Infection surveillance in home care: device-related incidence rates

Four home health agencies of different sizes, including a rural agency with many branch offices, participated in a surveillance study.

These agencies used the same definitions for symptomatic urinary tract infections in patients with urinary catheters and for bloodstream infections in patients receiving intravenous therapy. Identical data and methods were used for calculating infection rates, with device-days consistently used as the denominator. Each agency's primary goal was to develop baseline information about its own infection rates and to use these statistics to detect problems and trends. Chart audits were performed if trends or problems were identified. A secondary goal was to compare or benchmark infection rates, because there is almost no published information in this area of home care.

We found that our mean infection rates for symptomatic urinary tract infection among patients with urinary catheters and for bloodstream infection among patients receiving intravenous therapy were similar among the four agencies. The mean rates for all four agencies were 4.5 symptomatic urinary tract infections/1000 device-days and 1.1 bloodstream infections/1000 device-days.

The methods used here can be implemented in other home care agencies. Using the same definitions, collecting data for the same type of infections, and using the same rate calculations make infection control benchmarking possible between home health agencies.