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Unwelcome Passengers: Transferring Infection

In this article, Dr Anthony O' Dwyer and Dr Alexia Paolineli discuss the risk of the spread of multi-resistant organisms through transfer teams
© Dr Anthony O’Dwyer, North Central London Adult Critical Care Transfer Service (NCL-ACTS) & Dr Alexia Paolineli, Imperial College Healthcare NHS Trust

So far in the previous clinical cases we’ve seen examples of risks to the patient due to physiological deterioration, equipment failure and inadequate preparation, but we should remember that the risks of transfer are wider than just those to the patient. Here we explore the risks of spreading infections – an important aspect to remember when moving patients within and between healthcare facilities…

Transfer teams can be responsible for the spread of multi-resistant organisms
  • The WHO has highlighted the importance globally of antibiotic resistance as one of the biggest threats to global health, food security, and development today. As transfer medics and practitioners we have a duty to maintain infection prevention and minimise transmission.

Evacuation From War-Zones

  • Evacuating patients from war-zones to countries of safety or standard international repatriations risks spreading multi-resistant organisms across political and geographical borders.
  • When we couple the risk of transmission to staff, variable antibiotic stewardship in different parts of the world and the variable isolation precautions and barrier nursing practices there is a real risk of spreading multi-resistant germs to vulnerable populations.
  • A large number of factors can predispose the risk of infection or transmission of multi-resistant bacterial organisms.

See the factors linked to aeromedical evacuees and medical tourists – Table 1 from Rogers[1]

  • This graphic – Figure 1, from Rogers [1] – shows the transmission of Klebsiella pneumoniae and beta-lactamase producing organisms. The epicentres are in black and reported/potential importations are in grey – which demonstrates spread globally.

How Can We Prevent Spreading Multi-Drug-Resistant Germs?

  • Maintain vigilance
  • Customised screening at the receiving institution with focus on organisms that are not already endemic at that site
  • Consider referring patients to isolation areas at the receiving hospital
  • Build infection prevention into our medical device manufacturing – we will explore this further later.


© Dr Anthony O’Dwyer, North Central London Adult Critical Care Transfer Service (NCL-ACTS) & Dr Alexia Paolineli, Imperial College Healthcare NHS Trust
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A Journey Through Transfer Medicine

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