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Inter-Hospital Transfer Is an Independent Risk Factor for Hospital-Associated Infection.

Camden Gardner1,2, Ilan Rubinfeld1,2, Arielle Hodari Gupta1

  • 1Henry Ford Hospital, Detroit, Michigan, USA.

Surgical Infections
|December 20, 2023
PubMed
Summary
This summary is machine-generated.

Transferred surgical patients face a higher risk of hospital-associated infections (HAIs), including central line-associated blood stream infections, urinary tract infections, and C. difficile infections. This increased risk impacts regional centers managing these high-acuity patients.

Keywords:
CMSHACRPNational Healthcare Safety Networkhospital-associated infectionssurgerytransfers

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Area of Science:

  • Healthcare Quality and Safety
  • Infectious Diseases
  • Surgical Care Delivery

Background:

  • Regionalization of surgical care concentrates high-acuity patients in larger centers.
  • Hospital-associated infections (HAIs) are critical quality indicators with significant financial consequences.
  • Understanding the role of inter-hospital transfers in HAI occurrence is vital for infection control.

Purpose of the Study:

  • To investigate the association between inter-hospital transfers and the incidence of HAIs among surgical patients.
  • To quantify the risk of specific National Healthcare Safety Network (NHSN)-defined HAIs in transferred surgical patients.
  • To inform strategies for mitigating HAI risks within a multihospital system undergoing care regionalization.

Main Methods:

  • Analysis of adult surgical inpatient data from a five-hospital health system registry (2014-2021).
  • Inclusion of patient demographics, health characteristics, acuity, and NHSN-defined HAIs: CLABSI, CAUTI, and CDI.
  • Application of univariable and multivariable statistical analyses to assess HAI rates in transfer versus non-transfer patients.

Main Results:

  • The study identified 92,832 surgical patients, with 3,232 (3.5%) being transfers.
  • Overall HAI rate was 0.6% (528 cases), including CLABSI (0.09%), CAUTI (0.14%), and CDI (0.35%).
  • Transfer patients exhibited significantly higher rates across all three HAIs (CLABSI OR 4.79, CAUTI OR 4.20, CDI OR 3.59; p<0.001). Multivariable analysis confirmed increased HAI risk (OR 1.56; p<0.001).

Conclusions:

  • Transferred surgical patients demonstrate a statistically significant, increased risk-adjusted rate of HAIs.
  • This finding highlights a challenge for regional centers managing high-risk surgical transfers.
  • The downstream effects on healthcare reimbursement underscore the financial implications of HAIs in transferred populations.