Association between intrahospital transfer and hospital-acquired infection in the elderly: a retrospective case-control study in a UK hospital network.
Association between intrahospital transfer and hospital-acquired infection in the elderly: a retrospective case-control study in a UK hospital network.
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DOI：
10.1136/bmjqs-2020-012124
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发表时间：
2021-06
影响因子：
5.4
通讯作者：
Costelloe CE
中科院分区：
文献类型：
--
作者：
Boncea EE;Expert P;Honeyford K;Kinderlerer A;Mitchell C;Cooke GS;Mercuri L;Costelloe CE
由于医院工作人员在病人需求与床位可用性之间取得平衡，院内转院变得更加普遍。然而，这可能使患者更容易通过增加暴露于受污染表面和与个人接触的潜在病原体传播途径。本研究的目的是量化医院内转移的数量之间的关联进行了医院法术和医院获得性感染（HAI）的发展。一项回顾性病例对照研究使用了从2015年至2018年期间由三家医院组成的大型城市医院网络（n=24 240）的非择期医疗入院的电子健康记录和微生物学培养中提取的数据。由于老年患者占医院使用者的很大比例，并且是HAI的高风险人群，因此分析重点是65岁或以上的患者。进行Logistic回归，以获得发生HAI的OR，作为病例至HAI发作的院内转移或对照组出院的函数，同时控制年龄、性别、风险时间、Elixhauser合并症、入院部位、提供护理的主要医疗保健专业人员的专业、重症监护入院、手术总数和出院目的地。在24240个法术中，有2877个病例被纳入分析。72.2%的法术包含至少一次院内转移。在多变量分析中，每增加一次院内转移，获得HAI的几率增加9%（OR=1.09; 95%CI 1.05 - 1.13）。院内转移与发生HAI的几率增加有关。应考虑尽量减少院内转移的策略，并需要进一步研究以确定不必要的转移。它们的减少可能会减少医院环境中传染性病原体的传播。
Intrahospital transfers have become more common as hospital staff balance patient needs with bed availability. However, this may leave patients more vulnerable to potential pathogen transmission routes via increased exposure to contaminated surfaces and contacts with individuals. This study aimed to quantify the association between the number of intrahospital transfers undergone during a hospital spell and the development of a hospital-acquired infection (HAI). A retrospective case–control study was conducted using data extracted from electronic health records and microbiology cultures of non-elective, medical admissions to a large urban hospital network which consists of three hospital sites between 2015 and 2018 (n=24 240). As elderly patients comprise a large proportion of hospital users and are a high-risk population for HAIs, the analysis focused on those aged 65 years or over. Logistic regression was conducted to obtain the OR for developing an HAI as a function of intrahospital transfers until onset of HAI for cases, or hospital discharge for controls, while controlling for age, gender, time at risk, Elixhauser comorbidities, hospital site of admission, specialty of the dominant healthcare professional providing care, intensive care admission, total number of procedures and discharge destination. Of the 24 240 spells, 2877 cases were included in the analysis. 72.2% of spells contained at least one intrahospital transfer. On multivariable analysis, each additional intrahospital transfer increased the odds of acquiring an HAI by 9% (OR=1.09; 95% CI 1.05 to 1.13). Intrahospital transfers are associated with increased odds of developing an HAI. Strategies for minimising intrahospital transfers should be considered, and further research is needed to identify unnecessary transfers. Their reduction may diminish spread of contagious pathogens in the hospital environment.
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