期刊
INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY
卷 32, 期 11, 页码 1073-1078出版社
CAMBRIDGE UNIV PRESS
DOI: 10.1086/662375
关键词
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资金
- National Institutes of Health (NIH) [5K01AI071015-04, 1 K24 AI079040-03]
- Center for Health Information and Decision Systems at the Robert H. Smith School of Business at the University of Maryland
- American University
OBJECTIVES. The effect of patient movement between hospitals and long-termcare facilities (LTCFs) on methicillin-resistant Staphylococcus aureus (MRSA) prevalence levels is unknown. We investigated these effects to identify scenarios that may lead to increased prevalence in either facility type. METHODS. We used a hybrid simulation model to simulate MRSA transmission among hospitals and LTCFs. Transmission within each facility was determined by mathematical model equations. The model predicted the long-term prevalence of each facility and was used to assess the effects of facility size, patient turnover, and decolonization. RESULTS. Analyses of various healthcare networks suggest that the effect of patients moving from a LTCF to a hospital is negligible unless the patients are consistently admitted to the same unit. In such cases, MRSA prevalence can increase significantly regardless of the endemic level. Hospitals can cause sustained increases in prevalence when transferring patients to LTCFs, where the population size is smaller and patient turnover is less frequent. For 1 particular scenario, the steady-state prevalence of a LTCF increased from 6.9% to 9.4% to 13.8% when the transmission rate of the hospital increased from a low to a high transmission rate. CONCLUSIONS. These results suggest that the relative facility size and the patient discharge rate are 2 key factors that can lead to sustained increases in MRSA prevalence. Consequently, small facilities or those with low turnover rates are especially susceptible to sustaining increased prevalence levels, and they become more so when receiving patients from larger, high-prevalence facilities. Decolonization is an infection-control strategy that can mitigate these effects. Infect Control Hosp Epidemiol 2011; 32(11): 1073-1078
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