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

项目总结摘要 医疗保健相关感染(HAI)是美国前十大死亡原因。对环境的污染 医疗保健环境是传播病原体和人类免疫缺陷病毒的重要但被忽视的手段， 尤其是革兰阳性病原体，如耐甲氧西林金黄色葡萄球菌(MRSA)和 耐万古霉素肠球菌(VRE)。有证据表明，许多医疗保健环境并非如此 即使机构政策与国家指导方针保持一致，也要进行适当的清理。许多问题都有影响 缺乏足够的环境清洁。新的环境清洁和监测技术 流程显示出一些希望，但评估它们可能很复杂。环境的影响 传播和各种清洁和监测方法超出了个人医疗机构的范围 并涉及到一个地区医疗设施的动态生态系统。集成的计算建模 经济、运营和流行病学组成部分可以帮助更好地了解和解决 环境传播、清洁和监测的全生态系统影响。因此，我们建议 RHEA模式项目将修改和大幅扩展我们现有的奥兰治县(OC)和芝加哥 基于代理的模型(ABM)，以更好地了解医疗保健环境的传播、清洁和 监控。我们的团队由两名经验丰富的调查人员领导，他们在一起工作了十多年 开发ABM以更好地了解禽流感的传播、影响和控制，并拥有超过20个 作为传染病病原体研究(MIDAS)研究人员的模范，有多年经验。该项目将 向RHEA添加了四个主要类别：(1)创建更详细和明确的表示 医疗设施的内部结构和病人的流动情况；(2)介绍医疗保健 工人和环境服务(EVS)工作人员代理，以便更明确地表示和评估其 行为和行为，(3)赋予Rhea同时处理多个病原体的能力，因为 环境和清洁方法同时影响多个病原体，以及(4)明确表示 各种类型的环境清洁方法和涉及的过程。具体目标1将介绍 到我们的区域模拟模型中，详细表示医疗设施环境及其角色 在不同情况下，MRSA和VRE在医院和疗养院的传播 情况。具体目标2将探索各种环境清洁产品和方法如何 减少MRSA和VRE的传播、流行率以及基于扩展的 来自目标1的区域模拟模型。特定目标3将评估不同 环境清洁方法和途径以及其他MRSA和VRE预防和 在不同情况下采取控制措施，以确定最合适的利用区域 来自AIMS 1和2的仿真模型。

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.