Shang Jingjing, Larson Elaine, Liu Jianfang, Stone Patricia
School of Nursing, Columbia University, New York, NY.
School of Nursing, Columbia University, New York, NY.
Am J Infect Control. 2015 May 1;43(5):454-9. doi: 10.1016/j.ajic.2014.12.017. Epub 2015 Feb 10.
Patients in home health care (HHC), the fastest growing health care sector, are at risk for infection. The existing research on infection in HHC is often limited by small sample sizes, local scope of inquiry, and a lack of current data. There is no national study examining agency-level infection rates.
This secondary data analysis used a 20% random sample of the 2010 national Outcome and Assessment Information Set (OASIS) data. An infection case was identified when the HHC patient was hospitalized or received emergency care for respiratory infection, urinary tract infection, intravenous catheter-related infection, wound infection, or deterioration. Proportions of infection cases out of the total number of patients were calculated for the whole sample and for each HHC agency.
The final analysis included 199,462 patients from 8,255 HHC agencies. Approximately 3.5% of patients developed infections during their HHC stay, leading to emergency care treatment or hospitalization. Seventeen percent of unplanned hospitalizations among HHC patients were caused by infections. The agency-level infection rate ranged from 0%-34%, with an average of 3.5%.
To our knowledge, this is the first study to examine the proportion of hospitalizations or emergency care treatment caused by infection in HHC and the agency-level infection rate at a national level by using OASIS data. These data demonstrate that infection is a serious problem in HHC, and infection rates varied between agencies. The variance in agency level rates may be caused by differences in infection control policies and practices. Better infection surveillance system in HHC is needed to benchmark quality of care.
家庭医疗保健（HHC）是发展最快的医疗保健领域，该领域的患者存在感染风险。现有的关于家庭医疗保健中感染的研究往往受到样本量小、研究范围局限以及缺乏最新数据的限制。目前尚无全国性研究考察机构层面的感染率。
本二次数据分析使用了2010年全国结局与评估信息集（OASIS）数据的20%随机样本。当家庭医疗保健患者因呼吸道感染、尿路感染、静脉导管相关感染、伤口感染或病情恶化而住院或接受急诊护理时，即确定为感染病例。计算了整个样本以及每个家庭医疗保健机构中感染病例占患者总数的比例。
最终分析纳入了来自8255个家庭医疗保健机构的199462名患者。约3.5%的患者在接受家庭医疗保健期间发生感染，导致接受急诊护理或住院治疗。家庭医疗保健患者中17%的非计划住院是由感染引起的。机构层面的感染率在0%至34%之间，平均为3.5%。
据我们所知，这是第一项利用OASIS数据在全国层面考察家庭医疗保健中因感染导致的住院或急诊护理比例以及机构层面感染率的研究。这些数据表明，感染是家庭医疗保健中的一个严重问题，且各机构之间的感染率存在差异。机构层面感染率的差异可能是由感染控制政策和做法的不同所致。家庭医疗保健需要更好的感染监测系统来衡量护理质量。
