Efficacy and safety of a Belgian tertiary care outpatient parenteral antimicrobial therapy (OPAT) program.

PURPOSE: Evidence supports the implementation of outpatient parenteral antimicrobial therapy (OPAT) as standard of care. Until 2015 the overall experience with OPAT in Belgium remained limited. The aim of this study was to evaluate the efficacy and safety of a Belgian 'OPAT at home' program, which was implemented in University Hospitals Leuven starting from January 2017. METHODS: A mono-centric, prospective, observational study was carried out. All OPAT cases discharged between 10 January 2017 and 10 January 2019 were included in the study. Relevant demographic and clinical patient data were collected. The outcomes were clinical cure rate, OPAT related readmission rate, adverse event rate and patients' satisfaction. RESULTS: Over the two-year study period, 152 OPAT episodes were started in 130 patients, resulting in 3153 avoided hospitalization days which corresponds to 5.4 freed hospital beds. Urinary tract infections accounted for 40.8% of OPAT courses and temocillin was the most frequently used antibiotic (24.3%). Cure was achieved in 97.9% of the OPAT episodes. During 22 (14.5%) OPAT episodes, patients experienced adverse events, including line related adverse events (7.9%) and adverse drug events (6.6%). An OPAT related readmission rate of 9.2% was observed, mostly related to line-associated adverse events. All patients who completed the satisfaction survey (n = 23) were very satisfied with their OPAT course. CONCLUSION: The University Hospitals Leuven OPAT program is associated with a high level of clinical cure and low all-cause readmission and adverse event rates. Improvement actions are described to further reduce the readmission rate to less than 5.0%.

Outpatient parenteral antimicrobial therapy and antibiotic stewardship: opponents or teammates?

PURPOSE: This narrative review aims to describe barriers of outpatient parenteral antimicrobial therapy at home (OPAT), potentially compromising general standards of antibiotic stewardship (ABS) and facilitators of OPAT for ABS. METHODS: After a literature review, five authors determined the barriers and facilitators to discuss in this review. RESULTS: Sixty-six publications were included in the narrative review and seven barriers and five facilitators are discussed in this article. The impracticability of multiple daily dosing during OPAT, the impact of real-life temperature variations, deviations of the infusion rates of elastomeric devices, access to prolonged intravenous antibiotic therapy, not administering loading doses before the initiation of extended or continuous infusions and the transmural nature of care associated with OPAT, can lead to deviations of recommended treatment regimens and sub-optimal clinical and laboratory follow-up, with a risk of inferior clinical outcomes, adverse events, drug-resistance and higher costs. On the other hand, OPAT provides access to treatments with intravenous antibiotics and simultaneously avoids prolonged hospitalization. CONCLUSION: Implementing ABS guidelines in OPAT programs, e.g., by using a multidisciplinary team approach and facility-specific protocols for OPAT with patient selection criteria and instructions for selection, storage, preparation and administration of antibiotics, can improve appropriate antibiotic use. Additionally, further research should examine the effectiveness of these interventions on outcomes of OPAT.

Compliance with evidence-based guidelines for the prevention of central line-associated bloodstream infections in a Belgian home care setting: An observational study.

This study assessed the compliance of Belgian home care nurses with good practice recommendations to prevent central line-associated bloodstream infections. The compliance to 3 care bundles was 0% (0 out of 7), 13.3% (2 out of 15), and 22.2% (2 out of 9), respectively. This finding is important given the increasing number of home care patients with an intravascular catheter and underscores the need for quality improvement strategies to prevent central line-associated bloodstream infections in home care.

Use of a symptom diary during chemotherapy: A mixed-methods evaluation of the patient perspective.

PURPOSE/OBJECTIVES: Patients' perceptions about tools for self-reporting symptoms experienced at home may influence both the patients' use of the tool and ultimately the efficacy of the interventions. The aim of this study was to determine the extent patients use a paper-pencil symptom-monitoring diary during chemotherapy treatment, to identify factors that mediate its use at home, and to determine perceptions patients have of the diary. METHODS: A quantitative survey assessed patients' use of the diary, their experiences and opinions. A secondary analysis of semi-structured interviews used was performed to determine how patients perceived being offered the diary for tracking symptoms and, if they did use it, their experiences with the diary. RESULTS: Eighty-seven patients (78%) used or had been using the diary during their chemotherapy treatment. Most patients felt that the diary supported them in discussing treatment-related symptoms with their doctors and nurses during hospital visits and helped them to deal with symptoms at home. However, diary users felt that their professional caregivers viewed the diary differently, specifically not valuing it enough to actively use it in their care. CONCLUSIONS: This study indicates that the majority of chemotherapy patients at our hospital perceive the symptom diary to be a feasible tool in terms of ease of use and time investment and that it is helpful. However, from the patient perspective, healthcare professionals' implementation of the diary in their behalf is lacking.

Prevention of fracture-related infection: a multidisciplinary care package.

Fracture-related infection (FRI) remains a challenging complication. It may result in permanent functional loss or even amputation in otherwise healthy patients. For these reasons, it is important to focus attention on prevention. In treatment algorithms for FRI, antibiotic stewardship programmes have already proved their use by means of a multidisciplinary collaboration between microbiologists, surgeons, pharmacists, infectious disease physicians and nursing staff. A similar approach, however, has not been described for infection prevention. As a first step towards achieving a multidisciplinary care package for infection prevention, this review summarises the most recent guidelines published by the World Health Organization (WHO) and US National Institutes of Health Centers for Disease Control and Prevention (CDC), primarily focusing on the musculoskeletal trauma patient. The implementation of these guidelines, together with close collaboration between infection control physicians, surgeons, anaesthesiologists and nursing staff, can potentially have a beneficial effect on the rate of FRI after musculoskeletal trauma surgery. It must be stated that most evidence presented here in support of these guidelines was not obtained from musculoskeletal trauma research. Although most preventive measures described in these studies can be generalised to the musculoskeletal trauma patient, there are still important differences with nontrauma patients that require further attention. Future research should therefore focus more on this very defined patient population and more specifically on FRI prevention.

Implementation and Use of a Patient Symptom Diary During Chemotherapy: A Mixed-Methods Evaluation of the Nurse Perspective.

PURPOSE/OBJECTIVES: To gain a deeper understanding of nurses' experience working with a patient diary for tracking and treating side effects during chemotherapy.
. DESIGN: A mixed-methods design was used to learn about oncology nurses' use and perceptions of a symptom diary. 
. SETTING: Six oncology wards and two outpatient clinics at the University Hospitals Leuven, Belgium.
. SAMPLE: 79 nurses completed a survey, and 14 nurses participated in focus group discussions.
. METHODS: First, a survey sampled nurses' use and perceptions of the diary. Next, focus group discussions were held with the aim of arriving at a deeper understanding of the survey results.
. MAIN RESEARCH VARIABLES: Use and perceptions of a symptom diary.
. FINDINGS: Most nurses reported performing diary-related behavior to some extent. The survey and focus groups indicated that many nurses strongly believed in the value of the diary, but some were still hesitant or had concerns about patients' perceptions of the diary. The focus group results showed that nurses' use of the diary in daily practice was influenced by their personal beliefs about the value of the diary, the team's, and those of their patients.
. CONCLUSIONS: Although a positive trend was noted, nurses' use of the symptom diary was suboptimal six months after its implementation.
. IMPLICATIONS FOR NURSING: This study highlights important issues that need to be addressed to advance the successful implementation of the symptom diary.