Improving MRSA control through simulation and surveillance

通过模拟和监测改善 MRSA 控制

• 批准号: 8195234
• 负责人: MICHAEL A. RUBIN
• 金额: --
• 依托单位: VA SALT LAKE CITY HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8195234
• 关键词: Address; Admission activity; Affect; Algorithms; Classification; Cohort Studies; Communities; Complex; Computer Simulation; Computerized Medical Record; Cost-Benefit Analysis; Costs and Benefits; Data; Economics; Effectiveness; Electronics; Environment; Epidemiologic Methods; Epidemiology; Evaluation; Future; Healthcare Systems; Hospitals; Infection; Infection Control; Informatics; Inpatients; Intervention; Investigation; Knowledge; Methods; Mind; Modeling; Nosocomial Infections; Outcome; Patients; Performance; Policies; Population; Prevalence; Process; Relative (related person); Research; Research Personnel; Resistance; Risk Estimate; Simulate; Site; Staphylococcus aureus; System; Techniques; Testing; Time; Training; Translational Research; Validation; Veterans; Work; base; biomedical informatics; cost; design; electronic data; high risk; improved; innovation; insight; methicillin resistant Staphylococcus aureus; models and simulation; novel; prospective; research study; response; simulation; surveillance strategy; tool; transmission process

Improving MRSA control through simulation and surveillance BACKGROUND: The infection control community is highly divided on the most appropriate strategy to control transmission of methicilllin-resistant Staphylococcus aureus (MRSA) in hospitals. One approach used at VA hospitals is to perform surveillance testing on all patients to identify and isolate MRSA carriers. An alternative approach that is more efficient and/or cost-beneficial would be of tremendous value to the VA. Our previous work suggests that an approach using targeted surveillance of patients classified as high risk for MRSA carriage using electronic data may be a more practical alternative consideration for an approach to MRSA surveillance. Given that large studies of infection control strategies are often prohibitively difficult and expensive, however, an alternative approach using detailed computer simulations might provide important insight and direction for future research efforts. OBJECTIVES: Control of MRSA transmission is dependent on the interactions of innumerable factors and processes, although relatively little is known about these interactions or the relative effectiveness of different MRSA control strategies. With this in mind, our objectives are to (a) develop an electronic classification algorithm to identify VA patients at high risk of MRSA carriage at the time of hospital admission; (b) adapt, calibrate, and validate an agent-based computer simulation of MRSA transmission to the VA inpatient setting; (c) use this computer simulation to gain a deeper understanding of the factors that influence MRSA transmission and control in hospitals; and (d) evaluate and compare alternative policies for MRSA control in VA hospitals, including targeted surveillance, with a particular focus on assessing the cost-benefit of these different strategies. METHODS: First we will create and validate an electronic classification rule to estimate risk of MRSA carriage in hospitalized veterans at the time of admission. Predictors of MRSA carriage in this population will be determined through a retrospective cohort study performed using electronic data from our collaborating VA sites. We will then gather local patient- and facility-level data from our collaborating VA sites to adapt our simulation to the VA setting and to create a base-case simulation scenario. Following validation of the model, we will then assess the various strategies and factors that impact MRSA transmission through simulation experiments. A targeted active surveillance strategy will be included by incorporating the performance of our classification rule into the simulation. Traditional quantitative epidemiologic methods will be used to analyze simulation results, with a focus on MRSA prevalence and transmission rates as outcomes. Cost-benefit analyses will also be performed using simulated cost figures.

通过模拟和监测改善MRSA控制 背景技术背景： 感染控制界在最适当的控制策略上存在很大分歧 耐甲氧西林金黄色葡萄球菌（MRSA）在医院的传播。使用的一种方法是 在退伍军人管理局医院，对所有病人进行监测测试，以确定和隔离MRSA携带者。 一种更有效和/或更具成本效益的替代方法将具有巨大的价值， 退伍军人事务部我们以前的工作表明，一种方法使用有针对性的监测病人分类， 因为使用电子数据的MRSA携带的高风险可能是更实际的替代考虑 对MRSA进行监测鉴于对感染控制策略的大型研究往往是 然而，一种使用详细的计算机的替代方法是困难和昂贵的， 模拟可能为今后的研究工作提供重要的见解和方向。 目的： MRSA传播的控制取决于无数因素和过程的相互作用， 尽管对这些相互作用或不同MRSA的相对有效性知之甚少 控制策略。有见及此，我们的目标是：（a）发展电子分类系统， 在入院时识别MRSA携带高风险的VA患者的算法;（B） 调整、校准和验证MRSA向VA传播的基于代理的计算机模拟 住院设置;（c）使用这种计算机模拟来更深入地了解 影响医院内耐甲氧西林金黄色葡萄球菌传播和控制;及（d）评估和比较其他方法 VA医院的MRSA控制政策，包括有针对性的监测，特别关注 评估这些不同策略的成本效益。 方法： 首先，我们将创建并验证一个电子分类规则，以估计MRSA携带的风险， 住院的退伍军人在入院时。该人群中MRSA携带的预测因素将是 通过回顾性队列研究确定，使用我们合作的电子数据进行 VA站点。然后，我们将从我们的合作VA站点收集当地患者和机构级别的数据， 使我们的模拟适应VA设置，并创建基本情况模拟场景。以下 为了验证模型，我们将评估影响MRSA的各种策略和因素 通过仿真实验验证了其传输性能。一个有针对性的积极监测战略将包括在 将我们的分类规则的性能结合到模拟中。传统定量 流行病学方法将用于分析模拟结果，重点是MRSA的患病率 和传输率作为结果。还将使用模拟成本进行成本效益分析 数字