Infection prevention and control infrastructure, policies and procedures and outbreak preparedness at U.S. home health agencies was found to be suboptimal in nationally-representative survey conducted just prior to the COVID-19 pandemic.
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Affiliation(s)
- Jingjing Shang
- Center for Health Policy, Columbia University School of Nursing, 560 West 168th Street, Mail Code 6, New York 10032, NY, USA.
| | - Ashley M Chastain
- Center for Health Policy, Columbia University School of Nursing, 560 West 168th Street, Mail Code 6, New York 10032, NY, USA
| | - Uduwanage Gayani E Perera
- Center for Health Policy, Columbia University School of Nursing, 560 West 168th Street, Mail Code 6, New York 10032, NY, USA
| | - Andrew W Dick
- The RAND Corporation, 20 Park Plaza, 9th Floor, Suite 920, Boston 02116, MA, USA
| | - Caroline J Fu
- Center for Health Policy, Columbia University School of Nursing, 560 West 168th Street, Mail Code 6, New York 10032, NY, USA
| | | | - Monika Pogorzelska-Maziarz
- Thomas Jefferson University, College of Nursing, 130 S. 9th Street, Suite 867, Philadelphia 19107, PA, USA
| | - Patricia W Stone
- Center for Health Policy, Columbia University School of Nursing, 560 West 168th Street, Mail Code 6, New York 10032, NY, USA
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28
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Dowding D, Russell D, McDonald MV, Trifilio M, Song J, Brickner C, Shang J. "A catalyst for action": Factors for implementing clinical risk prediction models of infection in home care settings. J Am Med Inform Assoc 2021; 28:334-341. [PMID: 33260204 PMCID: PMC7883974 DOI: 10.1093/jamia/ocaa267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/05/2020] [Accepted: 10/19/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The study sought to outline how a clinical risk prediction model for identifying patients at risk of infection is perceived by home care nurses, and to inform how the output of the model could be integrated into a clinical workflow. MATERIALS AND METHODS This was a qualitative study using semi-structured interviews with 50 home care nurses. Interviews explored nurses' perceptions of clinical risk prediction models, their experiences using them in practice, and what elements are important for the implementation of a clinical risk prediction model focusing on infection. Interviews were audio-taped and transcribed, with data evaluated using thematic analysis. RESULTS Two themes were derived from the data: (1) informing nursing practice, which outlined how a clinical risk prediction model could inform nurse clinical judgment and be used to modify their care plan interventions, and (2) operationalizing the score, which summarized how the clinical risk prediction model could be incorporated in home care settings. DISCUSSION The findings indicate that home care nurses would find a clinical risk prediction model for infection useful, as long as it provided both context around the reasons why a patient was deemed to be at high risk and provided some guidance for action. CONCLUSIONS It is important to evaluate the potential feasibility and acceptability of a clinical risk prediction model, to inform the intervention design and implementation strategy. The results of this study can provide guidance for the development of the clinical risk prediction tool as an intervention for integration in home care settings.
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Affiliation(s)
- Dawn Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - David Russell
- Department of Sociology, Appalachian State University, Boone, North Carolina, USA
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, New York, USA
| | - Margaret V McDonald
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, New York, USA
| | - Marygrace Trifilio
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, New York, USA
| | - Jiyoun Song
- Columbia University School of Nursing, New York, New York, USA
| | - Carlin Brickner
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, New York, USA
- Business Intelligence and Analytics, Visiting Nurse Service of New York, New York, New York, USA
| | - Jingjing Shang
- Columbia University School of Nursing, New York, New York, USA
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29
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Haghgoshayie E, Ghorbani Z, Hasanpoor E. Home care environments are not adequately catered for by existing infection prevention guidelines. Evid Based Nurs 2021; 25:30. [PMID: 33558210 DOI: 10.1136/ebnurs-2020-103369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Elaheh Haghgoshayie
- Department of Healthcare Management, Clinical Research Development Unit, Shahid Beheshti Hospital, Maragheh University of Medical Sciences, Maragheh, Iran.,Department of Healthcare Management, Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Zahra Ghorbani
- Department of Midwifery, Clinical Research Development Unit, Shahid Beheshti Hospital, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Edris Hasanpoor
- Department of Healthcare Management, Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, Maragheh, Iran
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30
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Shang J, Russell D, Dowding D, McDonald MV, Murtaugh C, Liu J, Larson EL, Sridharan S, Brickner C. A Predictive Risk Model for Infection-Related Hospitalization Among Home Healthcare Patients. J Healthc Qual 2021; 42:136-147. [PMID: 32371832 DOI: 10.1097/jhq.0000000000000214] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Infection prevention is a high priority for home healthcare (HHC), but tools are lacking to identify patients at highest risk of developing infections. The purpose of this study was to develop and test a predictive risk model to identify HHC patients at risk of an infection-related hospitalization or emergency department visit. A nonexperimental study using secondary data was conducted. The Outcome and Assessment Information Set linked with relevant clinical data from 112,788 HHC admissions in 2014 was used for model development (70% of data) and testing (30%). A total of 1,908 patients (1.69%) were hospitalized or received emergency care associated with infection. Stepwise logistic regression models discriminated between individuals with and without infections. Our final model, when classified by highest risk of infection, identified a high portion of those who were hospitalized or received emergent care for an infection while also correctly categorizing 90.5% of patients without infection. The risk model can be used by clinicians to inform care planning. This is the first study to develop a tool for predicting infection risk that can be used to inform how to direct additional infection control intervention resources on high-risk patients, potentially reducing infection-related hospitalizations, emergency department visits, and costs.
