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Infections and Infection Risks in Home Care Settings

Abstract Objectives: To describe the characteristics of home healthcare clients with respect to infection risks and the presence of infections. Design: Descriptive survey of client charts using a point prevalence design. Setting: A private San Francisco, California, Bay area home care agency. Participants: A random sample of 175 clients (28%) was taken from the active client list for a single day; demographic data and clinical data from the last visit prior to the selection day were collected from each chart. Results: The clients were predominantly elderly (mean= 68.6) with an average of 3.6 comorbid conditions; 12% had an invasive device. Over 20% had an infection on the day surveyed. Five percent had an infection that occurred during home care delivery Conclusions: A substantial proportion of home health clients have infections, and they represent persons with a number of the risks associated with infections. Guidelines for defining and monitoring infections in home care need to be developed. Hospital-based surveillance methods are not altogether appropriate in this setting; redesigning methods such as targeted surveillance, monitoring rehospitalization, or immunization practices are discussed as potential ways to measure quality of care in the home setting.