Advocacy News

Setting the record straight on home infusion therapy

1/24/2023

Originally published in McKnight’s Home Care.

Over the past few weeks, several news organizations, including Axios, FierceHealthcare, Becker’s Hospital Review, Infection Control Today and McKnight’s Home Care, have run stories based on a study claiming there is inadequate surveillance for central line-associated bloodstream infection (CLABSI) in home infusion and casting doubt on the safety of the home environment for patients receiving intravenous medications.

As a former home infusion pharmacist and the president and CEO of the National Home Infusion Association, I strongly disagree with both the premise and the assumptions arising from this small qualitative study. I am deeply disappointed that these news outlets took this study at face value considering the significant limitations of the methods used (i.e., snowball sampling, use of semi-structured interviews) to arrive at their recommendations.

What this study and the subsequent stories omitted is that CLABSI rates in home infusion have been consistently found to be much lower than other hospital settings. A systematic review of 63 peer-reviewed studies estimates the CLABSI rate for hospitalized patients at 4.59 per 1,000 catheter days (4.59/1000).1

By contrast, the home and ambulatory care literature consistently shows CLABSI rates of less than 1 per 1,000 catheter days, here, here, here, and here.2-5 For example: An 11-year surveillance from the University of North Carolina Health Care System found that its home care CLABSI rate was between 0 and 0.73/1,000.6 So, what is really going on here?

The researcher behind the study works in an acute care setting and claims that because surveillance methods differ from those used by hospitals, that patients at home are at a high risk of infection. This is a highly flawed rationale and ignores the significant differences between the acuity levels of patients at home, which is lower compared to patients in hospital settings, as well as differences in the environment itself.

Hospitals are well known to harbor more highly resistant bacteria compared to the home environment. Additionally, the recommendations from this study are misplaced as applying the surveillance measures used in hospital settings would likely do little to reduce CLABSI in the home because every patient has a different home situation.

Rather, home infusion providers invest heavily in preventing CLABSI by teaching and empowering patients to take control of their health. Home infusion nurses and pharmacists partner with home IV patients to teach them how to protect themselves from infection and how to identify and report suspected infections when they do occur. These clinicians know their patients will endure potentially devastating consequences from an infection and give them the best chance at success. Based on the data from numerous peer reviewed studies like those mentioned above, the methods employed by home infusion providers have proven successful.

To say that home infusion providers don’t conduct surveillance or analyze the rate of CLABSI in the home is also incorrect. Home infusion providers are held to standards by accreditation bodies such as Joint Commission and the Accreditation Commission for Health Care to collect information about a wide range of catheter events, including CLABSI.

Had the reporters of these stories reached out to NHIA or these accrediting bodies or patient organizations that represent users of home infusion, they would have learned why this study’s findings missed the mark. Finally, home infusion patients who utilize these services to manage their diseases report having better control, fewer missed days of work or school, and overall better health.7 Misleading stories about the risks of home infusion have real consequences and may result in fewer patients eventually having access to these essential services.

Connie Sullivan, BSPharm, is the president and CEO of the National Home Infusion Association.

References:

  1. Takashima M, Schults J, Mihala G, Corley A, Ullman A. Complication and Failures of Central Vascular Access Device in Adult Critical Care Settings. Crit Care Med. 2018 Dec;46(12):1998-2009. doi: 10.1097/CCM.0000000000003370. PMID: 30095499.
  2. Curley M, Larson J, Pomputius WFI, Maynard R. Central Vascular Access Device Complications in Pediatric Home Care Patients Managed by Family Caregivers or Nurses. Journal of Infusion Nursing. 2021;44(2):68-77. doi: 10.1097/nan.0000000000000417. PubMed PMID: 00129804-202103000-00002.
  3. Akhtar N, Lee L. Utilization and Complications of Central Venous Access Devices in Oncology Patients. Current Oncology. 2021;28(1):367-77. doi: 10.3390/curroncol28010039.
  4. Cotogni P, Mussa B, Degiorgis C, De Francesco A, Pittiruti M. Comparative Complication Rates of 854 Central Venous Access Devices for Home Parenteral Nutrition in Cancer Patients: A Prospective Study of Over 169,000 Catheter-Days. Journal of Parenteral and Enteral Nutrition. 2021;45(4):768-76. doi: https://doi.org/10.1002/jpen.1939.
  5. Buchman AL, Opilla M, Kwasny M, Diamantidis TG, Okamoto R. Risk factors for the development of catheter-related bloodstream infections in patients receiving home parenteral nutrition. JPEN J Parenter Enteral Nutr. 2014 Aug;38(6):744-9. doi: 10.1177/0148607113491783. Epub 2013 Jun 6. PMID: 23744839.
  6. Weber, D., Brown, V., Huslage, K., Sickbert-Bennett, E., & Rutala, W. (2009). Device-Related Infections in Home Health Care and Hospice Infection Rates, 1998–2008. Infection Control & Hospital Epidemiology, 30(10), 1022-1024. doi:10.1086/605641
  7. Polinski JM, Kowal MK, Gagnon M, Brennan TA, Shrank WH. Home infusion: Safe, clinically effective, patient preferred, and cost saving. Healthc (Amst). 2017 Mar;5(1-2):68-80. doi: 10.1016/j.hjdsi.2016.04.004. Epub 2016 Apr 29. PMID: 28668202.

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