A potential downside of home care: Insufficient CLABSI surveillance

A new study led by researchers at Baltimore-based Johns Hopkins University suggests the rise in home healthcare services could come with dangerous consequences: an increase in central line-associated bloodstream infections, or CLABSIs. 

On Jan. 12, a study published in the American Journal of Infection Control uncovered many staff who perform home infusion therapy, or HIT, received no formal training on CLABSI surveillance. Instead, HIT staff referenced learning on the job, prior experience and attending conferences. The findings are based on qualitative interviews researchers conducted with 21 home infusion staff from five large HIT agencies across 13 states and Washington, D.C.

Based on participant responses, researchers also identified three main barriers to HIT surveillance training on CLABSIs: A lack of user-friendly learning resources that accommodate demanding workloads; a lack of awareness on professional resources available; and a lack of formal training provided by HIT agencies. 

"There was a 300 percent increase in patients receiving HIT in the United States between 2008 and 2019, and many of these individuals are at risk for CLABSI," Sara Keller MD, study author and assistant professor of medicine at Johns Hopkins, said in a Jan. 12 statement. "Appropriate, accurate CLABSI surveillance to understand rates in the HIT setting is necessary to drive prevention efforts."

CLABSIs can occur when bacteria enter a patient's bloodstream through a central line catheter. Up to 1 in 4 patients who get a CLABSI may die, according to the CDC. 

In a Jan. 14 statement, the National Home Infusion Association said the findings are "not at all reflective of home infusion therapy standards and practices," citing a number of peer-reviewed studies that demonstrate the safety of home infusion. 

"NHIA and the association's members acknowledge that CLABSI is a serious complication that can occur in patients receiving IV therapies. However, we strongly disagree with the study's conclusions and generalizations about the infection prevention workforce in home infusion," Connie Sullivan, BSPharm, president and CEO of the association, said in the statement. "The infusion industry absolutely has specific requirements around monitoring and reporting rates of CLABSI and several independent, peer reviewed studies of home-based patients demonstrate lower rates of CLABSI compared to hospital settings. We do not agree that a qualitative study of five agencies is reflective of the entire industry, which consists of nearly 1,000 organizations."

Editor's note: This article was updated on January 17 at 1:45 p.m. CT. 



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