Thursday, April 2, 2009

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.

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

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