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31
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Woo K, Adams V, Wilson P, Fu LH, Cato K, Rossetti SC, McDonald M, Shang J, Topaz M. Identifying Urinary Tract Infection-Related Information in Home Care Nursing Notes. J Am Med Dir Assoc 2021; 22:1015-1021.e2. [PMID: 33434568 PMCID: PMC8106637 DOI: 10.1016/j.jamda.2020.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 07/28/2020] [Accepted: 12/06/2020] [Indexed: 12/12/2022]
Abstract
Objectives: Urinary tract infection (UTI) is common in home care but not easily captured with standard assessment. This study aimed to examine the value of nursing notes in detecting UTI signs and symptoms in home care. Design: The study developed a natural language processing (NLP) algorithm to automatically identify UTI-related information in nursing notes. Setting and Participants: Home care visit notes (n = 1,149,586) and care coordination notes (n = 1,461,171) for 89,459 patients treated in the largest nonprofit home care agency in the United States during 2014. Measures: We generated 6 categories of UTI-related information from literature and used the Unified Medical Language System (UMLS) to identify a preliminary list of terms. The NLP algorithm was tested on a gold standard set of 300 clinical notes annotated by clinical experts. We used structured Outcome and Assessment Information Set data to extract the frequency of UTI-related emergency department (ED) visits or hospitalizations and explored time-patterns in documentation of UTI-related information. Results: The NLP system achieved very good overall performance (F measure = 0.9, 95% CI: 0.87–0.93) based on the test results obtained by using the notes for patients admitted to the ED or hospital due to UTI. UTI-related information was significantly more prevalent (P < .01 for all the tests) in home care episodes with UTI-related ED admission or hospitalization vs the general patient population; 81% of home care episodes with UTI-related hospitalization or ED admission had at least 1 category of UTI-related information vs 21.6% among episodes without UTI-related hospitalization or ED admission. Frequency of UTI-related information documentation increased in advance of UTI-related hospitalization or ED admission, peaking within a few days before the event. Conclusions and Implications: Information in nursing notes is often overlooked by stakeholders and not integrated into predictive modeling for decision-making support, but our findings highlight their value in early risk identification and care guidance. Health care administrators should consider using NLP to extract clinical data from nursing notes to improve early detection and treatment, which may lead to quality improvement and cost reduction.
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Affiliation(s)
- Kyungmi Woo
- College of Nursing, Seoul National University, Seoul, Republic of Korea.
| | - Victoria Adams
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Paula Wilson
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Li-Heng Fu
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Kenrick Cato
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Sarah Collins Rossetti
- Department of Biomedical Informatics, Columbia University, New York, NY, USA; School of Nursing, Columbia University, New York, NY, USA
| | - Margaret McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Jingjing Shang
- School of Nursing, Columbia University, New York, NY, USA
| | - Maxim Topaz
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA; School of Nursing, Columbia University, New York, NY, USA; Data Science Institute, Columbia University, New York, NY, USA
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32
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Pogorzelska-Maziarz M, Chastain AM, Mangal S, Stone PW, Shang J. Home Health Staff Perspectives on Infection Prevention and Control: Implications for Coronavirus Disease 2019. J Am Med Dir Assoc 2020; 21:1782-1790.e4. [PMID: 33256957 PMCID: PMC7584445 DOI: 10.1016/j.jamda.2020.10.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/12/2022]
Abstract
Objectives The role of home healthcare (HHC) services in providing care to vulnerable, often frail individuals with chronic conditions is critical. Effective infection prevention and control (IPC) in HHC is essential to keeping both healthcare workers and patients safe, especially in the event of an emerging infectious disease outbreak. Prior to the coronavirus disease 2019 pandemic, we explored successes and challenges with IPC from the perspectives of HHC staff. Design Qualitative descriptive study. Setting and Participants From May to November 2018, we conducted in-depth telephone interviews with 41 staff from 13 agencies across the nation. Methods Transcripts were coded by a multidisciplinary coding team, and several primary and subcategories were identified using directed content analysis. Results Four primary categories were generated including (1) uniqueness of HHC; (2) IPC as a priority; (3) importance of education; and (4) keys to success and innovation. Participants perceived that IPC plays a big part in patient safety and reducing rehospitalizations, and protection of patients and staff was a major motivator for compliance with IPC. The identified challenges included the unpredictability of the home environment, patient/family dynamics, the intermittent nature of HHC, and staffing issues. Education was seen as a tool to improve staff, patient, caregiver and families' compliance with IPC. Keys to success and innovation included a leadership focus on quality, using agency infection data to improve quality, and a coordinated approach to patient care. Conclusions and Implications This qualitative work identified barriers to effective IPC in HHC, as well as important facilitators that HHC agencies can use to implement policies and procedures to improve patient care and keep staff safe. Leadership prioritization of IPC is key to implementing appropriate IPC policies and may be especially important in midst of a crisis such as coronavirus disease 2019.
