OBJECTIVES: The effect of patient movement between hospitals and long-term care 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.
OBJECTIVES: The effect of patient movement between hospitals and long-term care 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.
Authors: David L Smith; Jonathan Dushoff; Eli N Perencevich; Anthony D Harris; Simon A Levin Journal: Proc Natl Acad Sci U S A Date: 2004-02-25 Impact factor: 11.205
Authors: Jon P Furuno; Joan N Hebden; Harold C Standiford; Eli N Perencevich; Ram R Miller; Anita C Moore; Sandra M Strauss; Anthony D Harris Journal: Am J Infect Control Date: 2008-09 Impact factor: 2.918
Authors: Philip W Smith; Gail Bennett; Suzanne Bradley; Paul Drinka; Ebbing Lautenbach; James Marx; Lona Mody; Lindsay Nicolle; Kurt Stevenson Journal: Infect Control Hosp Epidemiol Date: 2008-09 Impact factor: 3.254
Authors: Bruce Y Lee; Ashima Singh; Sarah M Bartsch; Kim F Wong; Diane S Kim; Taliser R Avery; Shawn T Brown; Courtney R Murphy; S Levent Yilmaz; Susan S Huang Journal: Infect Control Hosp Epidemiol Date: 2012-12-18 Impact factor: 3.254
Authors: Bruce Y Lee; Sarah M Bartsch; Kim F Wong; Ashima Singh; Taliser R Avery; Diane S Kim; Shawn T Brown; Courtney R Murphy; Server Levent Yilmaz; Margaret A Potter; Susan S Huang Journal: Med Care Date: 2013-03 Impact factor: 2.983
Authors: Abel N Kho; Bradley N Doebbeling; John P Cashy; Marc B Rosenman; Paul R Dexter; David C Shepherd; Larry Lemmon; Evgenia Teal; Shahid Khokar; J Marc Overhage Journal: Clin Infect Dis Date: 2013-04-10 Impact factor: 9.079
Authors: Bruce Y Lee; Kim F Wong; Sarah M Bartsch; S Levent Yilmaz; Taliser R Avery; Shawn T Brown; Yeohan Song; Ashima Singh; Diane S Kim; Susan S Huang Journal: J Am Med Inform Assoc Date: 2013-04-09 Impact factor: 4.497
Authors: Paul R McAdam; Kate E Templeton; Giles F Edwards; Matthew T G Holden; Edward J Feil; David M Aanensen; Hiba J A Bargawi; Brian G Spratt; Stephen D Bentley; Julian Parkhill; Mark C Enright; Anne Holmes; E Kirsty Girvan; Paul A Godfrey; Michael Feldgarden; Angela M Kearns; Andrew Rambaut; D Ashley Robinson; J Ross Fitzgerald Journal: Proc Natl Acad Sci U S A Date: 2012-05-14 Impact factor: 11.205
Authors: Nataliya G Batina; Christopher J Crnich; David F Anderson; Dörte Döpfer Journal: Antimicrob Resist Infect Control Date: 2016-09-22 Impact factor: 4.887