Healthcare Associated Infections in Home Health Care

描述（由申请人提供）：由于医疗保健服务从医院向社区的转变，家庭医疗保健在过去三十年中迅速发展。2010年，大约有1200万家庭护理病人，随着人口老龄化，这个数字预计会增加。卫生保健相关感染（HAIs）是一种可预防的不良健康结果，在家庭卫生保健环境中普遍存在。据估计，每年有120万例感染发生在家庭护理患者中，其中大多数与导尿管或静脉（IV）导尿管有关。以往关于家庭护理患者HAIs的研究是在地方层面进行的，没有使用当前的数据，并且受样本量小和方法缺陷的限制。此外，没有研究调查患者的生活环境或照顾者的特征。这些因素在家庭护理环境中很重要，感染控制和流行病学专业人员协会在家庭保健感染研究中强调了这一点。因此，利用现有的国家数据库，包括可测量的环境因素和照顾者特征，并采用合理的方法进行研究，对于更好地了解家庭护理环境中HAIs的流行病学是必要的。该研究将通过使用结果和评估信息集（OASIS）国家家庭护理数据集来解决这一挑战，该数据集测量患者的社会人口统计学、环境因素、支持系统、健康状况、功能状态和卫生服务利用特征。目的是：1)描述家庭护理环境中器械相关感染的发生率和趋势，特别是导尿管相关尿路感染和静脉导尿管相关感染；2)识别与家庭护理环境中这些设备相关感染相关的风险因素。2000年至2009年期间留置导尿管或接受家庭输液治疗的家庭保健患者的数据将从OASIS数据集中获得。如果患者因这两种感染中的任何一种而住院或接受紧急护理，将确定感染病例。将计算每年每种感染类型的患者感染比例。将使用普通最小二乘回归来确定趋势的统计显著性。目标2只使用2009年的数据。多层Cox比例风险模型将用于确定每种感染类型的危险因素。研究结果将是发展国家家庭卫生保健感染监测系统的关键一步，并为未来预防和控制家庭卫生保健环境感染的干预计划提供基础。

DESCRIPTION (provided by applicant): Home health care has been growing rapidly in past three decades because of the shift of health care delivery from hospitals to communities. There were approximately 12 million home care patients in 2010, and this number is expected to increase as the population ages. Healthcare associated infections (HAIs), a preventable adverse health outcome, are prevalent in home health care settings. An estimated 1.2 million infections occur annually among home care patients, and most are related to urinary catheter or intravenous (IV) catheters. Previous research studies on HAIs among home care patients were conducted at the local level, did not use current data, and were limited by small sample sizes and methodological flaws. Furthermore, no research has examined patients' living environments or caregivers characteristics. These elements are important in home care settings and are emphasized by the Association for Professionals in Infection Control and Epidemiology, Inc. for studies on home health care infection. Therefore, a study using a current national database with measurable environmental factors and caregiver characteristics, and utilizing sound methodology is imperative to better understand the epidemiology of HAIs in home care settings. The proposed study will address this challenge by using the Outcome and Assessment Information Set (OASIS) national home care dataset that measures patient socio-demographics, environmental factors, support systems, health status, functional status, and health service utilization characteristics. The Aims are to: 1) describe the incidence and trends of device-associated infections, specifically catheter associated urinary tract infections and intravenous catheter related infections, in home care settings; and 2) identify risk factors associated with these device-associated infections in home care settings. Data on home health care patients with indwelling urinary catheters or receiving home infusion therapy between 2000 and 2009 will be obtained from the OASIS dataset. Infection cases will be identified if patients were hospitalized or received emergency care for any of the two types of infection. The proportion of patients with infections will be calculated for each type of infection in each individual year. Ordinary least squares regressions will be used to determine the statistical significance of the trends. For Aim 2, only data from 2009 will be used. Multilevel Cox proportional hazard model will be used to identify the risk factors for each type of infection. The study findings will be a critical step in the development of a national surveillance system for home health care infections and provide a basis for future intervention programs to prevent and control infections in home health care settings.