Patient Sharing Among Hospitals Common, Likely Source of spread of Infectious Pathogens

Patient sharing is common among hospitals, and it likely presents an avenue for infectious-disease transmission, according to a study presented here at the Society for Healthcare Epidemiology of America (SHEA) 19th Annual Scientific Meeting.

The study found that only 1 in 9 of these shared patients were directly transferred from one hospital to another; most of the patients were discharged and then readmitted to another hospital within 1 year. This amount of patient sharing between hospitals might increase the spread and transmission of infectious pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE).

To assess the frequency of interfacility sharing in 1 county (Orange County, the third-most-populous and largely suburban county in California), the direct and indirect transfers among 31 acute-care hospitals were assessed in a retrospective evaluation using 2005 California hospital-discharge data. The study evaluated the likelihood that adult patients admitted to each hospital in 2005 would subsequently be transferred or admitted to another hospital in the county within 1 year of discharge.

Dr. Huang and colleagues found that in 2005, 239,456 adult patients were admitted to Orange County hospitals, with a median length of stay of 3 days. The study found that patients were widely shared among the hospitals, sharing at least 1 patient with a median of 28 other hospitals; only 16% of interfacility patient sharing occurred by direct patient transfer. Among those discharged, 22% were readmitted to a median of 2 hospitals in the subsequent year; median time to readmission was 23 days.

According to Dr. Rupp, the following bacilli are of concern:

• Pseudomonas aeruginosa is a gram-negative rod that belongs to the family Pseudomonadaceae, and is a pathogen of increasing clinical relevance and a frequent cause of nosocomial pneumonia, especially in intensive-care units. Several epidemiologic studies that have tracked its occurrence as a nosocomial pathogen indicate that antibiotic resistance is increasing in clinical isolates.
• Acinetobacter strains are nosocomial pathogens that have caused a number of American military casualties to develop serious infections.
• Klebsiella pneumoniae causes serious infections in the critically and chronically ill and is rapidly developing resistance to all available antibiotics.

Source:

Society for Healthcare Epidemiology of America (SHEA) 19th Annual Scientific Meeting: Abstract 59. Presented March 20, 2009.