Welcome to Home Infusion Continuum

Outpatient parenteral anti-infective therapy (OPAT) has become an accepted mode of treatment worldwide. It is estimated that more than a quarter of a million Americans are treated with OPAT each year, and the growth rate for this practice continues to increase significantly. A variety of factors contribute to this growth including an increased emphasis on cost containment, the availability of antibiotics that can be administered once or twice daily, technological advances in vascular access and in infusion devices, increased acceptance of such therapy by both patients and healthcare personnel, and the availability of structured services for OPAT. The benefits of OPAT include the well-being accrued as a result of being at home and, from a societal standpoint, well-documented cost savings. To reduce the inherent risks in OPAT, Ms. Bing and Mr. Ross stress that all caregivers must work together to ensure that the appropriate therapy is provided without confusion or duplication, that the patient/caregiver is capable of safe and effective care, and that appropriate followup and communication take place among all those involved, including the patient.

Anti-infective therapy in home and ambulatory infusion
by Caryn M. Bing, RPh, MS, FASHP and Kevin L. Ross, RN, BSN

Outpatient parenteral anti-infective therapy (OPAT) has been the mainstay business of most home and ambulatory infusion providers for nearly thirty years. Reimbursement incentives, advances in electronic and disposable ambulatory infusion devices, vascular-access devices (VADs) and supplies, and newer parenteral anti-infective medications have contributed to the continued growth of this therapy type. Some of the earliest uses of OPAT were at home by pediatric cystic fibrosis (CF) patients with recurrent infections, cellulitis or osteomyelitis patients requiring extended therapy, and patients with opportunistic infections due to human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Advances in CF and HIV/AIDS management have reduced the use of OPAT in these populations, yet use of OPAT has continued to grow.
OPAT is not one therapy, it is many. Today’s OPAT patients may undergo short-term (i.e., days) therapy after hospital discharge or outpatient surgery, extended (i.e., weeks) treatment for serious infections, or intermittent/episodic treatment for recurrent infections. Table 1 summarizes the most common conditions treated with OPAT.

Antibiotic and ethanol lock therapy

Intravascular catheters are a critical component for current medical practice, providing necessary vascular access. The use of intravascular catheters, however, puts the patient at risk for local and systemic infections, including catheter-related bloodstream infections (CRBSI). The incidence of CRBSI varies according to catheter type, frequency and type of catheter manipulation, frequency and type of catheter care, underlying disease, and condition of the patient. Colonization of the intravascular catheter with an organism does not necessarily indicate an infection but may increase the risk of a CRBSI. According to the Centers for Disease Control and Prevention (CDC), there are an estimated 200,000 to 400,000 CRBSI occurrences annually, with medical-related costs estimated at $25,000 to $55,000 per incidence.

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