Healthcare Associated Infections in Home Health Care

描述（由申请人提供）：在过去的三十年里，由于医疗保健服务从医院转向社区，家庭医疗保健迅速增长。2010年约有1 200万家庭护理病人，随着人口老龄化，这一数字预计将增加。医疗保健相关感染（HAI）是一种可预防的不良健康结局，在家庭医疗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，大多数与导尿管或静脉内（IV）导管有关。以前对家庭护理患者中HAI的研究是在地方一级进行的，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，没有研究调查病人的生活环境或照顾者的特点。这些因素在家庭护理环境中很重要，并由感染控制和流行病学专业人员协会强调。用于研究家庭卫生保健感染。因此，一项研究使用当前的国家数据库与可测量的环境因素和照顾者的特点，并利用健全的方法是必不可少的，以更好地了解HAI的流行病学在家庭护理环境。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，功能状况和卫生服务利用特征。其目的是：1）描述家庭护理环境中器械相关感染的发生率和趋势，特别是导管相关尿路感染和静脉导管相关感染; 2）识别家庭护理环境中与这些器械相关感染相关的风险因素。从OASIS数据集中获得2000年至2009年期间留置导尿管或接受家庭输液治疗的家庭医疗保健患者的数据。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，则将确定感染病例。将计算每一年每种感染类型的感染患者比例。将使用普通最小二乘回归确定趋势的统计学显著性。对于目标2，将仅使用2009年的数据。将使用多水平考克斯比例风险模型确定每种感染类型的风险因素。这项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.