Preventing the Transmission of Multidrug-Resistant Organisms: Modeling the Relative Importance of Hand Hygiene and Environmental Cleaning Interventions
Preventing the Transmission of Multidrug-Resistant Organisms: Modeling the Relative Importance of Hand Hygiene and Environmental Cleaning Interventions
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DOI：
10.1086/677632
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发表时间：
2014-09-01
影响因子：
4.5
通讯作者：
Thom, Kerri A.
中科院分区：
文献类型：
--
作者：
Barnes, Sean L.;Morgan, Daniel J.;Thom, Kerri A.
客观的。手部卫生和环境清洁是重要的感染预防策略，但每种策略的相对影响尚不清楚。该信息对于评估资源分配非常重要。方法。我们在一个有 20 名患者的重症监护病房中开发了一种基于代理的患者间传播模型，通过短暂定植的医护人员和未完全清洁的房间进行传播。护士和医生被建模，并且在进出病房时具有不同的手部卫生合规水平。我们使用文献数据和观察数据模拟了鲍曼不动杆菌、耐甲氧西林金黄色葡萄球菌和耐万古霉素肠球菌的传播一年。结果。我们模拟了 175 个基于参数的场景，并比较了手部卫生和环境清洁对多重耐药微生物获得率的影响。对于所有生物体来说，手部卫生依从性的提高优于终端清洁彻底性的同等提高。从基线来看，终端清洁与手卫生相比需要 2:1 的改进，以匹配采集率的同等降低（例如，终端清洁需要改进 20%，以匹配由于手卫生依从性提高 10% 导致的采集减少）。结论。手部卫生仍应是感染控制计划的首要任务，但环境清洁对于手部卫生合规性较高或终端清洁彻底性较低的医院或个别医院单位具有显着的好处。
OBJECTIVE. Hand hygiene and environmental cleaning are essential infection prevention strategies, but the relative impact of each is unknown. This information is important in assessing resource allocation.METHODS. We developed an agent-based model of patient-to-patient transmission-via the hands of transiently colonized healthcare workers and incompletely terminally cleaned rooms-in a 20-patient intensive care unit. Nurses and physicians were modeled and had distinct hand hygiene compliance levels on entry and exit to patient rooms. We simulated the transmission of Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci for 1 year using data from the literature and observed data to inform model input parameters.RESULTS. We simulated 175 parameter-based scenarios and compared the effects of hand hygiene and environmental cleaning on rates of multidrug-resistant organism acquisition. For all organisms, increases in hand hygiene compliance outperformed equal increases in thoroughness of terminal cleaning. From baseline, a 2 : 1 improvement in terminal cleaning compared with hand hygiene was required to match an equal reduction in acquisition rates (eg, a 20% improvement in terminal cleaning was required to match the reduction in acquisition due to a 10% improvement in hand hygiene compliance).CONCLUSIONS. Hand hygiene should remain a priority for infection control programs, but environmental cleaning can have significant benefit for hospitals or individual hospital units that have either high hand hygiene compliance levels or low terminal cleaning thoroughness.