Outbreak Investigation, Public Health and Health Policy
Background: Home healthcare (HHC) is becoming a leading source of post-acute services. Currently, most HHC patients are 65 years of age and older and have multiple chronic conditions, thereby increasing their risk of infections and rehospitalizations. With a nationally-representative survey, we aimed to better understand the current state of infection prevention and control (IPC) at HHC agencies.
Methods: A national survey, directed at administrators and clinical managers, was conducted from October 2018 to November 2019. Agencies were recruited from a national HHC conference, and a national random sample of 1,505 agencies stratified by census region, ownership status and rural/urban location. Questions were asked about IPC staffing, IPC compliance and training, and current IPC policies and procedures. Descriptive statistics were computed using Stata 13.
Results: 575 HHC agencies (35% response rate) responded; 63% had for-profit ownership. At responding agencies, 35.4 % of staff members in charge of IPC had received no specific IPC training, and 5.6% reported that they currently did not have a staff member in charge of IPC.
Over 60% of agencies provided staff training on IPC topics either annually or at new employee orientation. 82.3% reported measuring adherence to hand hygiene policies; policy adherence was measured by shadowing (84.9%) and knowledge assessments (71.8%).
Most HHC agencies (87.6%) reported collecting and reviewing infection data to identify trends. Overall, only 31% of agencies required staff influenza vaccination; however, a majority (61.4%) offered free influenza vaccinations to their staff. During the past influenza season, 62.7% of agencies had 75% or more of their employees vaccinated for influenza, and 9% reported not tracking that data.
Conclusions: This national study examining the current state of IPC in HHC can be used as a benchmark for quality improvement initiatives. Particularly, we learned that staff training around IPC and policies and procedures related to staff vaccination are currently inadequate.