Risk of Infection Rises in Home Care

From the WebMD Archives

March 13, 2000 (Atlanta) -- Increasing numbers of patients are receivingcare at home -- a trend that is putting patients at greater risk of infection-- and placing a huge burden on families, according to research presented atthe CDC's 4th Decennial International Conference on Nosocomial andHealthcare-Associated Infections held in Atlanta.

Over the past decade, the number of patients receiving care at home hasrisen dramatically, the CDC report says. An estimated 8 million Americansreceived home care in 1996, based on the most recent data available. That sameyear, an estimated 11,400 home care agencies discharged nearly 7.8 millionpatients, representing 69% and 150% increases in discharged home care patientsrespectively since 1992.

Nearly 10% of home care patients had an invasive medical device that istypically used in other, more structured health care settings. For example,ventilators, urinary catheters, and intravascular (IV) catheters are used inthe home and are all potential sources of infection if not cared for properly,says Robert Gaynes, MD, chief of nosocomial infections surveillance activity inthe CDC's hospital infections program.

Gaynes tells WebMD, "The burden is being placed on family caregivers whohave to provide that care. A significant challenge lies in making sure thatfamily members are properly educated in health care procedures, in preventinginfections. Yet home care agencies -- often, because of economics -- can onlysupply visiting nurses in some cases no more than twice a week." HealthCare Financing Administration reimbursement drives much home care practice, andin many cases is now covering only twice-a-week home care nursing visits.

Preliminary investigations have revealed a very diverse industry, saysWilliam Jarvis, MD, chief of investigation and prevention branch for the CDC'shospital infections program. He tells WebMD, "In some instances, we'vefound that the home health company just delivers supplies to the front porchand family members provide therapy. ... This industry is changing very rapidly.Five to seven years ago, maybe two companies looked like they were going todominate the market. Now there are hundreds and hundreds of companies that areproviding home infusion therapy alone."

To assess the magnitude of the infection rate problem -- and to eventuallyprovide quality-of-care comparisons -- the CDC is beginning to collect datafrom home care companies across the country, says Jarvis. Without suchinformation, patients and their families will be choosing a home care company-- many of which do not have infection control programs -- without all thefacts.

"Otherwise, you're at your local hospital and they have 10 infusioncompanies they have contracts with. Do you go with the one that's moreconvenient? I want to go with the one that's best. And unless they'recollecting infection data, we really can't compare institutions," saysJarvis.

In providing commentary, John E. McGowan, MD, professor of epidemiology atEmory University's Rollins School of Public Health and professor of Medicine atEmory University School of Medicine, both in Atlanta, tells WebMD, "We haveforced families to become health care providers for patients who are sickerthan they used to be. I think that's a very difficult burden. We need to putour attention on family health education. It's a clear concern, a clearneed."

McGowan adds, "The home health care nurses are now on the clock justlike physicians in the hospital. All of a sudden they're obliged to see acertain number of patients in a certain number of minutes, so the amount ofeducation they have the time to provide is limited. I'm sure they have thedesire, but they don't have the time to spend with the families to make surethis gets done. These are great burdens, and I applaud the CDC [for] addressingthis in more detail."

In the course of monitoring his own patients, Charles Ericsson, MD, head ofclinical infectious diseases at the University of Texas School of Medicine inHouston, tells WebMD, "The whole concept [of home care] places a physicianlike myself in a very awkward position of having the same responsibility forthe patient but no way to monitor the patient. I typically insist that thepatient get back and see me once a week if they're on four or five more weeksof IV therapy, so I can monitor the site of the line myself because not allnurses are created equal and they sometimes miss symptoms that may be moresubtle clues."

Ericsson adds, "If you have the patients themselves [monitoring theirown IV lines], with the nurse coming out once a week, which we're seeing moreoften, it's no surprise to me that the infection rate is going up. It wouldn'tsurprise me that this is a hidden downside of trying to save money. A seriousinfection may require a brief hospitalization to not only get the line out butput [the patient] on an antibiotic for the new infection."

To help consumers identify good-quality home care companies, Ericsson offersadvice: "You'll get a sense if they appear truly devoted to teaching youexactly what needs to be done and following through to make sure you're doingwhat you were taught to do."

Vital Information:

  • Increasing numbers of Americans are receiving health care at home, and manyof these patients are using invasive medical devices, placing them at increasedrisk of an infection.
  • Family caregivers must be properly educated in health care procedures andpreventing infections.
  • Home health care companies can help families and patients, but evenhigh-quality companies' financial constraints often limit the number of visitsthe company is able to provide.