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Affiliation(s)
| | - Ashley M Chastain
- Center for Health Policy, Columbia University School of Nursing, New York, NY, USA
| | - Sabrina Mangal
- Center for Health Policy, Columbia University School of Nursing, New York, NY, USA
| | - Patricia W Stone
- Center for Health Policy, Columbia University School of Nursing, New York, NY, USA
| | - Jingjing Shang
- Center for Health Policy, Columbia University School of Nursing, New York, NY, USA
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33
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Tseng TG, Wu HL, Ku HC, Tai CJ. The Impact of the COVID-19 Pandemic on Disabled and Hospice Home Care Patients. J Gerontol A Biol Sci Med Sci 2020; 75:e128-e129. [PMID: 32246144 PMCID: PMC7184350 DOI: 10.1093/gerona/glaa081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Tzyy-Guey Tseng
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
| | - Hui-Ling Wu
- Department of Community Health, Pingtung Hospital, Ministry of Health and Welfare, Taiwan
| | - Hui-Chuan Ku
- Department of Community Health, Pingtung Hospital, Ministry of Health and Welfare, Taiwan
| | - Chi-Jung Tai
- Department of Community Health, Pingtung Hospital, Ministry of Health and Welfare, Taiwan.,Department of Family Medicine, Pingtung Hospital, Ministry of Health and Welfare, Taiwan.,Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Taiwan
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34
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Keller S, Salinas A, Williams D, McGoldrick M, Gorski L, Alexander M, Norris A, Charron J, Stienecker RS, Passaretti C, Maragakis L, Cosgrove SE. Reaching consensus on a home infusion central line-associated bloodstream infection surveillance definition via a modified Delphi approach. Am J Infect Control 2020; 48:993-1000. [PMID: 31982215 DOI: 10.1016/j.ajic.2019.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND A consensus on a central line-associated bloodstream infection (CLABSI) surveillance definition in home infusion is needed to standardize measurement and benchmark CLABSI to provide data to drive improvement initiatives METHODS: Experts across fields including home infusion therapy, infectious diseases, and healthcare epidemiology convened to perform a 3-step modified Delphi approach to obtain input and achieve consensus on a candidate home infusion CLABSI definition. RESULTS The numerator criterion was identified by participants as involving one of the 2 following: (1) recognized pathogen isolated from blood culture and pathogen is not related to infection at another site, or (2) one of the following signs or symptoms: fever of 38°C (100.4°F), chills, or hypotension (systolic blood pressure ≤90 mm Hg), and one of the 2 following: (A) common skin contaminant isolated from 2 blood cultures drawn on separate occasions and organism is not related to infection at another site, or (B) common skin contaminant isolated from blood culture from patient with intravascular access device and provider institutes appropriate antimicrobial therapy. The criteria for a denominator included days from the day of admission with a central venous catheter to day of removal of central venous catheter. In addition, 11 inclusion criteria and 4 exclusion criteria were included. DISCUSSION Home infusion therapy and healthcare epidemiology experts developed candidate criteria for a home infusion CLABSI surveillance definition. CONCLUSIONS Home care and home infusion agencies can use this definition to monitor their own CLABSI rates and implement preventative strategies.
