Infection control practices in home healthcare

Within the national health care system, there are as many patients receiving health care in the home as in the inpatient setting. Although home healthcare has expanded in the United States, national infection surveillance, prevention, and control efforts have not kept up with the growth. Home healthcare nurses' bags are carried from home to home and are used to transport blood pressure cuffs, gloves, and other equipment. The question of whether they may be contaminated with human pathogens has not been answered. The purpose of this study is to evaluate whether the different routine care and handling practices of nurses' bags influences the presence of human pathogens. Organized by an integrated model of the Epidemiologic Model with Donabedian's SPO framework, the concepts of environment and agent were categorized utilizing the System--Process--Outcome constructs. A longitudinal research design was implemented. Four home healthcare agencies participated in this study. The study sample consisted of 127 nurses' bags; a total of 456 cultures were collected. Research questions tested for any significant correlations between the types of bacterial organisms isolated and: bag surface material type; routine cleaning frequencies and cleaning products used; and agency characteristics. Nurses in three of the four agencies completed questionnaires documenting the routine care and handling practices of bags. The responses were linked to each bag's culture results (n = 47). Five nurses from one home care agency agreed to hand and clothing cultures.;Chi-square, relative risk, and logistic regression revealed that when human pathogens or MDROs are isolated from the outside of the nurses' bags, there is statistically significant greater risk for the presence of human pathogens and MDROs on the insides of the nurses' bags, and on the patient care equipment found inside of the bags. MDROs isolated from the outside are associated with cloth surface types; and more MDROs isolated when agencies did not supply the bags and did not clean the bags routinely for their nurses. Bags cleaned with health care cleaners and bleach combined with soap and water had fewer human pathogens isolated from the outsides as compared to cleaning with household cleaning products.