Are outside hospital laboratory exams preferred over hospital-based exams due to fear of hospital-acquired infections?

Patient Preference for Outside Hospital Laboratory Testing Due to Fear of Hospital-Acquired Infections

The available evidence does not directly address patient preferences for outside hospital versus hospital-based laboratory testing driven by fear of hospital-acquired infections. However, the evidence does provide important context about infection risks and testing location considerations.

Hospital-Acquired Infection Risk Context

Hospital-acquired infections (HAIs) are a legitimate concern, affecting 7-10% of hospitalized patients and accounting for approximately 80,000 deaths annually in the United States, with over 20% occurring in ICU patients 1. The overall burden is higher in developing countries 2. Common HAIs include ventilator-associated pneumonia, catheter-associated urinary tract infections, surgical site infections, and catheter-related bloodstream infections 1, 2.

Actual Risk from Laboratory Testing

• The risk of HAI transmission from routine laboratory specimen collection is minimal when proper infection control measures are implemented 3.
• For patients with suspected highly infectious diseases, samples should be taken in specialized isolation units to reduce healthcare worker exposure, not to protect the patient from other hospital infections 3.
• The American Academy of Pediatrics notes that avoiding hospitalization can reduce consequences of healthcare-associated infections as a benefit, but this applies to unnecessary admission for monitoring, not outpatient laboratory testing 3.

Laboratory Testing Location Considerations

Hospital-Based Laboratory Testing

For most clinical scenarios, hospital-based laboratory testing offers superior quality assurance, faster turnaround times for critical results, and appropriate biosafety measures 3.

• Hospital laboratories must meet the same inspection and approval standards as freestanding facilities through bodies like the Joint Commission on Accreditation of Healthcare Organizations 3.
• When cardiac catheterization is performed by hospital personnel in hospital-equipped laboratories, there is no difference in quality and efficacy compared to inpatient procedures 3.
• For highly pathogenic infectious diseases, samples should be processed in biosafety level 3 or 4 laboratories located close to or on the same campus as patient care areas to avoid unnecessary transportation of contaminated samples 3.

Point-of-Care and Outside Testing

• Point-of-care testing has advantages of lower cost and faster turnaround time, allowing clinical decisions during patient encounters 3.
• Laboratory-based testing may be more amenable to large-volume testing due to automation and batching capabilities 3.
• Community screening outside healthcare settings is not recommended because patients with positive tests may not seek appropriate follow-up, and there may be failure to ensure repeat testing for negative results 3.
• Testing should be carried out within the healthcare setting to ensure proper follow-up and discussion of abnormal results 3.

Clinical Decision Framework

When Hospital-Based Testing Is Preferred:

• Critically ill patients requiring rapid results for immediate clinical decisions 3
• Suspected highly pathogenic infections requiring specialized biosafety measures 3
• Situations requiring immediate therapeutic intervention based on results 3
• Patients requiring serial monitoring or complex diagnostic panels 3

When Outside/Ambulatory Testing May Be Appropriate:

• Stable outpatients without acute symptoms requiring routine screening 3
• Follow-up testing for chronic conditions in low-risk patients 3
• Situations where point-of-care testing can provide adequate diagnostic accuracy with faster turnaround 3

Important Caveats

The fear of hospital-acquired infections should not drive patients away from necessary hospital-based laboratory testing, as the actual risk from specimen collection is negligible with proper infection control measures 3, 4. Hospitals can be held liable for HAIs only when they fail to introduce or implement best practice infection control measures, or when staff negligently fail to comply with implemented measures 4.

Avoiding appropriate hospital-based testing due to infection fears may result in delayed diagnosis, inadequate follow-up, and missed opportunities for timely intervention 3. The benefits of accurate, timely laboratory diagnosis in appropriate healthcare settings far outweigh the minimal risk of infection transmission during specimen collection 3.