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35
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Shang J, Wang J, Adams V, Ma C. Risk factors for infection in home health care: Analysis of national Outcome and Assessment Information Set data. Res Nurs Health 2020; 43:373-386. [PMID: 32652615 DOI: 10.1002/nur.22053] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 05/21/2020] [Accepted: 06/23/2020] [Indexed: 11/06/2022]
Abstract
Patients in home health care (HHC), a rapidly growing healthcare sector, are at high risk for infections. This study aimed to identify risk factors for infections among HHC patients using the Outcome and Assessment Information Set (OASIS) data. We used a 5% random sample of the 2013 national OASIS data. Infections were identified if records indicated that patients were hospitalized or received emergency care for one of three types of infections (respiratory, wound site, and urinary tract infection). Multivariate logistic regression models were used to identify risk factors for each individual infection type. The final analysis included 128,163 patients from 8,255 HHC agencies nationwide. Approximately 3.2% of the patients developed infections during their HHC stay that led to hospitalization or emergency care treatment. We found that associations between demographics and infection risk are specific to the type of infection. In general, a history of multiple hospitalizations in past 6 months, comorbidity, having a severe condition at HHC admission, and impaired physical functioning increased HHC patients' risk of infections. We also identified that HHC patients with caregivers who needed training in providing medical procedure or treatment are at higher risk for wound-site infections. Our findings suggest that patients with underlying medical conditions and limited physical function status are more likely to develop infection. The caregiver's lack of training in providing needed care at home also places HHC patients at high risk for infection. Education for patients and caregivers should be tailored based on their health literacy level to ensure complete understanding.
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Affiliation(s)
- Jingjing Shang
- School of Nursing, Columbia University, New York City, New York
| | - Jinjiao Wang
- School of Nursing, University of Rochester, Rochester, New York
| | - Victoria Adams
- Infection Prevention and Control, Visiting Nurse Service of New York, New York City, New York
| | - Chenjuan Ma
- Rory Meyers College of Nursing, New York University, New York City, New York
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Dowding D, Russell D, Trifilio M, McDonald MV, Shang J. Home care nurses' identification of patients at risk of infection and their risk mitigation strategies: A qualitative interview study. Int J Nurs Stud 2020; 107:103617. [PMID: 32446014 PMCID: PMC7418527 DOI: 10.1016/j.ijnurstu.2020.103617] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/19/2020] [Accepted: 04/18/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is an increase in the number of individuals who receive care at home. A significant proportion of these patients acquire infections during their care episode. Whilst there has been significant focus on strategies for infection prevention and control in acute care environments, there is a lack of research into infection prevention in a home care setting. OBJECTIVES To understand (1) if and how home care nurses identify patients at high risk of infection and (2) the strategies they use to mitigate that risk. DESIGN A qualitative descriptive study, using semi-structured interviews. SETTING A large not for profit home care agency located in the New York region of the United States. PARTICIPANTS Fifty nurses with a range of experience in home care nursing. METHODS Purposive and snowball sampling was used to recruit nurses from across the home care agency with varied years of work experience. Interviews were audio recorded and transcribed. The interviews explored how home care nurses evaluate their patients' risk of developing an infection and if/how they modify the plan of care based on that risk. Data were analysed using thematic analysis. RESULTS Three themes were derived from the data; assessing a patient's risk of infection, the risk assessment process, and strategies for mitigating infection risk. Factors identified by nurses as putting a patient at higher risk of infection included being older, having diabetes, inadequate nutrition; along with inadequate clinical information available at start of care. The patient's knowledge and understanding of infection prevention, and the availability and knowledge of caregivers were also important, as was the cleanliness of the home environment. Given the context of home care, where nurses have little control over the environment and care processes in-between visits, the main strategy for infection prevention was patient and caregiver education. Nurses also discussed the importance of their own infection prevention behaviours, and the ability to adjust a patient's plan of care according to their infection risk. CONCLUSIONS The study highlights the complexity of the risk assessment process in relation to infection. Existing guidelines for infection prevention and control do not adequately cover the home care environment and more research needs to determine which interventions (such as patient/caregiver education) would be most effective to prevent infections in the home care setting.
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Affiliation(s)
- Dawn Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Room 4.327a, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK; Center for Home Care Policy and Research, Visiting Nurse Service of New York, 5 Penn Plaza, 12th Floor, New York, NY 10001, USA; Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, USA.
| | - David Russell
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, 5 Penn Plaza, 12th Floor, New York, NY 10001, USA; Department of Sociology, Appalachian State University, ASU Box 32115, 209 Chapell Wilson Hall, 480 Howard Street, Boone, NC 28608, USA.
| | - Marygrace Trifilio
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, 5 Penn Plaza, 12th Floor, New York, NY 10001, USA.
| | - Margaret V McDonald
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, 5 Penn Plaza, 12th Floor, New York, NY 10001, USA.
| | - Jingjing Shang
- Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, USA.
