The home healthcare frontier: new study explores nurses’ knowledge and attitudes toward infection control

Arlington, Va., December 13, 2018

Home healthcare workers’ beliefs about infection prevention influence whether they comply with prevention protocols more than their actual knowledge of how to comply, according to new research published in the American Journal of Infection Control (AJIC), the journal of the Association for Professionals in Infection Control and Epidemiology (APIC).

Based on these findings, the researchers conclude that altering perceptions about infection risk among home healthcare workers is a promising strategy for improving compliance with infection control procedures and decreasing rates of infections and hospitalizations for their patients.

A team of researchers from Columbia University and the Visiting Nurse Service of New York, funded by the Agency for Healthcare Research and Quality, conducted an online survey of home healthcare nurses at two large, Medicare-certified home healthcare agencies in the northeastern United States. The analytic sample included 359 nurses. While participants self-reported high levels of both infection control compliance and knowledge, results showed that the two factors were not significantly associated.

By contrast, the survey indicated that nurse compliance may be driven more by subjectively held information than by the accuracy of knowledge, suggesting that infection control strategies should include targeting the perception of home healthcare workers by challenging existing beliefs – a tactic that has proven effective in promoting hand hygiene.

“Nurses play a critical role in infection control in home healthcare settings,” said the study’s lead author, David Russell, PhD, Center for Home Care Policy & Research, Visiting Nurse Service of New York, NY, and Department of Sociology, Appalachian State University, Boone, NC, USA. “Moving beyond a singular focus of knowledge by sharing messages that challenge perceptions on topics – from the influenza vaccine to proper handling of nursing bags – may go a long way toward enhancing compliance with effective infection control strategies.”

Key survey results:

  • Only slightly more than two-thirds (68.5 percent) of nurses in the sample agreed that the influenza vaccine is safe. Similarly, only 60.4 percent of nurses said their agency employer made it easy for them to stay home when they are sick. These results suggest that home healthcare agencies may benefit from better educating staff on the influenza vaccine and employee sick leave policies.
  • While the survey results suggested that respondents had adequate knowledge about standard precautions to prevent the transmission of infection and protocols for handling exposure to bodily fluids, respondents were less knowledgeable about the required features of the nursing bag and hand hygiene practices. For instance, more than a quarter of the nurses surveyed failed to identify that hand hygiene should be performed after touching a nursing bag, and nearly 90 percent did not recognize that a nursing bag should have at least three separate compartments to segregate multi-use items (e.g., blood pressure cuffs and stethoscopes) from single-use items (e.g., sterile supplies and personal protective equipment), and that hand hygiene supplies must be stored in a separate (third) compartment so that hands can be cleaned before entering other compartments. “These gaps in knowledge are notable considering that that the nursing bag could potentially serve as a vector for transporting infectious pathogens between home healthcare patients,” commented the researchers.
  • All survey respondents (100 percent) reported compliance with wearing gloves when anticipating contact with body fluids or blood products, yet only 69.6 percent said they wore goggles or eye shields in these circumstances.

“This study demonstrates the importance of understanding and addressing home healthcare nurses’ misperceptions about infection control measures,” said 2018 APIC President Janet Haas, PhD, RN, CIC, FSHEA, FAPIC. “Efforts to improve compliance need to update knowledge and target common misperceptions in order to reinforce proven methods of infection prevention and control.”


Notes for editors
The article is “Factors for compliance with infection control practices in home healthcare: findings from a survey of nurses' knowledge and attitudes toward infection control,” by David Russell, PhD, Dawn W. Dowding, PhD, RN, FAAN, Margaret V. McDonald, MSW, Victoria Adams, BSN, MSN, FNP-BC, Robert J. Rosati, PhD, Elaine L. Larson, PhD, RN, FAAN, CIC, and Jingjing Shang, PhD, RN ( It appears in the American Journal of Infection Control, Volume 46, Issue 11 (November 2018) published by Elsevier. It is openly available.

The study is funded by the Agency for Healthcare Research and Quality (R01HS024723, PI Shang).

About AJIC: American Journal of Infection Control
AJIC: American Journal of Infection Control covers key topics and issues in infection control and epidemiology. Infection preventionists, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of APIC, AJIC the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. AJIC also publishes infection control guidelines from APIC and the CDC. Published by Elsevier, AJIC is included in MEDLINE and CINAHL.

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers.

Media contacts
Shannon Quinn
Qorvis Communications
+1 202 657 7364

Liz Garman
+1 202 365 7421