title: Hospital networks and the dispersal of hospital-acquired pathogens by patient transfer.
abstract: Hospital-acquired infections (HAI) are often seen as preventable incidents that result from unsafe practices or poor hospital hygiene. This however ignores the fact that transmissibility is not only a property of the causative organisms but also of the hosts who can translocate bacteria when moving between hospitals. In an epidemiological sense, hospitals become connected through the patients they share. We here postulate that the degree of hospital connectedness crucially influences the rates of infections caused by hospital-acquired bacteria. To test this hypothesis, we mapped the movement of patients based on the UK-NHS Hospital Episode Statistics and observed that the proportion of patients admitted to a hospital after a recent episode in another hospital correlates with the hospital-specific incidence rate of MRSA bacteraemia as recorded by mandatory reporting. We observed a positive correlation between hospital connectedness and MRSA bacteraemia incidence rate that is significant for all financial years since 2001 except for 2008-09. All years combined, this correlation is positive and significantly different from zero (partial correlation coefficient r = 0.33 (0.28 to 0.38)). When comparing the referral pattern for English hospitals with referral patterns observed in the Netherlands, we predict that English hospitals more likely see a swifter and more sustained spread of HAIs. Our results indicate that hospitals cannot be viewed as individual units but rather should be viewed as connected elements of larger modular networks. Our findings stress the importance of cooperative effects that will have a bearing on the planning of health care systems, patient management and hospital infection control.
authors.affiliation: Department of Medical Microbiology, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: Tjibbe
authors.initials: T
authors.lastname: Donker
authors.forename: Jacco
authors.initials: J
authors.lastname: Wallinga
authors.forename: Richard
authors.initials: R
authors.lastname: Slack
authors.forename: Hajo
authors.initials: H
authors.lastname: Grundmann
mesh_terms: D016470:Bacteremia / Q000453:epidemiology; D003198:Computer Simulation; D003428:Cross Infection / Q000453:epidemiology* / Q000635:transmission*; D018562:Disease Transmission, Infectious / Q000706:statistics & numerical data*; D004739:England; D006801:Humans; D015994:Incidence; D055624:Methicillin-Resistant Staphylococcus aureus; D008962:Models, Theoretical; D009313:National Health Programs; D009426:Netherlands; D010360:Patient Transfer / Q000706:statistics & numerical data*; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000635:transmission*