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Hoffman GJ, Min LC, Liu H, Marciniak DJ, Mody L. Role of Post-Acute Care in Readmissions for Preexisting Healthcare-Associated Infections. J Am Geriatr Soc 2020; 68:370-378. [PMID: 31644835 PMCID: PMC9045555 DOI: 10.1111/jgs.16208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/27/2019] [Accepted: 09/02/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Although preventable, healthcare-associated infections (HAIs) are commonly observed in post-acute care settings for at-risk older adults and are a leading cause of hospital readmissions. However, whether HAIs resulting in avoidable readmissions for preexisting HAIs (the same HAI as at the index admission) are more common for patients discharged to post-acute care as opposed to home is unknown. We examined the risk of preexisting HAI readmissions according to patient discharge disposition and comorbidity level. DESIGN We used 2013-2014 national hospital discharge data to estimate the likelihood of readmissions for preexisting HAIs according to patients' discharge disposition and whether the likelihood varies according to patient comorbidity level, across four common types of HAIs (not including respiratory infections). PARTICIPANTS A total of 702 304 hospital discharges for Medicare beneficiaries 65 years or older. MEASUREMENTS Our outcome was a 30-day preexisting, or "linked," HAI readmission (readmission involving the same HAI diagnosis as at the index admission). Patient discharge disposition was skilled nursing facility (SNF), home health care, and home care without home health care ("home"). RESULTS Of 702 304 index admissions involving HAI treatment, 353 073 (50%) were discharged to a SNF, 179 490 (26%) to home health care, and 169 872 (24%) to home. Overall, 17 523 (2.5%) of preexisting HAIs resulted in linked HAI readmissions, which were more common for Clostridioides difficile infections (4.0%) and urinary tract infections (2.4%) than surgical site infections (1.1%; P < .001). Being discharged to a SNF compared to home or to home health care was associated with a 1.15 percentage point (95% confidence interval = -1.29 to -1.00), or 38%, lower risk of a linked HAI readmission. This risk difference was observed to increase with greater patient comorbidity. CONCLUSIONS SNF discharges were associated with fewer avoidable readmissions for preexisting HAIs compared with home discharges. Further research to identify modifiable mechanisms that improve posthospital infection care at home is needed. J Am Geriatr Soc 68:370-378, 2020.
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Affiliation(s)
- Geoffrey J Hoffman
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Lillian C Min
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
- Department of Medicine, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, Michigan
- Veterans Affairs Center for Clinical Management and Research (CCMR), VA Medical Center, Ann Arbor, Michigan
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
- Geriatrics Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Haiyin Liu
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Dan J Marciniak
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lona Mody
- Department of Medicine, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, Michigan
- Geriatrics Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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Lin CJ, Chang YC, Tsou MT, Chan HL, Chen YJ, Hwang LC. Factors associated with hospitalization for community-acquired pneumonia in home health care patients in Taiwan. Aging Clin Exp Res 2020; 32:149-155. [PMID: 30877643 PMCID: PMC6974528 DOI: 10.1007/s40520-019-01169-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 03/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pneumonia is a leading cause of hospitalization and death worldwide. However, studies focusing on risk factors of community-acquired pneumonia (CAP) in the home health care (HHC) population remain scarce. AIMS This study aimed to evaluate risk factors associated with hospitalization for CAP among HHC patients in Taiwan. METHODS This retrospective cross-sectional study extracted data from patients' electronic medical records between 1 January 2017 and 31 December 2017. Multiple logistic regression analyses were performed to explore factors associated with hospitalization for CAP. RESULTS In total, 598 patients (men/women: 236/362) were included. One hundred ninety-nine patients (33.28%) were hospitalized for pneumonia. Inpatients showed a higher proportion of the following: male sex, functional impairment, hypoalbuminemia, anemia, nasogastric tube use, excessive polypharmacy, stroke, dementia, heart failure, chronic respiratory disease, and chronic liver disease. Furthermore, nasogastric tube use (odds ratio [OR] 3.01, 95% confidence interval [CI] 1.88-4.82), anemia (OR 2.37, 95% CI 1.48-3.80), male sex (OR 2.14, 95% CI 1.43-3.20), chronic respiratory disease (OR 2.09, 95% CI 1.33-3.30), dementia (OR 1.94, 95% CI 1.27-2.97), heart failure (OR 1.69, 95% CI 1.11-2.56), and hypoalbuminemia (OR 1.57, 95% CI 1.03-2.40) significantly increased the risk of hospitalization for CAP. CONCLUSIONS Our results revealed risk factors associated with hospitalization for CAP in HHC patients. In addition to chronic diseases, malnutrition is an important risk factor. Caregivers should make prompt assessments and take preventive measures for such patients.
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Affiliation(s)
- Chien-Ju Lin
- The Department of Family Medicine, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei, 104, Taiwan, ROC
| | - Yu-Chen Chang
- The Department of Family Medicine, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei, 104, Taiwan, ROC
| | - Meng-Ting Tsou
- The Department of Family Medicine, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei, 104, Taiwan, ROC
| | - Hsin-Lung Chan
- The Department of Family Medicine, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei, 104, Taiwan, ROC
- The Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist, 252, New Taipei City, Taiwan, ROC
| | - Ying-Ju Chen
- The Telehealth and Home Care Center, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei, 104, Taiwan, ROC
| | - Lee-Ching Hwang
- The Department of Family Medicine, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei, 104, Taiwan, ROC.
- The Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist, 252, New Taipei City, Taiwan, ROC.
