Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine, Irvine, California, USA.
Infect Control Hosp Epidemiol. 2010 Nov;31(11):1160-9. doi: 10.1086/656747.
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.
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.
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.
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.
评估医院内传染病的传播情况时，很少考虑到医院间的患者共享。对于潜伏期较长或存在携带者状态的病原体，这一点尤为重要。
我们利用医院出院数据，对加利福尼亚州奥兰治县（OC）的 32 家医院的所有患者进行了共享情况评估。同日内的医院间转院被视为“直接”转院，而患者在出院后居家或其他地方逗留一段时间后再转院的情况则被视为“间接”患者共享事件。我们评估了出院后不同时间点再次入住 OC 其他医院的频率，并研究了艰难梭菌感染患者的医院间共享情况。
2005 年，OC 医院共有 319918 例入院。29%的患者至少接受过 2 次住院治疗，出院至再次入院的中位间隔时间为 53 天。在有 2 次或以上入院记录的患者中，75%的患者曾入住过不止 1 家医院。94%的医院间患者共享是间接的。当我们以 10 名共享患者作为潜在医院间暴露的衡量标准时，6 家（19%）医院在 6 个月内“暴露”了 OC 所有医院的 50%以上，17 家（53%）医院在 12 个月内“暴露”了 OC 所有医院的 50%以上。每家医院都与中位数为 28 家的其他医院共享了 1 名或更多的患者。当我们评估艰难梭菌感染患者时，25%的患者在 12 周内再次入院；41%的患者转至不同的医院，而这些再入院中不到 30%是直接转院。
在一个大型都市区，医院间的患者共享是传染病传播的一个潜在途径。与居家或其他地方逗留相关的间接共享构成了大部分潜在暴露，且这种情况是医院所不知道的。
