Healthcare Associated Infections in Home Health Care

描述(申请人提供)：由于卫生保健服务从医院转移到社区，家庭卫生保健在过去30年中迅速增长。2010年约有1200万名家庭护理患者，随着人口老龄化，这一数字预计还会增加。医疗保健相关感染(HAI)是一种可预防的不良健康后果，在家庭保健环境中普遍存在。据估计，每年在家庭护理患者中发生120万感染，大多数与尿管或静脉(IV)导管有关。以前关于家庭护理患者中的HAIS的研究是在地方层面上进行的，没有使用当前的数据，并且受到样本量小和方法缺陷的限制。此外，还没有研究检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卫生保健感染研究中强调了这些因素。因此，使用当前具有可测量的环境因素和照顾者特征的国家数据库并使用合理的方法进行研究，对于更好地了解家庭护理环境中的禽流感的流行病学是必不可少的。拟议的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应对这一挑战，该数据集衡量患者的社会人口统计数据、环境因素、支持系统、健康状况、功能状况和卫生服务利用特征。其目的是：1)描述家庭护理环境中设备相关感染的发生率和趋势，特别是导管相关性尿路感染和静脉导管相关感染；以及2)确定家庭护理环境中与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。将计算每一年每种感染类型的感染患者的比例。将使用普通的最小二乘回归来确定趋势的统计意义。对于AIM 2，将只使用2009年的数据。将使用多水平COX比例风险模型来确定每种感染类型的危险因素。这项研究结果将是发展国家家庭保健感染监测系统的关键一步，并为未来预防和控制家庭保健环境中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.