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Surveillance of home health central venous catheter care outcomes: Challenges and future directions. Am J Infect Control 2019; 47:1382-1387. [PMID: 31676067 DOI: 10.1016/j.ajic.2019.04.177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Limited data are available regarding central venous catheter (CVC)-related complications that occur in home care. A practical out-of-hospital surveillance mechanism is needed. METHODS Home health/infusion agencies in 4 states submitted monthly data from January 2011 through March 2015. Data were collected by patient age and included number of patients on service with a CVC, device days, central line-associated bloodstream infection (CLABSI), CVC-occlusions, doses of fibrinolytics administered, and number of patients receiving fibrinolytics. RESULTS Ten agencies from 4 states contributed data across the study period. A total of 913 occlusions and 73 CLABSIs occurred during the 51-month surveillance period. The CLABSI rates per 1,000 device days per year across the study surveillance period ranged from 0-0.40 for pediatric and from 0-0.37 for adult patients, whereas occlusion rates per 1,000 device days ranged from 0.26-1.59 for pediatric and from 2.59-33.29 for adult patients. Doses of fibrinolytic agents administered per 1,000 device days ranged from 0.26-1.80 in pediatric and 3.53-33.85 in adult patients. CONCLUSIONS Opportunities exist to further expand efforts to quantify the presence of CVCs in home settings to enable improvements with measuring and tracking patient outcomes as they relate to CVC care. Exploration of continued sustainability of surveillance and data validation are warranted to optimize home health/infusion care practices and outcomes.
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40
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Dick AW, Murray MT, Chastain AM, Madigan EA, Sorbero M, Stone PW, Shang J. Measuring Quality in Home Healthcare. J Am Geriatr Soc 2019; 67:1859-1865. [PMID: 31063621 DOI: 10.1111/jgs.15963] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/26/2019] [Accepted: 04/03/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND/OBJECTIVES Improving quality performance in home health is an increasingly high priority. The objective of this study was to examine trends in industry performance over time using three quality measures: a composite quality metric (Q index), an infection prevention measure (vaccination verification), and an outcome measure (hospital avoidance). DESIGN/SETTING/PARTICIPANTS/MEASURES We linked Home Health Compare and Provider of Services data from 2012 to 2016, which included 39 211 observations during the 5-year study period and 7670 agencies in 2016. The Q index was developed to allow comparability over time, equally weighting the contributions of each element. After examining summary statistics, we developed three regression models stratified by ownership (for-profit/nonprofit agency) and included two constructs of nurse staffing, in addition to controlling for known confounders. RESULTS Most agencies (80.4%) were for-profit agencies. The Q index and vaccination verification improved substantially over time, but there was no change in hospital avoidance. Ownership status was associated with all three measures (P < .001). Registered nurse staffing (relative to licensed practical nurses and home health aides) was associated with higher Q index and vaccination verification (P < .001). CONCLUSION The Q index allows for assessment of trends over time in home healthcare. Ownership and nurse staffing are important factors in the quality of care. The overall home care market is driven by for-profit agencies, but their characteristics and outcomes differ from nonprofit agencies. J Am Geriatr Soc 67:1859-1865, 2019.
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Affiliation(s)
- Andrew W Dick
- RAND Health, The RAND Corporation, Boston, Massachusetts
| | - Meghan T Murray
- Center for Health Policy, Columbia University School of Nursing, New York, New York
| | - Ashley M Chastain
- Center for Health Policy, Columbia University School of Nursing, New York, New York
| | | | - Mark Sorbero
- RAND Health, The RAND Corporation, Boston, Massachusetts
| | - Patricia W Stone
- Center for Health Policy, Columbia University School of Nursing, New York, New York
| | - Jingjing Shang
- Center for Health Policy, Columbia University School of Nursing, New York, New York
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Shih WY, Chang CC, Tsou MT, Chan HL, Chen YJ, Hwang LC. Incidence and Risk Factors for Urinary Tract Infection in an Elder Home Care Population in Taiwan: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040566. [PMID: 30781460 PMCID: PMC6406410 DOI: 10.3390/ijerph16040566] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/07/2019] [Accepted: 02/12/2019] [Indexed: 11/16/2022]
Abstract
Urinary tract infection (UTI) is a common infection worldwide. Numerous studies have demonstrated risk factors for UTI in facilities and communities. In this study, we aimed to identify risk factors for UTI in home care patients. Patients who received home care for at least three months in 2017 were included. A UTI episode was defined by admission for UTI treatment, and/or a visit to an outpatient department for UTI and receiving antibiotic prescription. A total of 598 patients aged 81.9 years were included. Overall 47% (281) had at least one UTI episode. After analysis, urinary catheter indwelling was the most important risk factor (odds ratio (OR), 3.21). Underlying diseases (coronary artery disease (CAD), chronic kidney disease (CKD), diabetes mellitus (DM)) were related to UTI with OR ranging from 1.46 to 1.79. Higher Alb (albumin) (OR 0.68) and Hb (hemoglobin) (OR 0.91) were inversely related to UTI. Polypharmacy (OR 1.84) and lower Barthel index scores (OR 1.62) were also related to UTI by different degrees. In conclusion, apart from the unmodifiable factors, avoiding prolonged urinary catheter placement, unnecessary prescriptions, and keeping good nutritional status may help to prevent UTI in home care patients.
