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On January 25th, IV Nurse Day was celebrated across the country by members of the Infusion Nurses Society (INS). I joined INS when I became a home healthcare nurse 23 years ago. It is important to recognize that back then, as well as today, our technical IV skills as home health nurses are important, but equally important are our patient education skills, especially as we focus on ensuring safe practice and reducing the risk for complications such as infection. The first article that I ever wrote and published was in Home Healthcare Nurse in 1987, entitled "Effective Teaching of Home IV Therapy." That article led to many subsequent home infusion therapy publications and presentations and increasing involvement with INS. I most recently had the honor of serving as the INS President from 2007-2008 and am now happy to serve as the Guest Editor for this issue of Home Healthcare Nurse, with a focus on infusion nursing.


Patients with invasive devices at home, such as IV catheters, are at risk for infections and other complications. Home health agencies accredited by The Joint Commission will pay more attention to central line infections starting this year as the 2009 National Patient Safety Goals require that organizations "implement best practices or evidence-based guidelines to prevent central line-associated bloodstream infections" (Joint Commission, n.d.). Agencies will be required to measure central line-associated bloodstream rates, monitor compliance with best practices or evidence-based guidelines, and evaluate infection prevention efforts. One year ago, the Association for Practitioners in Infection Control & Epidemiology and the Healthcare Infection Control Practices Advisory Committee (2008) published an important document with surveillance definitions for home health-associated infections. We must use these definitions for consistency in reporting. While there is relatively little published data documenting the incidence of central line infections in home health, the data suggest a relatively low rate (Moureau et al., 2002; Gorski, 2004). However, within each organization, every central line infection should be carefully evaluated for potential causes. In acute care settings, the rate of central line infections in intensive care units is sharply decreasing, largely due to implemention of the "central line bundle," a group of evidence-based recommendations as defined and promoted by the Institute for Healthcare Improvement (n.d.) and also endorsed by several other organizations. If the rate of acute care line infections can be minimized, we must ask ourselves, what is acceptable in home health? Should there be any infections? Many of you will say we can't control all that happens in the home, and that is most certainly true. But if an infection happens, can we look back and say that we always did an excellent job in educating the patient about risk and prevention? Did we use the best technology? Did we follow accepted standards of practice? Guidelines for best home care practices is still limited, with most recommendations based on research from acute care settings. Home care research is clearly needed to address the incidence, patient risk factors, and best practices for infection prevention.


In her article, Marjorie McCaskey discusses prevention of bloodstream infections within the context of a pediatric case study, emphasizing the importance of patient and parent education. Two other aspects of infusion therapy are also addressed in this issue. I wrote a Commentary addressing the importance of selecting a peripheral IV catheter over a central line whenever possible. Peripheral IV catheters have the lowest risk of infection compared to any other venous access device and are safe and appropriate for selected home health patients. Jane Kirmse contributed an article reviewing home administration of IV immunoglobulin for patients with primary or secondary immune deficiency disorders.


As always, Home Healthcare Nurse includes a wide variety of articles with valuable information for the home healthcare nurse. I hope you enjoy the content of this issue.




Association for Practitioners in Infection Control & Epidemiology/Healthcare Infection Control Practices Advisory Committee. (2008). APIC-HICPAC surveillance definitions for home healthcare and home hospice infections. Available at:§ion=Surveillance_Definitions&template=/CM[Context Link]


Gorski, L. A. (2004). Central venous access device outcomes in a homecare agency: a 7-year study. Journal of Infusion Nursing, 27(2), 104-111. [Context Link]


Institute for Healthcare Improvement. (n.d.) Implement the central line bundle. Retrieved November 17, 2008 from[Context Link]


Joint Commission. (n.d.). Home care accreditation program-2009 chapter: national patient safety goals. Available at:[Context Link]


Moureau, N., Poole, S., Murdock, M. A., Gray, S. M., & Semba, C. P. (2002). Central venous catheters in home infusion care: Outcomes analysis in 50,470 patients. Journal of Vascular and Interventional Radiology, 13(10), 1009-1016. [Context Link]