Shang Jingjing, Ma Chenjuan, Poghosyan Lusine, Dowding Dawn, Stone Patricia
Columbia University School of Nursing, New York, NY.
National Database of Nursing Quality Indicators, University of Kansas School of Nursing, Kansas City, KS.
Am J Infect Control. 2014 May;42(5):479-84. doi: 10.1016/j.ajic.2013.12.018. Epub 2014 Mar 20.
Home health care (HHC) has been the fastest growing health care sector for the past 3 decades. The uncontrolled home environment, increased use of indwelling devices, and the complexity of illnesses among HHC patients lead to increased risk for infections.
A systematic review of studies evaluating infection prevalence and risk factors among adult patients who received HHC services was conducted and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Literature was searched using Medline, PubMed, and the Cumulative Index to Nursing and Allied Health as well as hand searching. Two reviewers independently assessed study quality using validated quality assessment checklists.
Twenty-five studies met the inclusion criteria and were reviewed. The infection rates and identified risk factors for infections varied dramatically between studies. In general, patients receiving home parental nutrition treatments had higher infection rates than patients receiving home infusion therapy. The identified risk factors were limited by small sample sizes and other methodologic flaws.
Establishing a surveillance system for HHC infections, identifying patients at high risk for infections, tailoring HHC and patient education based on patient living conditions, and facilitating communication between different health care facilities will enhance infection control in HHC settings. Future studies should use a nationally representative sample and multivariate analysis for the identification of risk factors for infections.
在过去30年中，家庭医疗保健（HHC）一直是增长最快的医疗保健领域。家庭环境不受控制、留置设备使用增加以及HHC患者疾病的复杂性导致感染风险增加。
在《系统评价和Meta分析的首选报告项目》的指导下，对评估接受HHC服务的成年患者感染患病率和危险因素的研究进行了系统评价。使用Medline、PubMed和护理及相关健康累积索引以及手工检索进行文献检索。两名评价者使用经过验证的质量评估清单独立评估研究质量。
25项研究符合纳入标准并进行了综述。不同研究之间的感染率和确定的感染危险因素差异很大。一般来说，接受家庭肠内营养治疗的患者比接受家庭输液治疗的患者感染率更高。确定的危险因素受到样本量小和其他方法学缺陷的限制。
建立HHC感染监测系统，识别感染高危患者，根据患者生活条件调整HHC和患者教育，并促进不同医疗机构之间的沟通，将加强HHC环境中的感染控制。未来的研究应使用具有全国代表性的样本和多变量分析来识别感染危险因素。