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Affiliation(s)
- Wei-Yi Shih
- Department of Family Medicine, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
| | - Chia-Chen Chang
- Department of Family Medicine, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
| | - Meng-Ting Tsou
- Department of Family Medicine, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
| | - Hsin-Lung Chan
- Department of Family Medicine, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
| | - Ying-Ju Chen
- Telehealth and Home Care Center, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
| | - Lee-Ching Hwang
- Department of Family Medicine, MacKay Memorial Hospital No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City 104, Taiwan.
- Department of Medicine, MacKay Medical College No. 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan.
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Russell D, Dowding DW, McDonald MV, Adams V, Rosati RJ, Larson EL, Shang J. Factors for compliance with infection control practices in home healthcare: findings from a survey of nurses' knowledge and attitudes toward infection control. Am J Infect Control 2018; 46:1211-1217. [PMID: 29866633 DOI: 10.1016/j.ajic.2018.05.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/03/2018] [Accepted: 05/03/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Infection is a leading cause of hospitalization among home healthcare patients. Nurses play an important role in reducing infection among home healthcare patients by complying with infection control procedures. However, few studies have examined the compliance of home healthcare nurses with infection control practices or the range of sociocultural and organizational factors that may be associated with compliance. METHODS This study analyzed survey responses from nurses at 2 large, certified home healthcare agencies (n = 359), to explore levels of compliance with infection control practices and identify associated demographic, knowledge, and attitudinal correlates. RESULTS Nurses reported a high level of infection control compliance (mean = 0.89, standard deviation [SD] = 0.16), correct knowledge (mean = 0.85, SD = 0.09), and favorable attitudes (mean = 0.81, SD = 0.14). Multivariate mixed regression analyses revealed significant positive associations of attitudinal scores with reported level of compliance (P < .001). However, knowledge of inflection control practices was not associated with compliance. Older (P < .05) and non-Hispanic black (P < .001) nurses reported higher compliance with infection control practices than younger and white non-Hispanic nurses. CONCLUSION These findings suggest that efforts to improve compliance with infection control practices in home healthcare should focus on strategies to alter perceptions about infection risk and other attitudinal factors.
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Affiliation(s)
- David Russell
- Department of Sociology, Appalachian State University, Boone, NC; Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY.
| | - Dawn W Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Margaret V McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY
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Shang J, Dick AW, Larson EL, Stone PW. A research agenda for infection prevention in home healthcare. Am J Infect Control 2018; 46:1071-1073. [PMID: 29703637 PMCID: PMC6119629 DOI: 10.1016/j.ajic.2018.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/31/2018] [Accepted: 03/11/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Jingjing Shang
- Center for Health Policy, Columbia University School of Nursing, New York, NY.
| | | | - Elaine L Larson
- Center for Health Policy, Columbia University School of Nursing, New York, NY
| | - Patricia W Stone
- Center for Health Policy, Columbia University School of Nursing, New York, NY
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44
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Siclovan DM. The effectiveness of home health care for reducing readmissions: an integrative review. Home Health Care Serv Q 2018; 37:187-210. [DOI: 10.1080/01621424.2018.1472702] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Goodyear N, Markkanen P, Beato-Melendez C, Mohamed H, Gore R, Galligan C, Sama S, Quinn M. Cleaning and disinfection in home care: A comparison of 2 commercial products with potentially different consequences for respiratory health. Am J Infect Control 2018; 46:410-416. [PMID: 29169933 DOI: 10.1016/j.ajic.2017.09.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/27/2017] [Accepted: 09/27/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Home care aides perform personal care and homemaking services in client homes, including cleaning and disinfection (C&D). Although C&D are performed to remove soil and dust, they are increasingly performed for infection prevention. Many C&D products contain respiratory irritants. The objective of this study was to evaluate 2 commercial products for C&D effectiveness on common household surfaces in seniors' homes. METHODS Two C&D visits were conducted in 46 seniors' homes. One visit applied a bleach-containing cleaning product and the other applied an environmentally preferable product. Before and after C&D, the study team performed organic soil bioluminometer measurements on surfaces and collected cotton swab and wipe samples for total bacteria count, Staphylococcus aureus, and Clostridium difficile identification. RESULTS Both products removed microorganisms from tested surfaces. S aureus was found in 7 households, 1 strain of which was methicillin-resistant. Both products removed S aureus from all surfaces. Bleach-containing products removed somewhat more soil than environmentally preferable products, although results were statistically significant for only 1 surface. CONCLUSIONS The study showed similar, not identical, C&D performance for 2 cleaning products with potentially different consequences for respiratory health. Additional research is needed to develop robust recommendations for safe, effective C&D in home care.
