Infectious Disease Prevention and Home Health

Infectious disease prevention contributes significantly to keeping patients and health care providers safe.  The World Health Organization (WHO) estimates that there are 1.4 million health associated infections (HAI) at any given time.  Homecare treatments that have high susceptibility to infection are infusion therapy, urinary tract care, enteral therapy, and wound treatments.  Health care providers are often the cause for spreading infection to their patients.  Proper hand hygiene alone can dramatically reduce the risk of spreading infectious organisms.

The CDC reports that “on average, health care providers clean their hands less than half of the times they should.  Eighty percent of communicable diseases are transmitted by touch.  The CDC reports that in the general population proper hand washing reduces respiratory illness (cold, flu) by 16%-21% and diarrheal illness by 31%.  There is a reduction of diarrhea illness by 58% for people who have compromised immune systems.  Feces is a major cause of diarrhea and respiratory illness. These germs can spread after a person fails to wash their hands properly after using the toilet, changing a brief/diaper, or handling raw meats that have invisible amounts of animal feces on it.  When the lid is up on a toilet and it is flushed, a fine mist containing bacteria such as E. Coli and Staph is spread over an area of 6 square meters. Are you and your employees washing your hands properly in all situations that warrant hand washing?

Infectious organisms (germs) can remain transferable for several minutes to 24 hours, depending on the type of bacteria or virus.  Germs generally remain active longer on stainless steel, plastic, and similar hard surfaces than on fabric or other soft surfaces.  Personal contact with an infected person — such as a handshake or breathing in droplets from a cough or sneeze — is the most common way respiratory germs spread. It’s possible to catch a respiratory illness from handling an object shortly after an infected person sneezed or coughed. Frequent ways to transmit infectious organisms include frequently touching your eyes, nose, and mouth.  Objects with high susceptibility to transmit infectious disease are computer keyboards/mouse, tablet screens, cell phones, handrails, doorknobs, sinks, table tops, toilets, assistive devices, food and drink.   Utilizing proper hand washing technique can minimize the occurrence of transmitting an infectious disease and reduce the usage of antibiotics.  Common areas missed with hand washing are the finger nails, dorsum of the hand, wrists, and thumb.  The nails and fingertips are the most prevalent areas for microbes.

The lack of or poor hand washing statistics and data associated with transmitting infectious disease are astonishing.  In home health, hand washing is an important part of maintaining a safe and healthy environment for our patients.   As providers in home health, we need to be held accountable for all aspects of hand washing, including before and after all patient care.  The acuity and number of patients on home health is continuing to increase due to the focus on reducing hospital and skilled nursing admissions and length of stay.  Therefore, patients receiving home health services have higher susceptibility to contracting an infectious disease.

The infectious prevention and disease program in home health should be an area of focus for all agencies.  This needs to involve clinician education, competencies before, during, and after patient care and the tracking of data to identify trends and areas of opportunity to decrease the transmission of infectious diseases to patients, caregivers, and clinicians.  Home health utilizes various protocols to prevent the spread of infectious diseases, such as bag technique and hand washing.  However, how confident are you that everyone in your home health agency is performing proper hand washing and equipment cleaning techniques correctly for all patients and situations?

Home health utilization continues to increase due to longer life expectancy, advanced medical interventions, and decreased length of stay for hospital and skilled nursing.   The information stated above in conjunction with increased antibiotic resistance and the acuity of the patients receiving home health could change the standard precautions required to prevent the spread of infectious diseases in home health.  Home health involves hands-on treatment that can transfer microbes between the clinicians and patients during wound care, catheter care, transfers, gait, bathing, toileting, and dressing training.  Clinicians then travel from one patient’s home to the next patient’s home throughout the same day.  Is proper hand washing, bag technique, and current procedures for cleaning equipment enough to decrease the spread of infectious diseases or will foot covers, gowns, and/or masks become mandatory requirements in home health? Will the evolving changes in health care require the addition of mandated measures to the current standard precautions to prevent the spread of infectious disease in home health?

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