Table 1.

Requirements for reporting CLABSIs in home infusion therapy

Current need	Example of problem	Example of possible solution
Denominator definition	Should a catheter day be counted on a day when an outpatient infusion center accesses the CVC?	All days between CVC placement or hospital discharge and CVC removal or hospital admission could be counted.
Attribution determination	Should a CLABSI be counted if the CVC is accessed both at home and in an outpatient oncology clinic?	All CLABSIs could be counted if a patient has been in their home with the CVC.
Ownership ofthe home infusion patient	Should a CLABSI be counted by a home infusion agency if a separate home nursing agency provides CVC-related education and nursing visits?	Home nurses specially trained in home infusion therapy could preferentially provide services to home infusion patients, and any CLABSIs affiliated with these patients counted.
SIRs	How can home infusion agencies caring for very different populations benchmark their data?	SIRs could account for risks such as patients on home parenteral nutrition and the length of time on home infusion therapy.
CLABSI reporting platform	Where can home infusion agencies report their data?	NHSN could develop a module for CLABSI in home health.
CLABSI reporting requirement	Why would a home infusion agency devote effort to surveillance?	Insurers could require reportingofCLABSIs for reimbursement.
Accessing inpatient records	How does a home infusion agency know that a patient has been admitted for a CLABSI?	Acute care IPs could provide data to home infusion agencies if a patient was admitted with a CLABSI.
Trained IPs at home infusion agencies	Few home infusion agencies hire IPs.	Hospitals and home infusion agencies could collaborate to perform surveillance.

CLABSI, central line-associated bloodstream infection; CVC, central venous catheter; IP, infection preventionist; NHSN, National Healthcare Safety Network; SIR, standardized infection ratio.