Peripatetic health-care workers as potential superspreaders
Peripatetic health-care workers as potential superspreaders
复制标题
DOI：
10.1073/pnas.0900974106
复制
发表时间：
2009-10-27
影响因子：
11.1
通讯作者：
Guillemot, Didier
中科院分区：
文献类型：
--
作者：
Temime, Laura;Opatowski, Lulla;Guillemot, Didier
许多医院内爆发的疫情表现出“超级传播事件”，即通过单个个体向大量患者交叉传播。我们调查了卫生保健工作者(HCW)行为的异质性，特别是对手卫生的遵从性，可能会导致超级传播事件。特别是，我们比较了巡回(非队列)卫生工作者和其他卫生工作者的超扩散潜力。我们开发了一种基于代理的医院病房内病原体手传模型。允许三个HCW配置文件：两个指定配置文件，一个与有限数量的患者频繁接触，另一个接触较少但患者较多；以及一个巡回配置文件，与所有患者每天一次接触。我们使用文献中关于常见医院病原体(金黄色葡萄球菌、肠球菌)的数据。在1个月以上定居的患者的平均数量随着手部卫生的不遵守而增加。重要的是，我们发现这种增长依赖于非顺应性HCW的分布；例如，对于单个非顺应性分配的HCW，它保持较低的值，但对于单个非顺应性的巡回HCW，它可能相当大。这一完全不符合的巡回HCW(仅占工作人员的4.5%)的暴发与所有HCW在23%的患者接触后不符合时的预测相似。不合规的巡回卫生工作者在医院病房传播病原体方面可能扮演着不成比例的角色。他们独特的个人资料使他们成为潜在的超级传播者。这表明，对卫生的平均遵从性可能不是具有多个HCW概况的真实生活卫生保健环境中医院风险的良好指标。
Many nosocomial outbreaks exhibit "superspreading events" in which cross-transmission occurs via a single individual to a large number of patients. We investigated how heterogeneity in Health-Care Worker (HCW) behaviors, especially compliance to hand hygiene, may cause superspreading events. In particular, we compared the superspreading potential of peripatetic (noncohorted) HCWs with that of other HCWs. We developed an agent-based model for hand transmission of a pathogen in a hospital ward. Three HCW profiles were allowed: 2 assigned profiles, one with frequent contacts with a limited number of patients, another with fewer contacts but with more patients; and one peripatetic profile, with a single daily contact with all patients. We used data from the literature on common nosocomial pathogens (Staphylococcus aureus, Enterococci). The average number of patients colonized over 1 month increases with noncompliance to hand hygiene. Importantly, we show that this increase depends on the profile of noncompliant HCWs; for instance, it remains low for a single noncompliant assigned HCW but can be quite large for a single noncompliant peripatetic HCW. Outbreaks with this single fully noncompliant peripatetic HCW (representing only 4.5% of the staff) are similar to those predicted when all HCWs are noncompliant following 23% of patient contacts. Noncompliant peripatetic HCWs may play a disproportionate role in disseminating pathogens in a hospital ward. Their unique profile makes them potential superspreaders. This suggests that average compliance to hygiene may not be a good indicator of nosocomial risk in real life health care settings with several HCW profiles.