Analyzing pathogen transmission in the dialysis unit: Time for a (schedule) change?
Analyzing pathogen transmission in the dialysis unit: Time for a (schedule) change?
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DOI：
10.2215/cjn.00130107
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发表时间：
2007-11-01
影响因子：
9.8
通讯作者：
Crooke, Philip S.
中科院分区：
文献类型：
--
作者：
Hotchkiss, John R.;Holley, Paul;Crooke, Philip S.
背景和目的：感染性疾病和耐药性微生物是透析人群日益严重的问题。透析治疗期间患者就诊的频率以及与无生命环境的亲密、长时间的身体接触使这些设施成为医院病原体传播的潜在有效场所。隔离措施和感染控制措施可能不方便，并消耗有限的资源。分析不同遏制战略效果的定量工具有助于确定进一步研究的最佳战略。然而，空间和时间上的考虑密切相关的透析单元大大复杂的分析依赖于传统的数学approaches.Design，设置，参与者，和测量：一个随机的，基于个人的，蒙特卡罗模拟工具，预测的影响，各种感染控制策略的病原体传播通过透析单元在面对诊断的不确定性。该模型被配置为模拟中型透析装置。预测的各种政策安排谁被怀疑是传染性的患者的后果进行了探讨，使用基于文献的估计病原体的传播能力，患病率和诊断的不确定性。结果：环境净化预测是最重要的限制病原体传播。时间隔离（调度病人谁被怀疑是传染性透析轮班，在当天晚些时候）预计有最大的有效性，在减少传输，连续days.Conclusions之间给予足够的环境净化：净化病人的环境（椅子）可以显着减弱病原体传播。时间隔离可能是一种简单、低成本、系统水平的干预措施，具有显著降低透析室院内传播的潜力。
Background and objectives: Infectious diseases and antimicrobial-resistant microorganisms are a growing problem for the dialysis population. The frequency of patient visits and intimate, prolonged physical contact with the inanimate environment during dialysis treatments make these facilities potentially efficient venues for nosocomial pathogen transmission. Isolation measures and infection control practices can be inconvenient and consume limited resources. Quantitative tools for analyzing the effects of different containment strategies can help to identify optimal strategies for further study. However, spatial and temporal considerations germane to the dialysis unit greatly complicate analyses relying on conventional mathematical approaches.Design, setting, participants, & measurements: A stochastic, individual-based, Monte Carlo simulation tool that predicts the effects of various infection control strategies on pathogen dissemination through the dialysis unit in the face of diagnostic uncertainty was developed. The model was configured to emulate a medium-sized dialysis unit. The predicted consequences of various policies for scheduling patients who were suspected of being infectious were then explored, using literature-based estimates of pathogen transmissibility, prevalence, and diagnostic uncertainty.Results: Environmental decontamination was predicted to be of paramount importance in limiting pathogen dissemination. Temporal segregation (scheduling patients who were suspected of being infectious to dialysis shifts that are later in the day) was predicted to have the greatest effectiveness in reducing transmission, given adequate environmental decontamination between successive days.Conclusions: Decontamination of the patient's environment (chair) can markedly attenuate pathogen dissemination. Temporal segregation could be a simple, low-cost, system-level intervention with significant potential to reduce nosocomial transmission in the dialysis unit.