Infection prevention and control challenges in Flemish homecare nursing: a pilot study
Home nursing is evolving towards more invasive care. Nevertheless, no national data are available on the prevalence of HAI in this setting. The aim of this pilot study is to explore the Flemish home care setting as a first step toward a national surveillance program. A survey, focused on patient characteristics and HAI, was conducted between 7 May and 20 July 2018 on 711 Flemish patients. Most of the patients (74%) are 65 years or older and half of them had a form of comorbidity. Assisting with personal hygiene and wound care were the most frequent services delivered by home care nurses. A comparison of the prevalence of infections diagnosed by a physician or applying uniform criteria (ECDC), revealed a similar prevalence of skin and soft tissue infections (9% vs. 8.5%) and urinary tract infections (4% vs. 4.5%). A positive MDRO-screening was found in 6% of the patients. This pilot study is a first step towards a standardized national surveillance in home care to collect information on the prevalence of HAI and it reveals several interesting facts and study pitfalls for this setting.
The importance of healthcare-associated infections (HAIs) in homecare (patients being cared for at their homes) is increasing year by year due to several factors. The first is a shift in focus from hospital care to homecare, a trend noted not only in Belgium but throughout Europe (Tarricone and Tsouros, 2008). This trend has been accelerated by governmental budget cuts and the emergence of patient-centred care. Belgian hospitals are pushed by the government to limit the number of hospitalisation days, resulting in earlier discharge from the hospital even, for example, when indwelling catheters are in place for patients. Further, most patients prefer continuing their medical treatment at home (Ellenbecker et al, 2008). Nowadays, patients are discharged with central lines for the administration of antibiotics, chemotherapy or parenteral nutrition at home. This, in turn, mandates more advanced homecare, resulting in a need for additional training for homecare nurses, with a specific focus on infection control. Dedicated and well-trained healthcare staff are crucial to prevent potentially life-threatening infections, such as catheter-related blood-stream infections. Shang et al (2014) studied the patient risk factors for infections in a homecare setting, and one of their conclusions was that the risk of HAIs was higher among frail patients who are receiving invasive and advanced care at home, than that among non-frail patients and those not receiving intensive care at home (Shang et al, 2014).
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