Examination of Clutter, Cleanliness, and Hazards in Home Environments of Home Health Care Patients with High Risk of Infection: A Multi-Site Observational Study.

BACKGROUND: Despite high infection risk among home healthcare (HHC) patients, little is known about home environmental conditions that may affect infection prevention and control (IPC). METHODS: We conducted a cross-sectional study of 250 HHC patients and caregivers from two Medicare-certified agencies. In-home surveys and structured observations assessed household hazards, and, in more detail, cleanliness and clutter. Multivariate linear regression examined associations between home environment and sociodemographic, clinical, and community factors. RESULTS: On average, at least one household hazard was observed; poor lighting and clutter were the most common, followed by infestation. Homes were predominantly assessed as mostly clean but exhibited moderate clutter. Older age, being Hispanic, and more favorable IPC attitudes were associated with greater cleanliness. Difficulty paying medical bills was associated with higher clutter scores. High neighborhood deprivation was associated with lower clutter scores. DISCUSSION: Although homes were mostly clean, clutter and hazards were common and may impede IPC practices. Individual-level factors, particularly difficulty paying medical bills and attitudes towards the home environment, were most strongly associated with home environmental conditions. CONCLUSIONS: Incorporating structured home environment assessments into HHC practice may help identify modifiable barriers to IPC and inform targeted interventions in home-based care.