Home Health Staff Perspectives on Infection Prevention and Control: Implications for COVID-19

Pogorzelska-Maziarz, Monika; Chastain, Ashley M.; Mangal, Sabrina; Stone, Patricia W.; Shang, Jingjing

Objectives The role of home healthcare (HHC) services in providing care to vulnerable, often frail individuals with chronic conditions is critical. Effective infection prevention and control (IPC) in HHC is essential to keeping both healthcare workers and patients safe, especially in the event of an emerging infectious disease outbreak. Prior to the COVID-19 pandemic, we explored successes and challenges with IPC from the perspectives of HHC staff. Design Qualitative descriptive study Setting and Participants From May to November 2018, we conducted in-depth telephone interviews with 41 staff from 13 agencies across the nation. Methods Transcripts were coded by a multidisciplinary coding team, and several primary and subcategories were identified using directed content analysis. Results Four primary categories were generated, including: 1) Uniqueness of Home Healthcare, 2) Infection Prevention and Control as a Priority, 3) Importance of Education, 4) Keys to Success and Innovation. Participants perceived that IPC plays a big part in patient safety and reducing rehospitalizations, and protection of patients and staff was a major motivator for compliance with IPC. The identified challenges included the unpredictability of the home environment, patient/family dynamics, the intermittent nature of HHC, and staffing issues. Education was seen as a tool to improve staff, patient, caregiver and families’ compliance with IPC. Keys to success and innovation included: a leadership focus on quality, using agency infection data to improve quality, and a coordinated approach to patient care. Conclusions and Implications This qualitative work identified barriers to effective IPC in HHC, as well as important facilitators that HHC agencies can use to implement policies and procedures to improve patient care and keep staff safe. Leadership prioritization of infection prevention and control is key to implementing appropriate infection prevention and control policies and may be especially important in midst of a crisis such as COVID-19.