Quantifying Interhospital Patient Sharing as a Mechanism for Infectious Disease Spread

Huang, Susan S.; Avery, Takuser R.; Song, Yeohan; Elkins, Kristen; Nguyen, Christopher; Nutter, Sandra K.; Nafday, Alaka. A.; Condon, Curtis J.; Chang, Michael T.; Chrest, David; Boos, John; Bobashev, Georgiy; Wheaton, William; Frank, Steven A.; Platt, Richard; Lipsitch, Marc; Bush, R. Mitchell; Eubank, Stephen; Burke, Donald S.; Lee, Bruce Y.

doi:10.1086/656747

Cited by 71 publications

(60 citation statements)

References 14 publications

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“…A related limitation is that whereas 92% of adults in the data set for patient transfer had identifiers (thus only 8% were untracked), the majority (86%) of children lacked such identifiers. However, of these, 63% were <6 mo of age, and a large proportion of these would have been hospitalized at birth and would not have been readmitted (17). Second, the current study did not assess the impact of strains categorized as hospital-onset (HO)-MRSA vs. community-onset (CO)-MRSA (3).…”

Section: Discussionmentioning

confidence: 95%

“…The finding that greater patient sharing is associated with greater genetic similarity of MRSA strains, after adjusting for possible confounders, supports the idea that patients track contagious pathogens across hospitals. This result is important given the perhaps unexpectedly large volume of patient sharing that occurs during routine medical care in US hospitals (17).…”

Section: Discussionmentioning

confidence: 97%

“…Thus, failure of one hospital's infection control could in principle affect the prevalence of MRSA in other hospitals that share patients with it (16). Previous studies have suggested that patient transfer or patient referral patterns (17) could affect the prevalence of MRSA in hospitals (1, 2, 16, 18, 19), on the basis of theoretical arguments and observations that clones of MRSA appear in neighboring hospitals. Population genetics can provide a test of the hypothesis that patient sharing plays an important role in MRSA dynamics: If so, one might expect that hospitals that share large numbers of patients would also tend to share genetically similar populations of MRSA.…”

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confidence: 99%

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Patient sharing and population genetic structure of methicillin-resistant Staphylococcus aureus

Ke¹,

Huang

Hudson

et al. 2012

Proc. Natl. Acad. Sci. U.S.A.

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Rates of hospital-acquired infections, specifically methicillin-resistant Staphylococcus aureus (MRSA), are increasingly being used as indicators for quality of hospital hygiene. There has been much effort on understanding the transmission process at the hospital level; however, interhospital population-based transmission remains poorly defined. We evaluated whether the proportion of shared patients between hospitals was correlated with genetic similarity of MRSA strains from those hospitals. Using data collected from 30 of 32 hospitals in Orange County, California, multivariate linear regression showed that for each twofold increase in the proportion of patients shared between 2 hospitals, there was a 7.7% reduction in genetic heterogeneity between the hospitals’ MRSA populations (permutation P value = 0.0356). Pairs of hospitals that both served adults had more similar MRSA populations than pairs including a pediatric hospital. These findings suggest that concerted efforts among hospitals that share large numbers of patients may be synergistic to prevent MRSA transmission.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

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Patient sharing and population genetic structure of methicillin-resistant Staphylococcus aureus

Ke¹,

Huang

Hudson

et al. 2012

Proc. Natl. Acad. Sci. U.S.A.

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“…The Kingston Public Hospital is the only national trauma hospital in the national and it is the largest trauma hospital in the English- The issue of patient-sharing is a widely practiced phenomenon around the globe [28][29][30]. Some health care institutions do not encourage or want to support patient-sharing because it is said to expose patients to hospital-infections [40][41][42][43][44]. While the reality of hospital-infections is a part of patient-sharing [45][46][47][48][49][50], some patients in Jamaica must be transferred to Kingston Public hospital if there is a specialized trauma issue.…”

Section: Discussionmentioning

confidence: 99%

Substitution and Complementary Effects of Hospitalizations in Jamaica: an Analysis of Spanish Town and Kingston Public Hospitals

