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Quantifying interhospital patient sharing as a mechanism for infectious disease spread

Huang, SS and Avery, TR and Song, Y and Elkins, KR and Nguyen, CC and Nutter, SK and Nafday, AA and Condon, CJ and Chang, MT and Chrest, D and Boos, J and Bobashev, G and Wheaton, W and Frank, SA and Platt, R and Lipsitch, M and Bush, RM and Eubank, S and Burke, DS and Lee, BY (2010) Quantifying interhospital patient sharing as a mechanism for infectious disease spread. Infection Control and Hospital Epidemiology, 31 (11). 1160 - 1169. ISSN 0899-823X

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Abstract

BACKGROUND. Assessments of infectious disease spread in hospitals seldom account for interfacility patient sharing. This is particularly important for pathogens with prolonged incubation periods or carrier states. METHODS. We quantified patient sharing among all 32 hospitals in Orange County (OC), California, using hospital discharge data. Same-day transfers between hospitals were considered "direct" transfers, and events in which patients were shared between hospitals after an intervening stay at home or elsewhere were considered "indirect" patient-sharing events. We assessed the frequency of readmissions to another OC hospital within various time points from discharge and examined interhospital sharing of patients with Clostridium difficile infection. RESULTS. In 2005, OC hospitals had 319,918 admissions. Twenty-nine percent of patients were admitted at least twice, with a median interval between discharge and readmission of 53 days. Of the patients with 2 or more admissions, 75% were admitted to more than 1 hospital. Ninety-four percent of interhospital patient sharing occurred indirectly. When we used 10 shared patients as a measure of potential interhospital exposure, 6 (19%) of 32 hospitals "exposed" more than 50% of all OC hospitals within 6 months, and 17 (53%) exposed more than 50% within 12 months. Hospitals shared 1 or more patient with a median of 28 other hospitals. When we evaluated patients with C. difficile infection, 25% were readmitted within 12 weeks; 41% were readmitted to different hospitals, and less than 30% of these readmissions were direct transfers. CONCLUSIONS. In a large metropolitan county, interhospital patient sharing was a potential avenue for transmission of infectious agents. Indirect sharing with an intervening stay at home or elsewhere composed the bulk of potential exposures and occurred unbeknownst to hospitals. © 2010 by The Society for Healthcare Epidemiology of America. All rights reserved.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Huang, SS
Avery, TR
Song, Y
Elkins, KR
Nguyen, CC
Nutter, SK
Nafday, AA
Condon, CJ
Chang, MT
Chrest, D
Boos, J
Bobashev, G
Wheaton, W
Frank, SA
Platt, R
Lipsitch, M
Bush, RM
Eubank, S
Burke, DSdonburke@pitt.eduDONBURKE
Lee, BYbyl1@pitt.eduBYL1
Centers: Other Centers, Institutes, Offices, or Units > Center for Vaccine Research
Date: 1 November 2010
Date Type: Publication
Journal or Publication Title: Infection Control and Hospital Epidemiology
Volume: 31
Number: 11
Page Range: 1160 - 1169
DOI or Unique Handle: 10.1086/656747
Schools and Programs: Graduate School of Public Health > Epidemiology
School of Medicine > Biomedical Informatics
School of Medicine > Medicine
Refereed: Yes
ISSN: 0899-823X
Date Deposited: 07 May 2015 19:40
Last Modified: 02 Feb 2019 16:56
URI: http://d-scholarship.pitt.edu/id/eprint/24393

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