[Hygiene in home care. A study with home care providers]

Barriers and facilitators to infection prevention practices in home healthcare: a scoping review and proposed implementation framework

Infection prevention and control (IPC) research has focused on the hospital setting, neglecting the rapidly expanding home healthcare (HHC) sector. Current infection prevention recommendations do not reflect the challenges specific to the HHC setting. This scoping review considered any original studies reporting on barriers or facilitators to infection prevention practices in the context of HHC. Study characteristics were mapped, and a descriptive content analysis was performed. Based on the findings we propose a framework of eight HHC setting characteristics relevant to infection prevention implementation. 33 studies fulfilled the eligibility criteria. A majority of studies addressed sharps injury or blood and body fluid exposure prevention (N=15) and the majority were conducted in the United States (N=23). Study methodologies employed were surveys (N=18), qualitative (N=11), direct observation (N=7), and one interventional study. The HHC setting characteristics relevant to infection prevention implementation were: the care process in the patient's immediate environment; the need to bring equipment and materials into the home; the provision and financing of equipment and materials; the use of patient space and facilities; the unique position of and the expectations towards HHC providers; working alone with little support; the intermittent nature of care; the attitudes of HHC providers formed by their work circumstances. Interventional studies generating higher-quality evidence for implementation are lacking. Furthermore, implementation of aseptic technique and the decontamination and reprocessing of equipment are poorly studied in the HHC setting and deserve more research interest. The proposed framework may guide future research and implementation work.

[Methicillin-resistant Staphylococcus (MRSA, MRSE) in the nose, paranasal sinuses and sputum]

Detection of Staphylococcus in humans can be of extremely varying importance ranging from commensal to pathogens of fatal infections. MRSAs in particular are iatrogenic and nosocomial infective pathogens, which are a threat to the success of medical treatment. In this review the causes for occurrence and the spread of MRSA are presented and the heterogeneity of MRSA due to the presence of additional resistant pathogens (VISA, VRSA) and pathogenetic forms (cMRSA) will be discussed. The current diagnostic and therapeutic procedures in various situations for MRSA in the nasal and paranasal sinuses and sputum will be discussed exemplified by an actual case. The danger of colonization by MRSA will be discussed with reference to the literature as nasal colonization can be accompanied by a greatly increased risk of an invasive infection and transmission of the pathogen to other persons.

[Risk of infection in the home environment. Plea for a new risk assessment]

Within the last two decades risks posed by infectious diseases outside of hospitals and nursing homes had no high significance in the public perception. The home environment is regarded as a save shelter from infectious risks. In the mean time there have been dramatic socio-demographic, health policy and technological changes which have increased infectious risks outside medical facilities. In Germany up to 1.4 million people with multiple morbidities are nursed at home. Technological changes with the aim to protect the environment, like reduction of water temperature and water volumes in washing processes has lowered the efficacy to control pathogens. Thus it is time to revise the process of risk assessment in which not only aspects of environmental protection but also those of health protection must be taken into account. The article gives an overview of new risks and epidemiological changes and discusses the necessity of a new risk assessment and risk management approach which hopefully will lead to a changing paradigm.