title: The prevalence of infections and patient risk factors in home health care: a systematic review.
abstract: BACKGROUND
  Home health care (HHC) has been the fastest growing health care sector for the past 3 decades. The uncontrolled home environment, increased use of indwelling devices, and the complexity of illnesses among HHC patients lead to increased risk for infections.
  
  
  METHODS
  A systematic review of studies evaluating infection prevalence and risk factors among adult patients who received HHC services was conducted and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Literature was searched using Medline, PubMed, and the Cumulative Index to Nursing and Allied Health as well as hand searching. Two reviewers independently assessed study quality using validated quality assessment checklists.
  
  
  RESULTS
  Twenty-five studies met the inclusion criteria and were reviewed. The infection rates and identified risk factors for infections varied dramatically between studies. In general, patients receiving home parental nutrition treatments had higher infection rates than patients receiving home infusion therapy. The identified risk factors were limited by small sample sizes and other methodologic flaws.
  
  
  CONCLUSIONS
  Establishing a surveillance system for HHC infections, identifying patients at high risk for infections, tailoring HHC and patient education based on patient living conditions, and facilitating communication between different health care facilities will enhance infection control in HHC settings. Future studies should use a nationally representative sample and multivariate analysis for the identification of risk factors for infections.
authors.affiliation: Columbia University School of Nursing, New York, NY. Electronic address: js4032@columbia.edu.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Shang
authors.affiliation: National Database of Nursing Quality Indicators, University of Kansas School of Nursing, Kansas City, KS.
authors.forename: Chenjuan
authors.initials: C
authors.lastname: Ma
authors.affiliation: Columbia University School of Nursing, New York, NY.
authors.forename: Lusine
authors.initials: L
authors.lastname: Poghosyan
authors.affiliation: Columbia University School of Nursing, New York, NY.
authors.forename: Dawn
authors.initials: D
authors.lastname: Dowding
authors.affiliation: Columbia University School of Nursing, New York, NY.
authors.forename: Patricia
authors.initials: P
authors.lastname: Stone
mesh_terms: D003141:Communicable Diseases / Q000453:epidemiology*; D018718:Home Infusion Therapy / Q000009:adverse effects*; D006801:Humans; D015995:Prevalence; D012307:Risk Factors
keywords: Home environment; Home infusion; Hospice; Increased risk; Infection rate; Infectious disease