Patients who need long-term central venous catheters (CVCs) for chemotherapy, total parenteral nutrition (TPN), outpatient parenteral antimicrobial therapy (OPAT), and other indications often maintain CVCs at home, with support from home nursing and home infusion agencies. The market for home infusion therapy grows 8% a year, and currently reaches 1.2 million patients yearly. Unlike in hospitals, home infusion therapy patients and their caregivers (i.e., family, friends, neighbors, or even coworkers) perform day-to-day CVC care and infusion initiation after training by home infusion or home health nurses. However, complications of home infusion therapy such as central line associated bloodstream infections (CLABSI) have not been a focus of research or regulation. In fact, we do not currently have a widely-accepted definition of CLABSI in home infusion therapy. Such a definition is urgently needed to perform benchmarking and industry-wide quality initiatives. Furthermore, improved understanding how to perform this work in home infusion therapy is needed. There is no CLABSI benchmark or reporting platform by which home infusion agencies can compare their CLABSI rates with others. There is no centralized reporting platform. Meanwhile, while CLABSI prevention toolkits are now standards of care in acute care hospitals, similar CLABSI prevention toolkits have not been widely implemented in home infusion therapy. Evidence-based adaptations, such as training materials specifically geared towards patients and informal caregivers, and specific advice on covering CVCs during bathing, have been developed but not widely implemented. We have previously gathered stakeholders in healthcare epidemiology, infection prevention, infusion nursing, and home infusion therapy using a modified Delphi approach to develop a pilot home infusion CLABSI definition. Through a collaborative of five home infusion agencies in different regions of the country, we will work, to validate and benchmark this new home infusion CLABSI definition, test the impact of feeding benchmarked home infusion CLABSI data back to agencies on CLABSI rates, and implement a CLABSI prevention maintenance toolkit in home infusion therapy. We will accomplish this through the following Specific Aims: (1) To determine the validity of a candidate home infusion CLABSI surveillance definition and barriers to its implementation by home infusion agencies, (2) To develop a benchmark for CLABSI rates in home infusion therapy patients and design and implement a dashboard for dissemination of benchmarked rates, and (3) To adapt and implement an existing CLABSI prevention toolkit for home infusion therapy and measure its impact on CLABSI rates in five home infusion agencies. The major outcomes of this work will be (1) a validated home infusion CLABSI surveillance definition, (2) a benchmark for home infusion CLABSI with a dashboard for dissemination of benchmarked rates, and (3) an understanding of the impact of a CLABSI prevention toolkit on home infusion CLABSI rates.

Public Health Relevance

Home infusion therapy, in which patients and informal caregivers perform central venous catheter maintenance, is a rapidly-growing area of healthcare, and central line-associated bloodstream infections (CLABSI) in this setting are an under-recognized concern that requires improved surveillance and prevention strategies. We propose to work with a collaboration of five home infusion agencies to validate and benchmark a candidate home infusion CLABSI surveillance definition, and to implement a healthcare worker and patient and caregiver-directed CLABSI prevention bundle.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
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Healthcare Patient Safety and Quality Improvement Research (HSQR)
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Henderson, Susan
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Johns Hopkins University
Internal Medicine/Medicine
Schools of Medicine
United States
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