Bruce Y Lee1,2, Sarah M Bartsch1,2, Mary K Hayden3, Joel Welling4, Jay V DePasse4, Sarah K Kemble3,5, Jim Leonard4, Robert A Weinstein3,6, Leslie E Mueller1,2, Kruti Doshi6, Shawn T Brown7, William E Trick3,6, Michael Y Lin3. 1. Public Health Computational and Operations Research, Baltimore, Maryland. 2. Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 3. Rush University Medical Center, Chicago, Illinois. 4. Public Health Applications, Pittsburgh Supercomputing Center, Pennsylvania. 5. Chicago Department of Public Health, Chicago, Illinois. 6. Cook County Health, Chicago, Illinois. 7. McGill Centre for Integrative Neuroscience, McGill University, Montreal, Quebec, Canada.
Abstract
BACKGROUND: Regions are considering the use of electronic registries to track patients who carry antibiotic-resistant bacteria, including carbapenem-resistant Enterobacteriaceae (CRE). Implementing such a registry can be challenging and requires time, effort, and resources; therefore, there is a need to better understand the potential impact. METHODS: We developed an agent-based model of all inpatient healthcare facilities (90 acute care hospitals, 9 long-term acute care hospitals, 351 skilled nursing facilities, and 12 ventilator-capable skilled nursing facilities) in the Chicago metropolitan area, surrounding communities, and patient flow using our Regional Healthcare Ecosystem Analyst software platform. Scenarios explored the impact of a registry that tracked patients carrying CRE to help guide infection prevention and control. RESULTS: When all Illinois facilities participated (n = 402), the registry reduced the number of new carriers by 11.7% and CRE prevalence by 7.6% over a 3-year period. When 75% of the largest Illinois facilities participated (n = 304), registry use resulted in a 11.6% relative reduction in new carriers (16.9% and 1.2% in participating and nonparticipating facilities, respectively) and 5.0% relative reduction in prevalence. When 50% participated (n = 201), there were 10.7% and 5.6% relative reductions in incident carriers and prevalence, respectively. When 25% participated (n = 101), there was a 9.1% relative reduction in incident carriers (20.4% and 1.6% in participating and nonparticipating facilities, respectively) and 2.8% relative reduction in prevalence. CONCLUSIONS: Implementing an extensively drug-resistant organism registry reduced CRE spread, even when only 25% of the largest Illinois facilities participated due to patient sharing. Nonparticipating facilities garnered benefits, with reductions in new carriers.
BACKGROUND: Regions are considering the use of electronic registries to track patients who carry antibiotic-resistant bacteria, including carbapenem-resistant Enterobacteriaceae (CRE). Implementing such a registry can be challenging and requires time, effort, and resources; therefore, there is a need to better understand the potential impact. METHODS: We developed an agent-based model of all inpatient healthcare facilities (90 acute care hospitals, 9 long-term acute care hospitals, 351 skilled nursing facilities, and 12 ventilator-capable skilled nursing facilities) in the Chicago metropolitan area, surrounding communities, and patient flow using our Regional Healthcare Ecosystem Analyst software platform. Scenarios explored the impact of a registry that tracked patients carrying CRE to help guide infection prevention and control. RESULTS: When all Illinois facilities participated (n = 402), the registry reduced the number of new carriers by 11.7% and CRE prevalence by 7.6% over a 3-year period. When 75% of the largest Illinois facilities participated (n = 304), registry use resulted in a 11.6% relative reduction in new carriers (16.9% and 1.2% in participating and nonparticipating facilities, respectively) and 5.0% relative reduction in prevalence. When 50% participated (n = 201), there were 10.7% and 5.6% relative reductions in incident carriers and prevalence, respectively. When 25% participated (n = 101), there was a 9.1% relative reduction in incident carriers (20.4% and 1.6% in participating and nonparticipating facilities, respectively) and 2.8% relative reduction in prevalence. CONCLUSIONS: Implementing an extensively drug-resistant organism registry reduced CRE spread, even when only 25% of the largest Illinois facilities participated due to patient sharing. Nonparticipating facilities garnered benefits, with reductions in new carriers.
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
Authors: Gary Lin; Katie K Tseng; Oliver Gatalo; Diego A Martinez; Jeremiah S Hinson; Aaron M Milstone; Scott Levin; Eili Klein Journal: Infect Control Hosp Epidemiol Date: 2021-10-22 Impact factor: 6.520
Authors: Bruce Y Lee; Sarah M Bartsch; Michael Y Lin; Lindsey Asti; Joel Welling; Leslie E Mueller; Jim Leonard; Shawn T Brown; Kruti Doshi; Sarah K Kemble; Elizabeth A Mitgang; Robert A Weinstein; William E Trick; Mary K Hayden Journal: Am J Epidemiol Date: 2021-02-01 Impact factor: 4.897
Authors: A Boulle; A Heekes; N Tiffin; M Smith; T Mutemaringa; N Zinyakatira; F Phelanyane; C Pienaar; K Buddiga; E Coetzee; R van Rooyen; R Dyers; N Fredericks; A Loff; L Shand; M Moodley; I de Vega; K Vallabhjee Journal: Int J Popul Data Sci Date: 2019-11-20
Authors: Sarah M Bartsch; Kim F Wong; Leslie E Mueller; Gabrielle M Gussin; James A McKinnell; Thomas Tjoa; Patrick T Wedlock; Jiayi He; Justin Chang; Shruti K Gohil; Loren G Miller; Susan S Huang; Bruce Y Lee Journal: JAMA Netw Open Date: 2021-08-02