Regional Healthcare Ecosystem Analyst (RHEA) Modeling the Environment (MODE)

项目摘要 医疗相关感染（HAI）是美国十大死亡原因之一。污染 卫生保健环境是传播病原体和HAI的重要但被忽视的手段， 特别是革兰氏阳性病原体如耐甲氧西林金黄色葡萄球菌（MRSA）， 万古霉素耐药肠球菌（VRE）。有证据表明，许多医疗保健环境不是 即使机构政策与国家指导一致，也要充分清洁。许多问题有助于 缺乏足够的环境清洁。新的环境清洁和监测技术 和过程显示出一些希望，但评估它们可能是复杂的。环境的影响 传输和各种清洁和监测方法超出了单个医疗机构的范围 并涉及一个地区的医疗保健设施的动态生态系统。计算建模集成了 经济、操作和流行病学组成部分可以帮助更好地理解和解决 环境传播、清洁和监测的全生态系统影响。因此，我们建议 RHEA-MODE项目将修改并大幅扩展我们现有的橙子县（OC）和芝加哥 基于代理的模型（ABM），以更好地了解医疗环境传输，清洁， 监测.我们的团队由两位经验丰富的调查人员领导，他们在一起工作了十多年， 开发反弹道导弹系统，以更好地了解HAI的传播、影响和控制， 作为传染病病原体研究模型（MIDAS）的研究者，他有多年的经验。该项目将 为RHEA增加了四个主要类别：（1）创建更详细和更明确的表示 医疗设施的内部结构和病人的流动，（2）引入医疗保健 工人和环境服务（EVS）工作人员代理，以便更明确地代表和评估他们的 行动和行为，（3）赋予RHEA同时处理多种病原体的能力，因为 环境和清洁方法同时影响多种病原体，以及（4） 各种类型的环境清洁方法和所涉及的过程。具体目标1将介绍 在我们的区域模拟模型中，详细描述了医疗设施环境及其作用 在各种条件下，医院和疗养院中的耐甲氧西林金黄色葡萄球菌和耐甲氧西林金黄色葡萄球菌的传播， 情节具体目标2将探讨各种环保清洁产品和方法如何 减少MRSA和VRE的传播，患病率以及健康和经济影响， Aim 1的区域模拟模型。具体目标3将评估不同的经济价值 环境清洁方法和途径以及其他MRSA和VRE预防的组合， 在不同情况下的控制措施，以确定最合适的组合，利用区域 目标1和2的模拟模型。

PROJECT SUMMARY ABSTRACT Healthcare-associated infections (HAIs) are a top 10 cause of death in the US. Contamination of the healthcare environment is an important but overlooked means of transmitting pathogens and HAIs, particularly gram-positive pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Evidence shows that many healthcare environments are not adequately cleaned, even with institutional policies consistent with national guidance. Many issues contribute to the lack of adequate environmental cleaning. New environmental cleaning and monitoring technology and processes show some promise but evaluating them can be complex. The impact of environmental transmission and various cleaning and monitoring approaches extends beyond individual healthcare facilities and involves the dynamic ecosystem of healthcare facilities in a region. Computational modeling that integrates economic, operational, and epidemiologic components can help better understand and address the ecosystem-wide effects of environmental transmission, cleaning, and monitoring. Therefore, our proposed RHEA-MODE project will modify and substantially expand our existing Orange County (OC) and Chicago agent-based models (ABMs) to better understand healthcare environment transmission, cleaning, and monitoring. Our team is led by two seasoned investigators who have worked together for over a decade on developing ABMs to better understand the spread, impact, and control of HAIs and have over a combined 20 years of experience as Models of Infectious Disease Agent Study (MIDAS) investigators. The project will bring four major categories of additions to RHEA: (1) creating much more detailed and explicit representations of the internal structures of healthcare facilities and the movement of patients, (2) introducing healthcare worker and environmental services (EVS) staff agents in order to more explicitly represent and evaluate their actions and behaviors, (3) giving RHEA the capability of handling multiple pathogens simultaneously, because the environment and cleaning methods affect multiple pathogens at once, and (4) explicit representations of various types of environmental cleaning methods and the processes involved. Specific Aim 1 will introduce into our regional simulation models a detailed representation of the healthcare facility environment and its role in the transmission of MRSA and VRE in hospitals and nursing homes under various conditions and circumstances. Specific Aim 2 will explore how a variety of environmental cleaning products and methods can reduce MRSA and VRE transmission, prevalence, and health and economic impact based upon the expanded regional simulation models from Aim 1. Specific Aim 3 will evaluate the economic value of different combinations of environmental cleaning methods and approaches and other MRSA and VRE prevention and control measures under varying circumstances to identify the most suitable combinations utilizing the regional simulation models from Aims 1 and 2.