BACKGROUND: Hospital infection control strategies and programs may not consider control of methicillin-resistant Staphylococcus aureus (MRSA) in nursing homes in a county. METHODS: Using our Regional Healthcare Ecosystem Analyst, we augmented our existing agent-based model of all hospitals in Orange County (OC), California, by adding all nursing homes and then simulated MRSA outbreaks in various health care facilities. RESULTS: The addition of nursing homes substantially changed MRSA transmission dynamics throughout the county. The presence of nursing homes substantially potentiated the effects of hospital outbreaks on other hospitals, leading to an average 46.2% (range, 3.3%-156.1%) relative increase above and beyond the impact when only hospitals are included for an outbreak in OC's largest hospital. An outbreak in the largest hospital affected all other hospitals (average 2.1% relative prevalence increase) and the majority (~90%) of nursing homes (average 3.2% relative increase) after 6 months. An outbreak in the largest nursing home had effects on multiple OC hospitals, increasing MRSA prevalence in directly connected hospitals by an average 0.3% and in hospitals not directly connected through patient transfers by an average 0.1% after 6 months. A nursing home outbreak also had some effect on MRSA prevalence in other nursing homes. CONCLUSIONS: Nursing homes, even those not connected by direct patient transfers, may be a vital component of a hospital's infection control strategy. To achieve effective control, a hospital may want to better understand how regional nursing homes and hospitals are connected through both direct and indirect (with intervening stays at home) patient sharing.
BACKGROUND:Hospital infection control strategies and programs may not consider control of methicillin-resistant Staphylococcus aureus (MRSA) in nursing homes in a county. METHODS: Using our Regional Healthcare Ecosystem Analyst, we augmented our existing agent-based model of all hospitals in Orange County (OC), California, by adding all nursing homes and then simulated MRSA outbreaks in various health care facilities. RESULTS: The addition of nursing homes substantially changed MRSA transmission dynamics throughout the county. The presence of nursing homes substantially potentiated the effects of hospital outbreaks on other hospitals, leading to an average 46.2% (range, 3.3%-156.1%) relative increase above and beyond the impact when only hospitals are included for an outbreak in OC's largest hospital. An outbreak in the largest hospital affected all other hospitals (average 2.1% relative prevalence increase) and the majority (~90%) of nursing homes (average 3.2% relative increase) after 6 months. An outbreak in the largest nursing home had effects on multiple OC hospitals, increasing MRSA prevalence in directly connected hospitals by an average 0.3% and in hospitals not directly connected through patient transfers by an average 0.1% after 6 months. A nursing home outbreak also had some effect on MRSA prevalence in other nursing homes. CONCLUSIONS: Nursing homes, even those not connected by direct patient transfers, may be a vital component of a hospital's infection control strategy. To achieve effective control, a hospital may want to better understand how regional nursing homes and hospitals are connected through both direct and indirect (with intervening stays at home) patient sharing.
Authors: Carl Suetens; Luc Niclaes; Béatrice Jans; Jan Verhaegen; Annette Schuermans; Johan Van Eldere; Frank Buntinx Journal: J Am Geriatr Soc Date: 2006-12 Impact factor: 5.562
Authors: Alicia I Hidron; Ekaterina V Kourbatova; J Sue Halvosa; Bianca J Terrell; Linda K McDougal; Fred C Tenover; Henry M Blumberg; Mark D King Journal: Clin Infect Dis Date: 2005-06-08 Impact factor: 9.079
Authors: Ari Robicsek; Jennifer L Beaumont; Suzanne M Paule; Donna M Hacek; Richard B Thomson; Karen L Kaul; Peggy King; Lance R Peterson Journal: Ann Intern Med Date: 2008-03-18 Impact factor: 25.391
Authors: Nimalie D Stone; Donna R Lewis; H K Lowery; Lyndsey A Darrow; Catherine M Kroll; Robert P Gaynes; John A Jernigan; John E McGowan; Fred C Tenover; Chesley L Richards Journal: Infect Control Hosp Epidemiol Date: 2008-02 Impact factor: 3.254
Authors: Lona Mody; Carol A Kauffman; Susan Donabedian; Marcus Zervos; Suzanne F Bradley Journal: Clin Infect Dis Date: 2008-05-01 Impact factor: 9.079
Authors: R Monina Klevens; Melissa A Morrison; Joelle Nadle; Susan Petit; Ken Gershman; Susan Ray; Lee H Harrison; Ruth Lynfield; Ghinwa Dumyati; John M Townes; Allen S Craig; Elizabeth R Zell; Gregory E Fosheim; Linda K McDougal; Roberta B Carey; Scott K Fridkin Journal: JAMA Date: 2007-10-17 Impact factor: 56.272
Authors: Jacob E Simmering; Linnea A Polgreen; David R Campbell; Joseph E Cavanaugh; Philip M Polgreen Journal: Infect Control Hosp Epidemiol Date: 2015-06-15 Impact factor: 3.254
Authors: Zhiqiu Ye; Dana B Mukamel; Susan S Huang; Yue Li; Helena Temkin-Greener Journal: Infect Control Hosp Epidemiol Date: 2015-03-23 Impact factor: 3.254
Authors: Maria-Stephanie A Tolg; David M Dosa; Robin L P Jump; Angelike P Liappis; Kerry L LaPlante Journal: J Am Med Dir Assoc Date: 2018-06-19 Impact factor: 4.669
Authors: Angela Chow; Vanessa W Lim; Ateeb Khan; Kerry Pettigrew; David C B Lye; Kala Kanagasabai; Kelvin Phua; Prabha Krishnan; Brenda Ang; Kalisvar Marimuthu; Pei-Yun Hon; Jocelyn Koh; Ian Leong; Julian Parkhill; Li-Yang Hsu; Matthew T G Holden Journal: Clin Infect Dis Date: 2017-05-15 Impact factor: 9.079
Authors: Sarah M Bartsch; Kim F Wong; Owen J Stokes-Cawley; James A McKinnell; Chenghua Cao; Gabrielle M Gussin; Leslie E Mueller; Diane S Kim; Loren G Miller; Susan S Huang; Bruce Y Lee Journal: J Infect Dis Date: 2020-05-11 Impact factor: 7.759