Bourne¹

2016

J Healthc Commun

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Background and purpose: Despite significant medical and public health advances in Jamaica all too often health care planning lacks the flexibility to respond appropriately to the increased and varied demand of the population due to inadequate or inaccurate information. The accuracy of the information is pertinent to forward effective changes in the health care arena, which is instrumental in the coordination of care leading to cost reduction in health care management. This study sought to investigate: 1) Probabilities of hospitalization at two government hospitals in Jamaica; 2) Elasticities of hospitalization between two government hospitals in Jamaica; 3) Response-ability of patient-sharing between two government hospitals in Jamaica; and 4) The dual effect of patient-sharing in two government hospitals in Jamaica.

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“…[21][22][23][24] In 1 county over 1 year, 67 of 72 nursing homes directly transferred residents to another nursing home, and hospitals shared patients with nearly 30 other hospitals. 25,26 Such high connectivity between healthcare facilities has already been associated with multicenter and regional outbreaks. 27 Despite the high degree of patient sharing, most studies evaluating the transmission of antibioticresistant pathogens have focused on single or small groups of hospitals.…”

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confidence: 99%

Quantifying the Exposure to Antibiotic-Resistant Pathogens Among Patients Discharged From a Single Hospital Across All California Healthcare Facilities

Datta

Brown

Nguyen

et al. 2015

Infect. Control Hosp. Epidemiol.

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OBJECTIVETo assess the time-dependent exposure of California healthcare facilities to patients harboring methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum β-lactamase (ESBL)–producing Escherichia coli and Klebsiella pneumoniae, and Clostridium difficile infection (CDI) upon discharge from 1 hospital.METHODSRetrospective multiple-cohort study of adults discharged from 1 hospital in 2005–2009, counting hospitals, nursing homes, cities, and counties in which carriers were readmitted, and comparing the number and length of stay of readmissions and the number of distinct readmission facilities among carriers versus noncarriers.RESULTSWe evaluated 45,772 inpatients including those with MRSA (N=1,198), VRE (N=547), ESBL (N=121), and CDI (N=300). Within 1 year of discharge, MRSA, VRE, and ESBL carriers exposed 137, 117, and 45 hospitals and 103, 83, and 37 nursing homes, generating 58,804, 33,486, and 15,508 total exposure-days, respectively. Within 90 days of discharge, CDI patients exposed 36 hospitals and 35 nursing homes, generating 7,318 total exposure-days. Compared with noncarriers, carriers had more readmissions to hospitals (MRSA:1.8 vs 0.9/patient; VRE: 2.6 vs 0.9; ESBL: 2.3 vs 0.9; CDI: 0.8 vs 0.4; all P<.001) and nursing homes (MRSA: 0.4 vs 0.1/patient; VRE: 0.7 vs 0.1; ESBL: 0.7 vs 0.1; CDI: 0.3 vs 0.1; all P<.001) and longer hospital readmissions (MRSA: 8.9 vs 7.3 days; VRE: 8.9 vs 7.4; ESBL: 9.6 vs 7.5; CDI: 12.3 vs 8.2; all P<.01).CONCLUSIONSPatients harboring antibiotic-resistant pathogens rapidly expose numerous facilities during readmissions; regional containment strategies are needed.Infect. Control Hosp. Epidemiol. 2015;36(11):1275–1282

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Quantifying Interhospital Patient Sharing as a Mechanism for Infectious Disease Spread

Cited by 71 publications

References 14 publications

Patient sharing and population genetic structure of methicillin-resistant Staphylococcus aureus

Patient sharing and population genetic structure of methicillin-resistant Staphylococcus aureus

Substitution and Complementary Effects of Hospitalizations in Jamaica: an Analysis of Spanish Town and Kingston Public Hospitals

Quantifying the Exposure to Antibiotic-Resistant Pathogens Among Patients Discharged From a Single Hospital Across All California Healthcare Facilities

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