Modeling Interventions to Reduce the Spread of Multidrug-Resistant Organisms Between Health Care Facilities in a Region.
Modeling Interventions to Reduce the Spread of Multidrug-Resistant Organisms Between Health Care Facilities in a Region.
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DOI：
10.1001/jamanetworkopen.2021.19212
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发表时间：
2021-08-02
影响因子：
13.8
通讯作者：
Lee BY
中科院分区：
文献类型：
--
作者：
Bartsch SM;Wong KF;Mueller LE;Gussin GM;McKinnell JA;Tjoa T;Wedlock PT;He J;Chang J;Gohil SK;Miller LG;Huang SS;Lee BY
在一组卫生保健设施中，哪种耐多药生物干预措施最适合用于减少耐多药生物在区域范围内的传播？在这项对加利福尼亚州奥兰治县102个设施的计算模拟建模研究中，使用基于主体的模型表明，3年后，在42个目标设施中提高接触预防的有效性和实施去菌落程序将使耐甲氧西林金黄色葡萄球菌的患病率在全县范围内相对下降1%和24%，耐碳青霉烯类肠杆菌科的患病率在全县范围内相对下降2%和40%，但效果不同。设施间通信的增加并没有改变患病率或传播。本研究的结果表明，当对一组卫生保健设施进行干预时，建模可以为现实世界区域干预措施的设计提供信息，以控制mdro。耐多药生物（mdro）可在一个地区的卫生保健设施中传播。由于资源有限，某些干预措施只能在一些设施中实施；因此，决策者需要评估哪些干预措施可能是最好的。确定一组目标设施，并评估哪种MDRO干预措施最适合在奥兰治县（加利福尼亚州奥兰治县的一个大型区域公共卫生合作项目）实施，以消除危及生命的MDRO传播。2016年开发了一个基于agent的卫生保健设施模型，以模拟从2010年开始的10年耐甲氧西林金黄色葡萄球菌（MRSA）和耐碳青霉烯类肠杆菌科（CRE）的传播，并模拟从2017年开始的3年各种MDRO干预措施的使用。纳入了加利福尼亚州奥兰治县为成年住院患者提供服务的所有卫生保健机构（23家医院、5家长期急症护理医院和74家疗养院），并通过网络分析确定了42家目标机构。提高接触预防的有效性，加强机构间关于患者MDRO状态的沟通，并在特定目标机构中使用消毒沐浴皂和鼻产品进行去菌化。MRSA和CRE患病率和新携带者数量（即传播事件）。与截至2017年奥兰治县使用的持续感染控制措施相比，将42个目标设施的接触预防有效性从40%提高到64%，3年后全县卫生保健设施的MRSA患病率相对降低0.8%（范围，0.5%-1.1%），CRE患病率相对降低2.4%（范围，0.8%-4.6%），避免了761例新的MRSA传播事件（95% CI， 756-765事件）和166例新的CRE传播事件（95% CI， 158-174事件）。在这些目标机构中，将患者MDRO状态的机构间沟通提高到80%，并没有改变mrdo的患病率或传播。实施去菌落程序（清除率：医院39%，长期急症护理机构27%，疗养院3%）使MRSA患病率相对降低23.7%（范围23.5%-23.9%），避免了3515起新的传播事件（95% CI， 3509-3521起事件）。将抗菌沐浴皂的有效性提高到48%，CRE患病率相对降低39.9%（范围38.5%-41.5%），避免了1435起新的传播事件（95% CI， 1427-1442起事件）。本研究的结果强调了建模可以为区域干预措施的设计提供信息的方式，并建议非殖民化将是奥兰治县消除危及生命的mdro传播的共享医疗干预的最佳策略。本计算模拟建模研究使用基于主体的模型来确定目标设施，并评估最佳干预措施，以减少加州奥兰治县卫生保健设施中耐多药生物的区域传播。
Which multidrug-resistant organism (MDRO) intervention is best to implement in a set of health care facilities to reduce the spread of MDROs regionwide? In this computational simulation modeling study of 102 facilities in Orange County, California, the use of an agent-based model indicated that, after 3 years, increasing contact precaution effectiveness and implementing decolonization procedures in 42 target facilities would yield countywide relative decreases in the prevalence of methicillin-resistant Staphylococcus aureus of 1% and 24% and countywide relative decreases in the prevalence of carbapenem-resistant Enterobacteriaceae of 2% and 40%, respectively, but varied with effectiveness. Increasing interfacility communication produced no changes in prevalence or transmission. This study’s findings suggest that modeling can inform the design of real-world regional interventions to control MDROs when intervening in a set of health care facilities. Multidrug-resistant organisms (MDROs) can spread across health care facilities in a region. Because of limited resources, certain interventions can be implemented in only some facilities; thus, decision-makers need to evaluate which interventions may be best to implement. To identify a group of target facilities and assess which MDRO intervention would be best to implement in the Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, a large regional public health