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Affiliation(s)
- Nancy Goodyear
- Department of Biomedical and Nutritional Sciences, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA
| | - Pia Markkanen
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA.
| | - Christian Beato-Melendez
- Department of Biomedical and Nutritional Sciences, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA
| | - Hagir Mohamed
- Department of Biomedical and Nutritional Sciences, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA
| | - Rebecca Gore
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA
| | - Catherine Galligan
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA
| | - Susan Sama
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA
| | - Margaret Quinn
- Department of Public Health, College of Health Sciences, University of Massachusetts Lowell, Lowell, MA
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Ma C, Shang J, Miner S, Lennox L, Squires A. The Prevalence, Reasons, and Risk Factors for Hospital Readmissions Among Home Health Care Patients: A Systematic Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2017. [DOI: 10.1177/1084822317741622] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Gallone MS, Infantino V, Tafuri S. Health Care–Associated Infections in the Home Care Setting: Is It Time for a Surveillance System? J Am Med Dir Assoc 2017; 18:189-190. [DOI: 10.1016/j.jamda.2016.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
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Goodyear N. Increasing delivery of healthcare at home and the importance of hygiene. Perspect Public Health 2016; 136:208-9. [DOI: 10.1177/1757913916642964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Goodyear N, Brouillette N, Tenaglia K, Gore R, Marshall J. The effectiveness of three home products in cleaning and disinfection of Staphylococcus aureus
and Escherichia coli
on home environmental surfaces. J Appl Microbiol 2015; 119:1245-52. [DOI: 10.1111/jam.12935] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/23/2015] [Accepted: 08/04/2015] [Indexed: 12/14/2022]
Affiliation(s)
- N. Goodyear
- Department of Clinical Laboratory and Nutritional Sciences; University of Massachusetts Lowell; Lowell MA USA
| | - N. Brouillette
- Department of Work Environment; University of Massachusetts Lowell; Lowell MA USA
| | - K. Tenaglia
- Department of Work Environment; University of Massachusetts Lowell; Lowell MA USA
| | - R. Gore
- Department of Work Environment; University of Massachusetts Lowell; Lowell MA USA
| | - J. Marshall
- Toxics Use Reduction Institute; University of Massachusetts Lowell; Lowell MA USA
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Quinn MM, Markkanen PK, Galligan CJ, Sama SR, Kriebel D, Gore RJ, Brouillette NM, Okyere D, Sun C, Punnett L, Laramie AK, Davis L. Occupational health of home care aides: results of the safe home care survey. Occup Environ Med 2015. [PMID: 26209318 PMCID: PMC4819650 DOI: 10.1136/oemed-2015-103031] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES In countries with ageing populations, home care (HC) aides are among the fastest growing jobs. There are few quantitative studies of HC occupational safety and health (OSH) conditions. The objectives of this study were to: (1) assess quantitatively the OSH hazards and benefits for a wide range of HC working conditions, and (2) compare OSH experiences of HC aides who are employed via different medical and social services systems in Massachusetts, USA. METHODS HC aides were recruited for a survey via agencies that employ aides and schedule their visits with clients, and through a labour union of aides employed directly by clients or their families. The questionnaire included detailed questions about the most recent HC visits, as well as about individual aides' OSH experiences. RESULTS The study population included 1249 HC aides (634 agency-employed, 615 client-employed) contributing information on 3484 HC visits. Hazards occurring most frequently related to musculoskeletal strain, exposure to potentially infectious agents and cleaning chemicals for infection prevention and experience of violence. Client-hired and agency-hired aides had similar OSH experiences with a few exceptions, including use of sharps and experience of verbal violence. CONCLUSIONS The OSH experience of HC aides is similar to that of aides in institutional healthcare settings. Despite OSH challenges, HC aides enjoy caring for others and the benefits of HC work should be enhanced. Quantification of HC hazards and benefits is useful to prioritise resources for the development of preventive interventions and to provide an evidence base for policy-setting.
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Affiliation(s)
- Margaret M Quinn
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Pia K Markkanen
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Catherine J Galligan
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Susan R Sama
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - David Kriebel
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Rebecca J Gore
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Natalie M Brouillette
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Daniel Okyere
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Chuan Sun
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Laura Punnett
- Department of Work Environment, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Angela K Laramie
- Occupational Health Surveillance Programme, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Letitia Davis
- Occupational Health Surveillance Programme, Massachusetts Department of Public Health, Boston, Massachusetts, USA
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