Bug-mobiles?

There's a new study in the American Journal of Emergency Medicine that caught my eye this morning. It asks the interesting question: are patients who present to the hospital via advanced life support (paramedic) transport more likely to develop HAIs than those who do not.

The design was a retrospective cohort which evaluated over 150,000 hospital admissions over a 5-year period at a hospital with a level 1 trauma center. The study found no difference in community-acquired infections between the two groups. However, patients arriving by ambulance were 1.4 times more likely to develop an HAI.

Since observational studies can be plagued with bias and confounding, we can't determine whether the ambulance transport led to the higher rates of HAIs. Nonetheless, as infection rates fall in hospitals, the identification of new groups at potential risk is important, since this can lead to the implementation of new interventions. As I begin to put together our annual report on HAIs, it's evident that we've picked the low-hanging fruit, and although rates of infections continue to fall, the slope of the curve is flattening. Thus, we need to return to the drawing board to develop new strategies.