1. Alexander, Mary BS, CRNI

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Throughout our 30-year history, INS has enjoyed many fruitful collaborative relationships with other healthcare organizations. Because the infusion specialty intersects with so many other aspects of care, INS has been fortunate to serve as a resource for organizations that develop infusion-related standards and guidelines. In 2002, after serving on the Centers for Disease Control and Prevention's steering committee, we shared with you the Guidelines for Prevention of Intravascular Catheter-related Infections by reprinting them in a special supplemental issue. Now, at the back of this issue, we are again able to share with you a set of guidelines to which INS contributed infusion expertise.

FIGURE. Mary Alexand... - Click to enlarge in new windowFIGURE.

For the last 2 years, INS Education Manager Deborah Benvenuto, BS, CRNI, has served as an advisor on the committee to revise the Practice Guidelines for Outpatient Parenteral Antimicrobial Therapy (OPAT). The revised guidelines have been published this year on behalf of the Infectious Diseases Society of America (IDSA), and provide a framework for developing best practices in the delivery of outpatient antimicrobial therapy. The concept of delivering antimicrobial therapy outside the hospital has grown to a billion-dollar industry since it was first described in the literature in the 1970s. "OPAT" refers to the "provision of antimicrobial therapy in at least 2 doses on different days without intervening hospitalization." 1(p1652) The settings in which therapy is delivered include the patient's home, physicians' offices, hospital clinics, ambulatory care centers, and skilled nursing facilities.


The trend toward home-based and outpatient care has led to substantial benefits for both patients and clinicians. Delivering infusion therapies in alternate settings is more convenient than being hospitalized and helps keep costs under control. Infusion complications that are common in the hospital setting are decreased in the alternate setting where patients are exposed to fewer microbes. A once-daily drug administration regimen allows patients more independence and allows clinicians greater flexibility in scheduling.


OPAT is not without its risks, however. The provision of care in the outpatient setting requires expertise and coordination among clinicians to ensure patient safety, especially when there is a multidisciplinary team providing the care. The new OPAT guidelines describe the role of the infusion nurse as a member of the caregiving team. The infusion nurse may be responsible for patient assessment, recommending the appropriate type of vascular access device to be used, care and maintenance of the device, patient education, and coordination of care within the multidisciplinary team.


INS looks forward to continuing its relationship with IDSA by contributing a column on infusion therapy to its newsletter, which was set to begin publication this summer. Our first column will address the importance of specialty certification for nurses involved in OPAT. We thank IDSA for permitting us to reprint these important new guidelines and hope they will guide our readers in providing the best infusion care for their patients.




1. Tice AD, Rehm SJ, Dalovisio JR, et al. Practice guidelines for outpatient parenteral antimicrobial therapy. Clin Infect Dis. 2004;38:1651-1672. [Context Link]