2444. Infection Prevention in Home Healthcare: Results from a National Study of Home Health Agencies

BACKGROUND: As the population of older Americans with chronic conditions continues to grow, the role of home healthcare (HHC) services in improving care transitions between acute care and independent living has become a national priority. This has led to the development of value-based purchasing (VBP) initiatives, changes in the Centers for Medicare and Medicaid Services’ Home Health Conditions of Participation, and the Joint Commission’s national patient safety goals for HHC. We aimed to describe the infection prevention and control (IPC) infrastructure in US home health agencies (HHA). METHODS: From March to November 2018, we conducted in-depth, phone interviews with 41 staff from 13 HHAs across the United States, including administrators, IPC and quality improvement (QI) personnel, registered nurses and home health aides. In October 2018, we launched a nationwide survey to a random sample of 1,500 HHAs stratified by census region, ownership status and urban/rural location, and achieved a 40% response rate. Transcripts of the qualitative interviews were coded and themes were identified using content analysis. Survey data were analyzed using descriptive statistics. RESULTS: Themes from the interviews included: 1) Uniqueness of HHC setting, 2) Importance of staff and patient/caregiver education, (3) Care coordination challenges, and, (4) Keys to success and innovation. From the surveys, we found that, at the majority of HHAs, the staff member in charge of IPC had other responsibilities including QI (57%), clinical/administrative/managerial (49%), supervision of clinical services/patient coordination (48%), and education/training (45%). For those staff members in charge of IPC, over a third had received no specific IPC training, and only 5% were certified in IPC. For those staff who received training, the training was provided by external consultants (26%) or a professional society/health department (28%). Respondents cited the most challenging aspect of IPC as collecting/reporting infection data (24%), adherence to/monitoring bag technique (15%) and adequate staff coverage (13%). CONCLUSION: This work represents a current snapshot of IPC infrastructure and challenges in US HHC agencies and identifies important barriers to IPC in these settings. DISCLOSURES: All authors: No reported disclosures.