Another worry for the hospital epidemiologist

This morning's New York Times has a long piece on long-term acute care hospitals (LTACHs). The article focuses on quality and safety issues in these facilities, many of which are for-profit. From the epidemiologic standpoint, these hospitals pose special problems since patients are admitted there from many acute care hospitals typically after long stays and are colonized or infected with multi-drug resistant organisms (MDROs). The LTACH patients then may require re-admission to the acute care hospital after colonization or infection with other MDROs. So in essence the LTACH serves as an amplifier for MDROs. There's a nice review on the infection control issues associated with LTACHs by Munoz-Price in an issue of CID from last year.