The National Home Infusion Association (NHIA) has responded to a recent study that questioned infection control practices in home infusion settings.

A January 2023 study published in the American Journal of Infection Control said in its abstract, “Infection prevention and surveillance training approaches for home infusion therapy have not been well defined. We interviewed home infusion staff who perform surveillance activities about barriers to and facilitators for central line-associated bloodstream infection (CLABSI) surveillance and identified barriers to training in CLABSI surveillance. Our findings show a lack of formal surveillance training for staff.”

In response, the NHIA said it was “disappointed” by the study’s findings, saying the report “is not at all reflective of home infusion therapy standards and practices.”

NHIA President/CEO Responds

In the NHIA statement, NHIA President/CEO Connie Sullivan, BSPharm, said, “NHIA and the association’s members acknowledge that central line-associated bloodstream infection is a serious complication that can occur in patients receiving IV therapies. However, we strongly disagree with the study’s conclusions and generalizations about the infection prevention workforce in home infusion. The infusion industry absolutely has specific requirements around monitoring and reporting rates of CLABSI, and several independent, peer-reviewed studies of home-based patients demonstrate lower rates of CLABSI compared to hospital settings. We do not agree that a qualitative study of five agencies is reflective of the entire industry, which consists of nearly 1,000 organizations.”

Tim Affeldt, Vice President of Specialty/Infusion Operations, Fairview Pharmacy Services in Minneapolis, said in the NHIA statement, “As part of a major health system with a large home infusion program, I can say that the portrayal of the information in this very small study is not at all reflective of my experience and how our home infusion program works. Home infusion is a valued link in the continuum of care, allowing lower acuity patients to return to home and work sooner. With good patient education and regular contact from our multidisciplinary care team, we see excellent outcomes.”

NHIA Says Lower Infection Rates at Home

In its rebuttal to the study, NHIA said, “There is an abundance of peer-reviewed studies demonstrating the safety of home infusion, and infusion infection rates are in fact much lower in the home compared to hospital settings.”

The NHIA statement referenced a 2018 study called, “Complication and Failures of Central Vascular Access Device in Adult Critical Care Settings” and published in the journal Critical Care Medicine.

In that study, NHIA said, “A systematic review of 63 studies covering 396,951 catheter days found a CLABSI rate of 4.59 per 1,000 catheter days (4.59/1000) in hospitalized patients. Similarly, a study of critically ill hospital patients covering 11,110 catheter days found a rate of 6.03/1,000 for patients with central venous catheters and a rate of 1.62/1,000 in patients with peripherally inserted central catheters.

“By contrast, the home and ambulatory care literature consistently shows CLABSI rates of less than 1 per 1,000 catheter days. 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.

”Most CLABSI studies in home infusion look at the highest risk patients and therapies (e.g., parenteral nutrition). The CLABSI rates would likely be even lower across the entire home infusion population because most home infusion patients are not critically ill and are receiving short-term courses of IV antibiotics, which puts them at very low risk for CLABSI.”

The NHIA said in its statement that studies using qualitative methodology “have known limitations, including small samples sizes, potential bias in answers, self-selection bias, and potentially poor questions from researchers.”

The statement also said a research technique known as snowballing — which refers to asking study participants if they know other people who would like to participate in the study — can introduce bias “due to the non-random nature of selecting participants. These methods make it impossible to generalize the study findings to other situations and populations.”