An agent-based and spatially explicit model of pathogen dissemination in the intensive care unit
An agent-based and spatially explicit model of pathogen dissemination in the intensive care unit
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DOI：
10.1097/01.ccm.0000150658.05831.d2
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发表时间：
2005-01-01
影响因子：
8.8
通讯作者：
Crooke, PS
中科院分区：
文献类型：
--
作者：
Hotchkiss, JR;Strike, DG;Crooke, PS
目的：开发和传播重症监护室病原体接触传播的空间明确模型。设计：构建模拟直接接触传播的病原体（如耐甲氧西林金黄色葡萄球菌或耐万古霉素肠球菌）传播的模型。然后系统地检查了病原体传播的调节伴随着临床相关病原体和机构特异性因素的变化。环境和患者。该模型被配置为假设的 24 个床位的重症监护病房。该模型可以通过不同的病原体传播性、护理人员和/或患者污染的持续时间以及护理人员的分配和流动模式进行参数化。干预。检查的病原体和机构特定因素包括病原体传播性、护理人员污染的持续时间、污染或感染患者的区域队列、新污染患者的延迟检测和隔离、护理人员就诊次数的减少以及患者中护理人员分配的改变。测量和主要结果：该模型预测了在指定空间、初始流行率和动态条件下，给定人口比例被目标病原体污染或感染的概率。接触病原体的获得风险和护理人员携带病原体的持续时间对传播影响最大。即使没有其他干预措施，区域队列以及快速检测和隔离受污染患者都可以显着降低传播的可能性。减少护理人员领域之间“交叉”的策略会降低更广泛传播的可能性。结论。空间明确的离散元模型（例如所提出的模型）可能有助于分析重症监护病房内病原体的传播。
Objective: To develop and disseminate a spatially explicit model of contact transmission of pathogens in the intensive care unit.Design: A model simulating the spread of a pathogen transmitted by direct contact (such as methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus) was constructed. The modulation of pathogen dissemination attending changes in clinically relevant pathogen- and institution-specific factors was then systematically examined.Setting and Patients. The model was configured as a hypothetical 24-bed intensive care unit. The model can be parameterized with different pathogen transmissibilities, durations of caregiver and/or patient contamination, and caregiver allocation and flow patterns.Interventions. Pathogen- and institution-specific factors examined included pathogen transmissibility, duration of caregiver contamination, regional cohorting of contaminated or infected patients, delayed detection and isolation of newly contaminated patients, reduction of the number of caregiver visits, and alteration of caregiver allocation among patients.Measurements and Main Results: The model predicts the probability that a given fraction of the population will become contaminated or infected with the pathogen of interest under specified spatial, initial prevalence, and dynamic conditions. Perencounter pathogen acquisition risk and the duration of caregiver pathogen carriage most strongly affect dissemination. Regional cohorting and rapid detection and isolation of contaminated patients each markedly diminish the likelihood of dissemination even absent other interventions. Strategies reducing "crossover" between caregiver domains diminish the likelihood of more widespread dissemination.Conclusions. Spatially explicit discrete element models, such as the model presented, may prove useful for analyzing the transmission of pathogens within the intensive care unit.