An Agent-based Simulation Model for Clostridium difficile Infection Control
An Agent-based Simulation Model for Clostridium difficile Infection Control
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DOI：
10.1177/0272989x14545788
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发表时间：
2015-02-01
影响因子：
3.6
通讯作者：
Alagoz, Oguzhan
中科院分区：
文献类型：
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作者：
Codella, James;Safdar, Nasia;Alagoz, Oguzhan
背景。控制艰难梭菌感染（CDI）对于医疗机构来说是一个日益困难的问题。对抗 CDI 传播的常用策略包括口服万古霉素治疗 CDI、医护人员用肥皂和水加强手部卫生、对受感染病房进行日常环境消毒以及对患病患者进行接触隔离。然而，这些策略的有效性，特别是对于地方性 CDI 的有效性，尚未得到充分研究。本研究的目的是开发一种有效的、基于代理的模拟模型 (ABM)，以研究中型医院中艰难梭菌的传播和控制。方法。我们开发了一家中型医院的 ABM，其中包括患者、医护人员和访客等代理。我们使用马尔可夫链模拟患者 CDI 的自然进展以及通过药物和环境相互作用传播 CDI。我们从 2007-2010 年威斯康星州医院协会的汇总患者数据和已发表的医学文献中得出输入参数。我们定义了一个校准过程，通过将模拟结果与已发表文献中的基准值进行比较来估计马尔可夫模型的转移概率。结果。在对单独实施的 CDI 控制策略进行比较时，对 CDI 阳性病房进行常规漂白消毒可最大程度地减少院内无症状定植 (21.8%) 和院内 CDI (42.8%)。此外，万古霉素治疗可最大程度地减少 CDI 复发 (41.9%)、CDI 相关死亡率 (68.5%) 和患者总住院时间 (21.6%)。结论。我们开发了一种用于 CDI 控制的通用 ABM，可以定制并进一步扩展到特定机构和/或场景。此外，我们通过校准估计患者自然 CDI 进展的马尔可夫模型的转移概率。
Background. Control of Clostridium difficile infection (CDI) is an increasingly difficult problem for health care institutions. There are commonly recommended strategies to combat CDI transmission, such as oral vancomycin for CDI treatment, increased hand hygiene with soap and water for health care workers, daily environmental disinfection of infected patient rooms, and contact isolation of diseased patients. However, the efficacy of these strategies, particularly for endemic CDI, has not been well studied. The objective of this research is to develop a valid, agent-based simulation model (ABM) to study C. difficile transmission and control in a midsized hospital. Methods. We develop an ABM of a midsized hospital with agents such as patients, health care workers, and visitors. We model the natural progression of CDI in a patient using a Markov chain and the transmission of CDI through agent and environmental interactions. We derive input parameters from aggregate patient data from the 2007-2010 Wisconsin Hospital Association and published medical literature. We define a calibration process, which we use to estimate transition probabilities of the Markov model by comparing simulation results to benchmark values found in published literature. Results. In a comparison of CDI control strategies implemented individually, routine bleach disinfection of CDI-positive patient rooms provides the largest reduction in nosocomial asymptomatic colonization (21.8%) and nosocomial CDIs (42.8%). Additionally, vancomycin treatment provides the largest reduction in relapse CDIs (41.9%), CDI-related mortalities (68.5%), and total patient length of stay (21.6%). Conclusion. We develop a generalized ABM for CDI control that can be customized and further expanded to specific institutions and/or scenarios. Additionally, we estimate transition probabilities for a Markov model of natural CDI progression in a patient through calibration.