collaborative in Orange County, California. An agent-based model of health care facilities was developed in 2016 to simulate the spread of methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteriaceae (CRE) for 10 years starting in 2010 and to simulate the use of various MDRO interventions for 3 years starting in 2017. All health care facilities (23 hospitals, 5 long-term acute care hospitals, and 74 nursing homes) serving adult inpatients in Orange County, California, were included, and 42 target facilities were identified via network analyses. Increasing contact precaution effectiveness, increasing interfacility communication about patients’ MDRO status, and performing decolonization using antiseptic bathing soap and a nasal product in a specific group of target facilities. MRSA and CRE prevalence and number of new carriers (ie, transmission events). Compared with continuing infection control measures used in Orange County as of 2017, increasing contact precaution effectiveness from 40% to 64% in 42 target facilities yielded relative reductions of 0.8% (range, 0.5%-1.1%) in MRSA prevalence and 2.4% (range, 0.8%-4.6%) in CRE prevalence in health care facilities countywide after 3 years, averting 761 new MRSA transmission events (95% CI, 756-765 events) and 166 new CRE transmission events (95% CI, 158-174 events). Increasing interfacility communication of patients’ MDRO status to 80% in these target facilities produced no changes in the prevalence or transmission of MRDOs. Implementing decolonization procedures (clearance probability: 39% in hospitals, 27% in long-term acute care facilities, and 3% in nursing homes) yielded a relative reduction of 23.7% (range, 23.5%-23.9%) in MRSA prevalence, averting 3515 new transmission events (95% CI, 3509-3521 events). Increasing the effectiveness of antiseptic bathing soap to 48% yielded a relative reduction of 39.9% (range, 38.5%-41.5%) in CRE prevalence, averting 1435 new transmission events (95% CI, 1427-1442 events). The findings of this study highlight the ways in which modeling can inform design of regional interventions and suggested that decolonization would be the best strategy for the Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County. This computational simulation modeling study uses an agent-based model to identify target facilities and assess the optimal intervention to reduce the regional spread of multidrug-resistant organisms across health care facilities in Orange County, California.
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影响因子：
4.9
作者：
Lee BY;Yilmaz SL;Wong KF;Bartsch SM;Eubank S;Song Y;Avery TR;Christie R;Brown ST;Epstein JM;Parker JI;Huang SS
通讯作者：
Huang SS
影响因子：
4.5
作者：
Lee BY;Singh A;Bartsch SM;Wong KF;Kim DS;Avery TR;Brown ST;Murphy CR;Yilmaz SL;Huang SS
通讯作者：
Huang SS
DOI：
10.1016/j.cmi.2016.09.003
发表时间：
2017-01
期刊：
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
影响因子：
--
作者：
Bartsch SM;McKinnell JA;Mueller LE;Miller LG;Gohil SK;Huang SS;Lee BY
通讯作者：
Lee BY
DOI：
10.1093/cid/ciy399
发表时间：
2019-01-01
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Klein EY;Jiang W;Mojica N;Tseng KK;McNeill R;Cosgrove SE;Perl TM
通讯作者：
Perl TM
影响因子：
11.8
作者：
Golan, Y;Doron, S;Snydman, DR
通讯作者：
Snydman, DR