BackgroundIntrahospital 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.ObjectiveThis 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).MethodsA 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.ResultsOf 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).ConclusionIntrahospital 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.

Background: 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. Objective: 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). Methods: 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 trust comprising 3 hospital sites between 2016 and 2018 (n=24,239). As elderly patients comprise a large proportion of hospital users and are a high-risk population for HAIs, the analysis focused on those over 65-years old. Logistic regression was conducted to obtain the odds ratio (OR) for developing a 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, dominant treatment function code, intensive care admission, total number of procedures, and discharge destination. Results: Of the 24,239 spells, 2879 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 a HAI by 9% (OR 1.09; 95%CI 1.05 to 1.13). Conclusion: Intrahospital transfers are associated with increased odds of developing a 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.

Ward-transfers have become more common as hospital staff balance patient needs with bed availability on specific wards. However, increased movement through the hospital may leave patients more vulnerable to potential infectious pathogen transmission routes via increased exposure to contaminated surfaces and more contacts with individuals. This may increase their risk of hospital-acquired infections (HAIs), an adverse event associated with greater antibiotic resistance, patient costs, morbidity, and mortality. This study aimed to quantify the association between the number of ward-transfers undergone during a hospital spell and the outcome of HAI. As elderly patients comprise a large proportion of hospital users and are a high-risk population for HAIs, analysis was focused on people over 65-years old. A retrospective case-control study was undertaken using data extracted from electronic health records and microbiology cultures of non-elective medical admissions to a London hospital trust between January 2016 and December 2018 (n = 24,439). Logistic regression was used to obtain the odds ratio for developing a HAI as a function of the number of ward-transfers until onset of HAI for cases, or hospital discharge for controls, while controlling for covariates including length of stay, procedures and comorbidities. Each additional ward-transfer increased the odds of developing a HAI by 8% (OR 1.08; 95%CI:1.04-1.12). The hospital is a complex environment, and interventions should be viewed in light of their impact on the system as a whole. These findings indicate that non-essential ward-transfers of elderly patients should be minimised. This may lower the incidence of infections in this population, potentially reduce the number of pathogen transmission routes in hospitals and alleviate staff burden incurred by ward-transfer associated procedures. Key messages We analysed 3 years of patient movement and microbiology data of elderly patients in a London hospital trust. Each ward-transfer increased the risk of developing a hospital-acquired infection by 8%. Reducing the number of non-essential ward-transfers patients undergo may lower the incidence of hospital-acquired infections; the decision to move a patient should therefore be carefully considered.