The potential regional impact of contact precaution use in nursing homes to control methicillin-resistant Staphylococcus aureus.
The potential regional impact of contact precaution use in nursing homes to control methicillin-resistant Staphylococcus aureus.
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DOI：
10.1086/669091
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发表时间：
2013-02
影响因子：
4.5
通讯作者：
Huang SS
中科院分区：
文献类型：
--
作者：
Lee BY;Singh A;Bartsch SM;Wong KF;Kim DS;Avery TR;Brown ST;Murphy CR;Yilmaz SL;Huang SS
在养老院实施接触预防措施以防止耐甲氧西林金黄色葡萄球菌（MRSA）传播可能需要花费时间和精力，并可能对多个卫生机构产生广泛影响。计算模型可以预测潜在影响，指导政策制定。我们的多医院计算代理为基础的模型，区域医疗生态系统分析（RHEA）。加州奥兰治县的所有医院和疗养院我们的模拟模型比较了以下3种接触预防策略：(1)对任何养老院居民不采取接触预防措施，(2)对临床明显的MRSA感染采取接触预防措施，(3)对医院进行MRSA筛查确定的所有已知MRSA携带者采取接触预防措施。我们的模型表明，在养老院对临床明显的MRSA感染患者进行接触预防，导致养老院MRSA患病率相对下降中位数0.4%（范围，0%-1.6%）（坚持50%），但对医院MRSA患病率没有影响，甚至在开始治疗5年后也是如此。在所有已知MRSA携带者的养老院实施接触预防措施（50%的依从性）与实施一年后养老院MRSA患病率相对下降14.2%（范围，2.1%-21.8%）和医院MRSA患病率相对下降2.3%（范围，0%-7.1%）相关。好处随着时间的推移而积累，并随着依从性的增加而增加。我们的模型研究表明，将养老院的接触预防措施从那些临床明显感染的居民扩展到所有MRSA携带者，这表明医院和养老院分享和协调MRSA监测和携带状态信息的好处。
Implementation of contact precautions in nursing homes to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission could cost time and effort and may have wide-ranging effects throughout multiple health facilities. Computational modeling could forecast the potential effects and guide policy making. Our multihospital computational agent-based model, Regional Healthcare Ecosystem Analyst (RHEA). All hospitals and nursing homes in Orange County, California. Our simulation model compared the following 3 contact precaution strategies: (1) no contact precautions applied to any nursing home residents, (2) contact precautions applied to those with clinically apparent MRSA infections, and (3) contact precautions applied to all known MRSA carriers as determined by MRSA screening performed by hospitals. Our model demonstrated that contact precautions for patients with clinically apparent MRSA infections in nursing homes resulted in a median 0.4% (range, 0%–1.6%) relative decrease in MRSA prevalence in nursing homes (with 50% adherence) but had no effect on hospital MRSA prevalence, even 5 years after initiation. Implementation of contact precautions (with 50% adherence) in nursing homes for all known MRSA carriers was associated with a median 14.2% (range, 2.1%–21.8%) relative decrease in MRSA prevalence in nursing homes and a 2.3% decrease (range, 0%–7.1%) in hospitals 1 year after implementation. Benefits accrued over time and increased with increasing compliance. Our modeling study demonstrated the substantial benefits of extending contact precautions in nursing homes from just those residents with clinically apparent infection to all MRSA carriers, which suggests the benefits of hospitals and nursing homes sharing and coordinating information on MRSA surveillance and carriage status.
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DOI：
10.1016/j.jhin.2010.04.027
发表时间：
2010-10
期刊：
The Journal of hospital infection
影响因子：
--
作者：
Abad C;Fearday A;Safdar N
通讯作者：
Safdar N
影响因子：
39.2
作者：
BRADLEY, SF;TERPENNING, MS;KAUFFMAN, CA
通讯作者：
KAUFFMAN, CA
影响因子：
9.7
作者：
Lee, Bruce Y.;Bartsch, Sarah M.;Huang, Susan S.
通讯作者：
Huang, Susan S.
影响因子：
4.5
作者：
Lesosky, Maia;McGeer, Allison;Raboud, Janet
通讯作者：
Raboud, Janet
影响因子：
4.5
作者：
Bloemendaal, Alexander L. A.;Fluit, Ad C.;Verhoef, Jan
通讯作者：
Verhoef, Jan