Perspectives on central-line-associated bloodstream infection surveillance in home infusion therapy

The Infusion Nurses Society (INS) is a 6,000-member global organization of primarily nurses who work in all practice settings where infusion therapy is delivered, including home infusion therapy.5 The National Home Infusion Association (NHIA) is a 400-member trade organization focused on providing infusion products and services in the home.6 The Society for Healthcare Epidemiology of America Research Network (SRN) is a network of 111 unique healthcare institutions that collaborate on research to prevent healthcare-associated infections and antibiotic resistance.7 Eligible respondents were those whose primary practice setting was the home, who worked for a home infusion or home health nursing agency, or whose hospital had a relationship with home infusion or home nursing agencies. Variations in Components of Definitions for Central Line-Associated Bloodstream Infection in Home Infusion Therapy Characteristic Infusion Nurses (N = 87), No. (%) Healthcare Epidemiologists (N = 27), No. (%)a Home Infusion Agencies (N = 26), No, (%) P Value for Difference Denominator data Per overall no. of patients 7/62 (11.3) 4 (14.8) 0 (0.0) .40 Per line days at home 30/62 (48.4) 7 (25.9) 11 (42.3) .14 Per month N/A 5 (18.5) 1 (3.8) .092 Per quarter N/A 2 (7.4) 7 (26.9) .059 Therapy days at home 0/62 (0.0) 1 (3.7) 6 (23.1) .001 Unknown 5/62 (8.1) 3 (11.1) 0 (0.0) .61 Overall number of infections only 15/62 (24.2) N/A N/A N/A Line day definition Days at home with CVC N/A N/A 7 (26.9) N/A Days from third day at home with CVC to removal N/A N/A 1 (3.8) N/A Exclude days if patient is readmitted N/A N/A 3 (11.5) N/A Days from CVC insertion to removal N/A N/A 1 (3.8) N/A CLABSI definition: provider note in chart 36 (41.4) 4 (14.8) 11 (42.3) .042 Positive culture of CVC tip 38 (43.7) 2 (7.4) 11 (42.3) .002 NHSN criteria 35 (39.1) 9 (33.3) 8 (30.8) .61 Positive blood culture 23 (26.4) 2 (7.4) 8 (30.8) .080 APIC/HICPAC criteria 16 (18.4) 1 (3.7) 0 (0.0) .043 INS standards 2 (2.3) N/A 0 (0.0) .67 Inclusion criteria Would include data from patient whose home infusion and home nursing agencies are not affiliated 47 (54.0) 7 (25.9) 13 (50.0) .037 Would include data from patient whose CVC also accessed in outpatient infusion center 38 (43.7) 4 (14.8) 10 (38.5) .025 On hemodialysis 24 (27.6) 3 (11.1) 5 (19.2) .33 CVC also accessed in oncology clinics 35 (40.2) N/A 9 (34.6) .61 Someone also receiving home parenteral nutrition 55 (63.2) N/A 19 (73.1) .35 Someone receiving only product N/A N/A