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Quantifying Interhospital Patient Sharing as a Mechanism for Infectious Disease Spread

Published online by Cambridge University Press:  02 January 2015

Susan S. Huang ,
Taliser R. Avery ,
Yeohan Song ,
Kristen R. Elkins ,
Christopher C. Nguyen ,
Sandra K. Nutter ,
Alaka A. Nafday ,
Curtis J. Condon ,
Michael T. Chang  and
David Chrest
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Susan S. Huang*
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, California
Taliser R. Avery
Affiliation:
the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Yeohan Song
Affiliation:
Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Kristen R. Elkins
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, California
Christopher C. Nguyen
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, California
Sandra K. Nutter
Affiliation:
University of California Irvine, Irvine, and the California Office of Quality Management-Research, Orange County Health Care Agency, Santa Ana, California
Curtis J. Condon
Affiliation:
University of California Irvine, Irvine, and the California Office of Quality Management-Research, Orange County Health Care Agency, Santa Ana, California
Michael T. Chang
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, California
David Chrest
Affiliation:
Research Triangle Institute, Research Triangle Park, North Carolina
John Boos
Affiliation:
Research Triangle Institute, Research Triangle Park, North Carolina
Georgiy Bobashev
Affiliation:
Research Triangle Institute, Research Triangle Park, North Carolina
William Wheaton
Affiliation:
Research Triangle Institute, Research Triangle Park, North Carolina
Steven A. Frank
Affiliation:
Department of Ecology and Evolutionary Biology, California
Richard Piatt
Affiliation:
the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Marc Lipsitch
Affiliation:
Departments of Epidemiology, and Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
Robin M. Bush
Affiliation:
Department of Ecology and Evolutionary Biology, California
Stephen Eubank
Affiliation:
Virginia Bioinformatics Institute, Virginia Tech, Blacksburg, Virginia
Donald S. Burke
Affiliation:
Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
Bruce Y. Lee
Affiliation:
Department of Medicine, Epidemiology, and Biomedical Informatics, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania
*
University of California Irvine Medical Center, Division of Infectious Diseases, 101 The City Drive South, City Tower, Suite 400, Zot Code 4081, Orange, CA 928683217 ([email protected])
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Extract

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 11 , November 2010 , pp. 1160 - 1169
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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