APIC defines home health care infection criteria

Abstract

Definitions for nosocomial (hospitalacquired) infections have been in existence for a number of years; the last modification was published in 1996 (1). By its original definition, nosocomial (Gr. noses = disease, komeion = to take care of) referred to ANY facility involved in the care of the sick. HOWever, conventional usage over the past 30 to 40 years has applied the definition to hospitals only. To complement the approach to acute care, definitions for surveillance of infections in long-term care facilities were developed almost 10 years ago (2). The criteria for the definitions of infections occurring in the hospital or in long-term care facilities depend upon clinical findings and the results of a variety of diagnostic tests. Diagnostic testing is less frequently associated with home health care where only clinical observations may be used. This has resulted in situations where various agencies, for example those involved in reimbursement, may not accept a diagnosis. Consequently, the Home Care Membership Section of the Association of Practitioners of Infection Control (APIC) has published draft definitions for the surveillance of infections in the home heath care setting (3). The reasons for infection surveillance are process and outcome oriented Process involves the following issues: (i) compliance with regulatory and accrediting agencies, (ii) establishment of baselines including laboratory surveillance data, (iii) evaluation of control measures, (iv) education of home health care personnel at all levels, and (v) identification of outbreaks. Outcome objectives include reduction in morbidity, mortality, cost, and suffering. The purpose of employing definitions of surveillance in the home health setting is to establish a baseline so that each agency can monitor trends. Valid, written definitions will thus ensure consistency, accuracy, and reproducibility of the reported data. The use of definitions is only part of the equation. The individuals responsible for collecting information must be trained because there is a recognized paucity of trained infection control personnel employed by home health care agencies. Epidemiologists trained in analyzing, interpreting, and reporting the data must be included, as well as those who will make decisions to improve patient care based upon the results. Importantly, cause, the ability to prevent, and the etiology of the infection are not part of the definition, whether hospital-acquired or home health care associated. The acquisition of the disease at home does not mean it was caused by the home health care agency just as the acquisition of an infection in the hospital does not mean the hospital is responsible. Risk factors, the patient’s health and immune status, a variety of extrinsic factors, the nature and quantity (inoculum size) of the infectious agent, and various environmental factors all contribute to the acquisition of an i&&iOn. To this end the APIC membership group associated with home care pub lished their proposal for definitions of a variety of infections (3). These de&itions address infections at the following sites: (i) urinary tract (ii) respiratory tract, (iii) skin, (iv) bone, (v) eye, ear, nose, and mouth, (vi) gaatrointestmal, and vii) bloodstream. The details of the draft definitions are too extensive for this commentary and need to be examined in detail by those parties who areintereste4l. The underlying feature of the definitions is the issue of baseline. Consideration must be given to whether the symptoms are new or acutely worse from the established baseline. The definitions include more than a single sign, symptom, or laboratory finding. The availability of the &finitions will greatly assist home health care agencies in improving patient care in the home.