Discussion

Our survey analysis shows that professionals in healthcare epidemiology, home infusion therapy, and infusion nursing have different approaches to CLABSI surveillance in home infusion therapy. Although definitions for CLABSI in home infusion therapy have existed since 2008, ¹ these definitions have not been widely accepted among home infusion professionals. In addition, acute-care NHSN CLABSI criteria ² may not apply to home infusion therapy. The NHIA suggests that agencies report “access device complications,” including CLABSI, but they do not specify further. ⁹

We observed differences in what members of the 3 groups would consider a CLABSI. INS and NHIA members were more likely than SRN members to use a CVC tip culture or provider documentation as part of their criteria for CLABSI in home infusion therapy—neither of which is a component of acute-care NHSN or APIC-HICPAC criteria. ^{1 , 2} Few used APIC/HICPAC or acute-care NHSN criteria. ^{1 , 2} A prior study of pediatric home infusion agencies similarly showed that none used all APIC-HICPAC criteria in tracking CLABSIs.Reference Rinke, Bundy and Milstone ⁴

We also detected differences in CLABSI attribution and inclusion and exclusion criteria, particularly around whether to include data on a patient whose home infusion and home nursing agencies were unaffiliated with each other, or on patients who also receive care from outpatient infusion centers, outpatient oncology clinics, or hemodialysis centers. Participants also varied on CLABSI inclusion and exclusion criteria, including disagreement over what catheters should be included for CLABSI surveillance.

Ours is one of the first studies to obtain perspectives from home infusion agencies, home infusion nurses, and healthcare epidemiologists. We were able to gain perspectives from a wide variety of professionals, including those who work in nonprofit, for-profit, and academic settings.

However, our study had several limitations. We were unable to calculate response rates because we did not know which professional society members were eligible (ie, who worked in home infusion therapy). Low numbers of responses suggest the possibility of response bias. The surveys also differed among the professional societies because there were differences in item interpretation. We asked participants to forward the surveys to those with expertise in home infusion therapy CLABSI surveillance, but we are unsure how frequently that occurred.

Our data show that despite published definitions, ^{1 , 2 , 9 , 10} there are differences in how home infusion agencies, home infusion nurses, and healthcare epidemiologists perform CLABSI surveillance in home infusion therapy. We suggest that clarification of home infusion therapy CLABSI definitions occur through a transdisciplinary approach including experts in healthcare epidemiology, infection prevention, infusion nursing, home infusion therapy, home health nursing, parenteral nutrition, and quality metric development.

Table 1.

Variations in Components of Definitions for Central Line-Associated Bloodstream Infection in Home Infusion Therapy

Note. CLABSI, central line-associated bloodstream infection; CVC, central venous catheter; NHSN, National Healthcare Safety Network; APIC, Association of Professionals in Infection Control and Epidemiology; HICPAC, Healthcare Infection Control Practices Advisory Council; INS, Infusion Nurses Society; N/A, not applicable.

^a Healthcare epidemiologists were asked specifically about their main hospital’s internal home infusion agency.