In 1993, nurses working in home care began the Infection Surveillance Project (ISP). Criteria and definitions were developed for infections associated with central venous and bladder catheters. In addition, internal forms and procedures for home care agencies to use for active surveillance were developed.
ISP participants have benefited from being able to benchmark with other home care agencies. But more importantly, quality care for patients has improved because sources of infection related to patient population, staff and family, as well as techniques and compliance with accepted standards of care are identified.
Enroll your company as a project participant and join those on the forefront of home care data collection!
For additional information, please contact:
Missouri Alliance for Care at Home
2420 Hyde Park, Suite A
Jefferson City, MO 65109
Phone: (573) 634-7772
Email: admin@mocareathome.org
Infection Surveillance Project
Benchmarking Project Tools
Frequently Asked Questions
1. Is it best to collect data monthly or quarterly?
That depends on the time you have available for data collection and the size of your agency. Some agencies collect and tally data each month adding the numbers for their quarterly report. If you do it this way be sure you count the patient only once for the quarter. Others collect data for the entire quarter and tally at the end of the quarter. Either is acceptable and should be done according to the needs of your agency.
2. Do we count a CVC when our home health staff is not involved in accessing the device or its care?
Yes, always.
3. How do you count line days on a CVC that has more than one lumen?
Whether single, double or triple lumen, it is still one central line; therefore you count only the actual number of days on service with the device in place. However, if you have two central lines, then you would count the days for each line, but would count your patient only once.
4. Do we count a catheter as a device and count the days if the patient is on prophylactic antibiotics? When is an infection a second occurrence?
Yes, count the device days even when a patient is on prophylactic antibiotics. That patient would have an infection counted as a second occurrence if an exacerbation of symptoms caused a doctor to prescribe a new antibiotic or change the dose to treat symptoms listed under the project definitions.
As stated in the definition, a second occurrence of an infection happens when the patient is off antibiotics for 14 days with no recurring symptoms (noting that Zithromax extends treatment for five [5] days by pharmacologic properties).
5. How do we count patients whose services are on hold for PRN services, but remain in their home (frequency of skilled visits reduced to a medical need basis)?
As long as they are under a 485 treatment plan with your agency, continue to count the days as though they were being seen on a regular basis. They could get an infection that you would then treat.
6. How do I count days if a patient has both a suprapubic catheter and an indwelling urethral catheter?
Count the device days for each catheter, but count the patient only once.
7. Do you include a patient who does intermittent catheterization?
No.
8. Do we count nephrostomy tubes because they are draining urine?
No, only indwelling bladder catheters.
9. If your OASIS policy is to put patients on hold when they go to an inpatient facility, do you count the days while they are in the facility?
No, you begin counting again when they return to their home. Defining an infection to record on your data sheet then reverts to the 72-hour rule unless you know the patient entered the inpatient facility with the infection for diagnosis and treatment. The infection date would then become the date the symptoms caused them to enter the facility and resolution date would also be the same definition – 14 days after the completion of antibiotic treatment with no recurring symptoms. Remember that any portion of the day the patient is in their home is a day you count as a device day.