Simulating the Spread and Control of Multiple MDROs Across a Network of Different Nursing Homes

摘要 项目3：模拟多重MDRO的扩散和控制 跨越一个地区的疗养院网络 多药耐药生物(MDRO)导致近300万医疗保健相关感染(HAI)， 它们每年都是美国养老院(NHS)的主要死亡原因。虽然MDRO通常被研究 在隔离状态下，这些病原体同时循环，它们的传播和预防可能会影响和 相互复合。因此，确定这些策略在NHS中的价值需要了解 它们将如何同时影响各种MDRO的殖民和感染风险。此外，它的影响 MDRO及其预防和控制战略的范围超出了单个NHS，并涉及动态 一个地区的国民健康保险制度的生态系统。集成了流行病学、可操作性和 经济组成部分可以帮助描绘多个MDRO的流通和影响，测试各种 预防和控制战略，并确定与以下相关的后续全生态系统影响 以节省时间、精力和资源的方式传播和疾病负担。这个项目的总体目标是 拟议的项目是阐明(1)多个MDRO同时传播的综合影响 以及(2)政策和干预措施(例如，接触预防、非殖民化)可能如何产生影响 同时跨越各种MDRO，在奥兰治使用基于代理的NHS模型(ABM 加州(CA)县(OC)。NHS的这些详细说明将包括并帮助区分 在影响MDRO传播的各种多层次因素中。这个建模项目将在一个协同的， 与其他两个项目的迭代方式。模型结果将指导项目1的数据收集和分析 项目1和项目2的数据洞察将指导模型的进一步完善。转移焦点 从一次一个MDRO到各种MDRO将帮助决策者选择最好的 整体感染控制策略。具体目标1将为OC的70个护理NHS中的每个人开发ABM， CA模拟多重MDRO(耐甲氧西林金黄色葡萄球菌、耐万古霉素金黄色葡萄球菌 碳青霉烯类耐药产超广谱β-内酰胺酶肠球菌 肠杆菌和金黄色念珠菌)在载体和副载体之间相互作用，以促进传播。特定目标 2将评估不同的病原体、宿主因素(例如，合并症、伤口、卧床状态)和房间 特征(例如，室友、公共区域、共用设备)同时影响MDRO 使用各种NH ABM在一个地区的NHS中进行传输。具体目标3将评估不同的 病原体特异性和非特异性多模式策略可能会影响不同病毒的传播和传播 在使用NH ABM的整个地区的NHS中单独和同时进行MDRO。

Abstract Project 3: Simulating the Spread and Control of Multiple MDROs Across a Network of Nursing Homes in a Region Multidrug-resistant organisms (MDROs) cause nearly 3 million healthcare-associated infections (HAIs), which are a major cause of death in US nursing homes (NHs), annually. While MDROs are commonly studied in isolation, these pathogens circulate simultaneously, and their spread and prevention may affect and compound each other. Therefore, determining the value of such strategies in NHs requires an understanding of how they would affect colonization and infection risks of various MDROs simultaneously. Moreover, the impact of MDROs and their prevention and control strategies extend beyond individual NHs and involve the dynamic ecosystem of NHs in a region. Computational modeling that integrates epidemiologic, operational, and economic components can help delineate the circulation and impact of multiple MDROs, test various prevention and control strategies, and determine the subsequent ecosystem-wide effects related to transmission and disease burden in ways that can save time, effort, and resources. The overall goal of this proposed project is to elucidate (1) the combined effects of multiple MDROs spreading simultaneously and (2) how policies and interventions (e.g., contact precautions, decolonization) may have an impact across a variety of MDROs at the same time, using agent-based models (ABMs) of NHs in Orange County (OC), California (CA). These detailed representations of NHs will include and help differentiate among various multi-level factors affecting MDRO spread. This modeling Project will proceed in a synergistic, iterative manner with the other two Projects. Model results will guide data collection and analyses for Projects 1 and 2, and data insights from Projects 1 and 2 will guide further refinement of the models. Shifting the focus from one MDRO at a time to various MDROs collectively will help decision makers choose the best overall infection control strategy. Specific Aim 1 will develop ABMs for each of the 70 nursing NHs in OC, CA simulating how multiple MDROs (methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Enterobacterales, carbapenem-resistant Enterobacterales, and Candida auris) interact among carriers and co-carriers to promote spread. Specific Aim 2 will evaluate how different pathogens, host factors (e.g., comorbidities, wounds, bedbound status), and room characteristics (e.g., roommates, common areas, shared equipment) simultaneously affect MDRO transmission in NHs across a region using the various NH ABMs. Specific Aim 3 will estimate how various pathogen-specific and non-specific multi-modal strategies may affect the transmission and spread of different MDROs individually and simultaneously in NHs across a region using the NH ABMs.