Modeling the spread of methicillin-resistant Staphylococcus aureus in nursing homes for elderly.
Modeling the spread of methicillin-resistant Staphylococcus aureus in nursing homes for elderly.
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DOI：
10.1371/journal.pone.0029757
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Ruan S
中科院分区：
文献类型：
--
作者：
Chamchod F;Ruan S
耐甲氧西林金黄色葡萄球菌（MRSA）在许多医院环境中流行，包括疗养院。它是一种重要的院内病原体，可导致死亡，并给患者、医院和社区造成经济负担。这种细菌在养老院的流行病学既类似于医院，也类似于社区。传播途径为卫生保健工作者之手以及居民在社会活动期间的直接接触。在这项工作中，采用确定性和随机框架中的数学模型来研究MRSA在居民和医护人员中的传播，MRSA在人群中的持久性和流行程度，以及控制这种病原体在养老院传播的可能方法。该模型预测：如果入院时没有严格的筛查和去菌落，MRSA可能会持续存在；居民去殖民化、改善居民和卫生工作者的手部卫生、缩短卫生工作者受污染的时间、降低居民与医务人员的比例是可能的控制策略；同时，居民自入院以来仍然易受感染的时间可以通过对殖民个体进行筛查和非殖民化治疗而延长；在随机框架中，被定植的居民总数是不同的，并且随着被定植居民入境、定植持续时间、居民之间的平均接触次数或每个居民要求卫生保健工作者的平均接触次数的增加，被定植的居民总数可能会增加；将被定植的个体引入无mrsa的养老院比引入受污染的HCW更有可能导致重大疫情的爆发。
Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in many hospital settings, including nursing homes. It is an important nosocomial pathogen that causes mortality and an economic burden to patients, hospitals, and the community. The epidemiology of the bacteria in nursing homes is both hospital- and community-like. Transmission occurs via hands of health care workers (HCWs) and direct contacts among residents during social activities. In this work, mathematical modeling in both deterministic and stochastic frameworks is used to study dissemination of MRSA among residents and HCWs, persistence and prevalence of MRSA in a population, and possible means of controlling the spread of this pathogen in nursing homes. The model predicts that: without strict screening and decolonization of colonized individuals at admission, MRSA may persist; decolonization of colonized residents, improving hand hygiene in both residents and HCWs, reducing the duration of contamination of HCWs, and decreasing the resident∶staff ratio are possible control strategies; the mean time that a resident remains susceptible since admission may be prolonged by screening and decolonization treatment in colonized individuals; in the stochastic framework, the total number of colonized residents varies and may increase when the admission of colonized residents, the duration of colonization, the average number of contacts among residents, or the average number of contacts that each resident requires from HCWs increases; an introduction of a colonized individual into an MRSA-free nursing home has a much higher probability of leading to a major outbreak taking off than an introduction of a contaminated HCW.
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影响因子：
11.8
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