Healthcare-associated infections (HAIs) in homecare are increasing every year because of several reasons. Firstly, a shift in the treatment settings from hospital care to home care seems to dominate Belgium and the entire t Europe. This shift is articulated by the government’s budget cuts, an emergence of patient-centered treatment. Healthcare givers in Belgium are pushed by the government to minimize patients’’ length of stay by discharging clients from hospitals earlier than the needed period (Maelegheer et al., 2020). For instance, patients on drips are discharged even if the drips are available for every patient that needs a transfusion. Furthermore, a significant number of clients prefer home-based medical treatment than hospital-based ones. Contemporarily, patients are discharged with central lines to provide antibiotics, chemotherapy, or parenteral nutrition at home. This scenario, in turn, signalizes advanced home-based care, resulting in a prerequisite for supplementary training for homecare physicians, with an explicit emphasis on infection control (Maelegheer et al., 2020). Knowledgeable and devoted healthcare professionals are fundamental to prevent potentially life-threatening ailments, including catheter-related blood-stream diseases. Thus, the study intends to uncover the risk factors for infections in home-based care settings for skin and soft tissue infections and urinary tract infections.
The patient-risk factors for infections in a home-based care setting vary significantly with the ones within the healthcare agency. The risk factors of HAIs among fragile patients who are receiving bellicose and progressive care at home are higher compared to non-weak patients that are not receiving home-based rigorous care (Maelegheer et al., 2020). Additionally, data on the prevalence of HAI is limited in the homecare setting compared to those in the healthcare setting. A Belgian federal survey conducted in 2007 shown an HAI occurrence of 6.2% in hospitalized clients (Maelegheer et al., 2020). Contemporarily, no viable data are available in Belgium concerning the pervasiveness of HAIs in home-based care locales. More so, healthcare givers in the rest of Europe have limited epidemiological data on HAIs in the home care setting. The World Health Organization (WHO) acknowledges an increasing shift towards homecare. For example, HAI prevalence in France amounted to 6.8% among clients receiving home care, a percentage that is contrasted with the occurrence of HAI detected in healthcare agencies in Belgium (Maelegheer et al., 2020).
Like the ones conducted by Rykkje and Hem (2020), several studies focus on the prevalence of HAIs to patients in healthcare settings. However, no data available in Belgium that reveals the prevalence of HAIs in home-based settings. Thus, the present study’s objective was to examine the demographic physiognomies, comorbidities, and living conditions of HAIs to patients in-home care settings to better comprehend homecare nursing indications. Additionally, the study aimed at examining the prevalence of two types of HAIs, with these being the skin and soft tissue infections and urinary tract infections in the Flemish home-based care setting (Maelegheer et al., 2020). These statistics may offer understandings into the menaces of contracting HAIs at home, which signalize a primary point to formulate guidelines on infection control and prevention in homecare settings.
According to Maelegheer et al. (2020), the Flemish infection control group conducted a study on the prevalence of HAIs on patients in-home care settings. As noted by Maelegheer et al. (2020), the Methodology of the European Centre for Disease Prevention and Control (ECDC) played an advisory role in setting up the study conducted by the Belgian Institute for Public Health to identify the different point prevalent studies (Maelegheer et al., 2020). All participants in home-based care in the Flanders state, specifically, public corporations that provide homecare and the agencies representing autonomous homecare nurses, were contacted and enquired to participate in the research. This group was divided into two subgroups, with these being home healthcare agencies and self-employed nurses (Maelegheer et al., 2020).
Study design and data collection
The data was collected between the period of 7 May and 20 July 2018. All homecare nurses in Flanders were requested to participate in the research. Based on the nurses’ client lists’ arrangement, a randomized assortment was performed to include patients (Maelegheer et al., 2020). After obtaining oral informed consent from the patient, the participating home care nurses were asked to fill in questionnaires based on their hospital records. The patient’s consent was listed in the questionnaire. The ethics committee of Ghent University Hospital approved the study and methods of collecting data (Maelegheer et al., 2020).
Data collection relied on the announcement with the GP or appraising notes in the patients’ healthcare histories. Unavailability of information on MDRO colonization stemmed from a miscommunication between these hospital services (Maelegheer et al., 2020)
In Belgium, nurses denied ordering laboratory testing; thus, the availability of data on MDRO rerun depended entirely on the patient’s GP, who bear limited contact with patients compared with home-based care nurses. Aside from communication with the GP, excellent communication with healthcare agencies or other care amenities is also vital in MDRO administration (Maelegheer et al., 2020). A standardized transmission document between hospitals and home care can be part of the solution. In this study, MDRO screening recorded positive results in 6% of the patients, and the causal organism in half these cases was MRSA (Maelegheer et al., 2020).
Limitations of the Study
The study has myriad flaws. For instance, the target of a minimum of 2000 comprehensive appraisals was not reached. The minimal number of included patients prevented a valid estimation of the HAI occurrence and determining independent risk factors of HAI in Flemish homecare locales. In addition, the questionnaire was misunderstood despite consistent dialogs and pilot tests explained by the infection control team. Notably, the term ‘medical devices’ in a healthcare context refers to foreign medical bodies such as indwelling lines or inquiries, but homecare nurses use this term to mean buttresses or a wheelchair (Maelegheer et al., 2020). Thus, there is a possibility that patients scored these kinds of expedients as ‘other,’ resulting in a potential overestimation of a medical device used. Concerning the MDRO carriage, undesirable results could not be renowned from unknown ones due to several inadequate responses (Rykkje et al., 2020). Thirdly, the free text was denied in an attempt to standardize the outcomes. In some questions, this led to the ‘other’ grouping being noteworthy, without any existing context.
This study provides some understandings into the Flemish setting of homecare nursing and may contribute to subsequent studies on the risk of infections in this setting. The biographers believe that a consistent nationwide survey is essential to collect extra data on the pervasiveness of HAIs in-home care settings, which may help in the improvement of IPC guidelines specifically modified for homecare nursing. In the past few years, several conventions, studies, and strategies have been presented to indorse IPC in nursing homes. Still, for clients receiving increasingly aggressive and progressive care at home, the literature and guidelines are missing. In a view to supporting homecare services, funding is instantly needed, with an emphasis on certifying adequate staff figures and their suitable drill.
Maelegheer, K., Dumitrescu, I., Verpaelst, N., Masson, H., Broucke, C., Braekeveld, P., ... & Floré, K. (2020). Infection prevention and control challenges in Flemish homecare nursing: a pilot study. British Journal of Community Nursing, 25(3), 114-121. https://doi.org/10.12968/bjcn.2020.25.3.114
Rykkje, L., Holm, A. L., & Hem, M. H. (2020). Norwegian nurses’ reflections upon experiences of ethical challenges in older people care-A qualitative thematic analysis. https://assets.researchsquare.com/files/rs-26698/v1/8982e094-83be-42ea-bd88-92ca168c1d3e.pdf
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