Originally published by our sister publication General Surgery News

DALLAS—According to new research, surgical patients who are transferred between hospitals are more likely than non-transferred patients to develop a hospital-acquired or associated infection, which could have a downstream effect on the receiving hospital’s reputation and bottom line.

With the increasing scrutiny on hospital-acquired or associated infections (HAIs)—some of which are identified by Medicare as “never events”—the rate of HAIs has fallen substantially over the past decade. “Yet we really want to strive toward eliminating HAIs,” said Camden Gardner, BA, the Roger Smith Post-Bachelor Research Fellow at Henry Ford Health, in Detroit.

“We’d like to know how patient experiences prior to a hospital encounter influence the occurrence of a HAI. We haven’t had the data to explore that question, so we thought the best way to begin is by looking at transfers.”

Mr. Gardner presented his study at the 2022 annual meeting of the Surgical Infection Society.

To explore the hypothesis that surgical patients who undergo transfer have a higher risk for National Healthcare Safety Network–labeled HAIs, Mr. Gardner and his co-investigators conducted a retrospective review of data on surgical patients treated at five hospitals within Henry Ford Health System between 2014 and 2022, looking for central line–associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI) and Clostridioides difficile infection (CDI).

They identified 92,832 surgical patients, of whom 3,232 were transferred from another hospital. Overall, 544 patients (0.6%) acquired HAIs, with 86 (0.09%) cases of CLABSI, 133 (0.14%) cases of CAUTI and 325 (0.35%) cases of CDI. The rate of CLABSI was sevenfold higher in transfers than non-transfers, while the rates of CAUTI and CDI were six and three times higher in transferred patients, respectively.

On univariate analysis, patients with higher rates of HAIs included older patients, those born female, patients who lived alone, patients with a recent ER visit, urgent or emergent cases, and those with any Charleston comorbidity other than HIV/AIDS. Patients who were white and had private insurance had lower rates of HAIs. At the hospital level, patients were more likely to have HAIs if they were treated at academic centers than at community hospitals.

On multivariate analysis, female sex, having two Charleston comorbidities (dementia and mild liver disease), having urgent or emergent surgery, and with higher MS-DRG diagnosis weights, were significantly associated with HAIs. “Finally, transfers had a 1.49 times relative risk for experiencing HAIs compared to non-transfers, with an odds ratio of 1.56,” Mr. Gardner said.

There could be several reasons for the increased risk for HAIs in transferred patients, such as delays in care, extended antibiotic use, disruptions in communication and an increased opportunity for exposure to pathogens, said he noted.

“In conjunction, referring providers could be astutely aware of the risk presented to patients resulting in a preemptive transfer. Lastly, transfer status could be confounded by variables that were not accounted for within our model. Regardless of the underlying mechanism, receiving institutions inherit the increased risk of HAIs that is associated with transfer patients,” Mr. Gardner said.

Michaela West, MD, PhD, the chair of trauma research at Northern Memorial Health, in Minneapolis, and the discussant on this paper, was not surprised by the findings. “If a patient is transferred because they need a higher level of care, those patients are going to be at a higher risk of having those types of complications. But just because the findings aren’t surprising doesn’t mean they’re unimportant to document,” she said.

Dr. West suggested the research could be particularly useful if used as a base to uncover why transferred patients may be more vulnerable to HAIs. “If they risk-stratify these patients and find there is still a risk of HAI, then we can recognize opportunities to improve how the patients were cared for [at the sending hospital].”