Jordi Ferrer1, Pierre-Yves Boelle2, Jérôme Salomon3, Katiuska Miliani4, François L'Hériteau4, Pascal Astagneau5, Laura Temime3. 1. Laboratoire Modélisation, Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire national des Arts et Métiers, Paris, France. Electronic address: Jordi.ferrer-savall@jouy.inra.fr. 2. Université Pierre et Marie Curie - Paris 6, UMR-S 707, Paris, France. 3. Laboratoire Modélisation, Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire national des Arts et Métiers, Paris, France. 4. Regional Coordinating Centre for Nosocomial Infection Control (C-CLIN Paris Nord), Paris, France. 5. Regional Coordinating Centre for Nosocomial Infection Control (C-CLIN Paris Nord), Paris, France; EHESP School of Public Health, Paris, France.
Abstract
INTRODUCTION: Studies provide evidence that reduced nurse staffing resources are associated to an increase in health care-associated infections in intensive care units, but tools to assess the contribution of the mechanisms driving these relations are still lacking. We present an agent-based model of pathogen spread that can be used to evaluate the impact on nosocomial risk of alternative management decisions adopted to deal with transitory nurse shortage. MATERIALS AND METHODS: We constructed a model simulating contact-mediated dissemination of pathogens in an intensive-care unit with explicit staffing where nurse availability could be temporarily reduced while maintaining requisites of patient care. We used the model to explore the impact of alternative management decisions adopted to deal with transitory nurse shortage under different pathogen- and institution-specific scenarios. Three alternative strategies could be adopted: increasing the workload of working nurses, hiring substitute nurses, or transferring patients to other intensive-care units. The impact of these decisions on pathogen spread was examined while varying pathogen transmissibility and severity of nurse shortage. RESULTS: The model-predicted changes in pathogen prevalence among patients were impacted by management decisions. Simulations showed that increasing nurse workload led to an increase in pathogen spread and that patient transfer could reduce prevalence of pathogens among patients in the intensive-care unit. The outcome of nurse substitution depended on the assumed skills of substitute nurses. Differences between predicted outcomes of each strategy became more evident with increasing transmissibility of the pathogen and with higher rates of nurse shortage. CONCLUSIONS: Agent-based models with explicit staff management such as the model presented may prove useful to design staff management policies that mitigate the risk of healthcare-associated infections under episodes of increased nurse shortage.
INTRODUCTION: Studies provide evidence that reduced nurse staffing resources are associated to an increase in health care-associated infections in intensive care units, but tools to assess the contribution of the mechanisms driving these relations are still lacking. We present an agent-based model of pathogen spread that can be used to evaluate the impact on nosocomial risk of alternative management decisions adopted to deal with transitory nurse shortage. MATERIALS AND METHODS: We constructed a model simulating contact-mediated dissemination of pathogens in an intensive-care unit with explicit staffing where nurse availability could be temporarily reduced while maintaining requisites of patient care. We used the model to explore the impact of alternative management decisions adopted to deal with transitory nurse shortage under different pathogen- and institution-specific scenarios. Three alternative strategies could be adopted: increasing the workload of working nurses, hiring substitute nurses, or transferring patients to other intensive-care units. The impact of these decisions on pathogen spread was examined while varying pathogen transmissibility and severity of nurse shortage. RESULTS: The model-predicted changes in pathogen prevalence among patients were impacted by management decisions. Simulations showed that increasing nurse workload led to an increase in pathogen spread and that patient transfer could reduce prevalence of pathogens among patients in the intensive-care unit. The outcome of nurse substitution depended on the assumed skills of substitute nurses. Differences between predicted outcomes of each strategy became more evident with increasing transmissibility of the pathogen and with higher rates of nurse shortage. CONCLUSIONS: Agent-based models with explicit staff management such as the model presented may prove useful to design staff management policies that mitigate the risk of healthcare-associated infections under episodes of increased nurse shortage.
Authors: Martina Sansone; Paul Holmstrom; Stefan Hallberg; Rickard Nordén; Lars-Magnus Andersson; Johan Westin Journal: BMC Health Serv Res Date: 2022-05-27 Impact factor: 2.908
Authors: Kai O Hensel; Rhea van den Bruck; Ingo Klare; Michael Heldmann; Beniam Ghebremedhin; Andreas C Jenke Journal: Sci Rep Date: 2017-03-21 Impact factor: 4.379