EP 59 - Evolution of Infection Prevention and Control Policies and Processes in U.S. Home Health Care Agencies

Background: Home healthcare agencies (HHAs) provide essential post-acute care to elderly vulnerable populations. Prior to COVID-19, infection prevention and control (IPC) programs in HHAs were suboptimal, leaving many agencies underprepared for the pandemic. We studied the evolution of HHAs’ IPC policies and processes, especially in response to COVID-19.

Methods: We conducted a nationally representative survey twice (in 2019 and 2023) to examine IPC policies and processes in HHAs. For each survey, we randomly-selected 1,500 HHAs, stratified by HHA characteristics to ensure nationwide representativeness. The 2023 survey included 428 of the 536 agencies from the 2019 survey. The survey was able to be completed via paper or online; respondents were HHA administrators or clinical managers. Topics covered IPC staffing, IPC compliance/training, current IPC policies/processes, and IPC challenges. Data collection for the 2023 survey is ongoing; preliminary comparisons of 2019 and 2023 responses were done.

Results: Response rates were 37% in 2019 and 30% in 2023, with 70% HHAs completing the survey online in 2023 versus 53% in 2019. More agencies in 2023 reported specialized infection control training among staff responsible for IPC (87% vs. 65% in 2019), as well as specific committees or dedicated staff to review IPC activities/issues (92% vs. 78% in 2019). In 2023, fewer reported Clostridioides difficile (1% vs. 7% in 2019) and catheter-associated urinary tract infections (6% vs. 12% in 2019) as primary infection control challenges. In 2023, the aspect of IPC that was the most challenging was ensuring adequate field staffing, compared to infection data collection and reporting in 2019.

Conclusions: Since COVID-19, HHAs have updated their IPC policies/processes, with increased focus on specialized training, and committees and staff dedicated to IPC. Challenges related to field staffing persist. Since 2019, greater technological adoption and more frequent telework may have driven the increase in online survey completion in 2023.