Home IV Antibiotic Therapy for Skin and Soft Tissue Infections (SSTI's)

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Glossary

Obviously there is a need for the practicing social worker to be aware of the issues surrounding the patient suffering from soft tissue infections. The symptoms described in this Journal Club range from moderate to severe, beginning with the patients themselves that are receiving IV antibiotics which is a fairly invasive therapy in itself.  And, of course, all patients that suffer from a skin infection can have a pronounced effect on how they are received by others (and how they perceive themselves). There is also an existing financial consideration here. IV antibiotic therapy can last for several weeks.  Insurance will, in most cases, pick-up the majority of this cost. But there are patients that are either uninsured, underinsured, or on Medicare or Medicaid.  Different scenarios exist for each payor, and the patient's home situation may vary widely, possibly effecting outcomes.  It is the job of the social worker to help the patient access their financial resources in order to achieve a successful outcome, but the variables that exist can hinder these efforts. Which leads us to compliance. Patients receiving home infusion may be taught to self-administer, which requires the patient (and/or caregiver or family member) be taught the proper technique including cleaning the infusion site, becoming familiar with the infusion equipment and administration methods, and developing the discipline necessary to perform these tasks at the appropriate times. If skilled nursing support is not provided by the insurer, finding a reliable caregiver to perform these tasks can be difficult, if not impossible in some situations. The social worker can be extremely helpful here helping the patient to identify family members and others that may be candidates for these tasks. 

Perhaps the biggest concerns with the patient suffering from soft tissue infections are the psychosocial ones. Patients may have one site that is infected, and it may be confined to an area that can be covered up by clothing. However, depending upon the extent and condition of the infected site(s), clothing may not be able to cover it up (or covering it up may not recommended by their health care professional). These patients may suffer from anxiety at being seen in public, to the point where they even be dissuaded from going to see their doctors. In the worst case, patients may not even want their caregivers to see them. This is an extreme to be sure, but should be taken into consideration. Additionally, intravenous infusions can have a deleterious effect on patients that previously considered themselves to be healthy. Now that they have an indwelling catheter, however temporary, they may see themselves as sicker than they really are. Morale can suffer, and so can the length of their convalescence.