Simulation Shows Hospitals That Cooperate On Infection Control Obtain Better Results Than Hospitals Acting Alone

Health Affairs (Impact Factor: 4.64). 10/2012; 31(10):2295-303. DOI: 10.1377/hlthaff.2011.0992
Source: PubMed

ABSTRACT Efforts to control life-threatening infections, such as with methicillin-resistant Staphylococcus aureus (MRSA), can be complicated when patients are transferred from one hospital to another. Using a detailed computer simulation model of all hospitals in Orange County, California, we explored the effects when combinations of hospitals tested all patients at admission for MRSA and adopted procedures to limit transmission among patients who tested positive. Called "contact isolation," these procedures specify precautions for health care workers interacting with an infected patient, such as wearing gloves and gowns. Our simulation demonstrated that each hospital's decision to test for MRSA and implement contact isolation procedures could affect the MRSA prevalence in all other hospitals. Thus, our study makes the case that further cooperation among hospitals-which is already reflected in a few limited collaborative infection control efforts under way-could help individual hospitals achieve better infection control than they could achieve on their own.

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    ABSTRACT: Because hospitals in a region are connected via patient sharing, a norovirus outbreak in one hospital may spread to others. We utilized our Regional Healthcare Ecosystem Analyst software to generate an agent-based model of all the acute care facilities in Orange County (OC), California and simulated various norovirus outbreaks in different locations, both with and without contact precautions. At the lower end of norovirus reproductive rate (R0) estimates (1.64), an outbreak tended to remain confined to the originating hospital (≤6.1% probability of spread). However, at the higher end of R0 (3.74), an outbreak spread 4.1%-17.5% of the time to almost all other OC hospitals within 30 days, regardless of the originating hospital. Implementing contact precautions for all symptomatic cases reduced the probability of spread to other hospitals within 30 days and the total number of cases countywide, but not the number of other hospitals seeing norovirus cases. A single norovirus outbreak can continue to percolate throughout a system of different hospitals for several months and appear as a series of unrelated outbreaks, highlighting the need for hospitals within a region to more aggressively and cooperatively track and control an initial outbreak.
    09/2014; 1(2):ofu030. DOI:10.1093/ofid/ofu030
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    ABSTRACT: The Agency for Healthcare Research & Quality (AHRQ) found that Methicillin-resistant Staphylococcus aureus (MRSA) is associated with up to 375,000 infections and 23,000 deaths in the United States. It is a major cause of surgical site infections, with a higher mortality and longer duration of care than Methicillin-sensitive Staphylococcus aureus. A multifactorial bundled approach is needed to control this epidemic, with single interventions unlikely to have a significant impact on attenuating MRSA infection rates. Active surveillance has been studied in a wide range of surgical patients, including surgical intensive care and non-intensive care units; cardiac, vascular, orthopedic, obstetric, head and neck cancer and gastrostomy patients. There is sufficient evidence demonstrating a beneficial effect of surveillance and eradication prior to surgery to recommend its use on an expanded basis. Studies on MRSA surveillance in surgical patients that were published over the last 10 years were reviewed. In at least five of these studies, the MRSA colonization status of patients was reported to be a factor in preoperative antibiotic selection, with the modification of treatment regiments including the switching to vancomycin or teicoplanin in MRSA positive preoperative patients. Several authors also used decolonization protocols on all preoperative patients but used surveillance to determine the duration of the decolonization. Universal decolonization of all patients, regardless of MRSA status has been advocated as an alternative prevention protocol in which surveillance is not utilized. Concern exists regarding antimicrobial stewardship. The daily and universal use of intranasal antibiotics and/or antiseptic washes may encourage the promotion of bacterial resistance and provide a competitive advantage to other more lethal organisms. Decolonization protocols which indiscriminately neutralize all bacteria may not be the best approach. If a patient's microbiome is markedly challenged with antimicrobials, rebuilding it with replacement commensal bacteria may become a future therapy. Preoperative MRSA surveillance allows the selection of appropriate prophylactic antibiotics, the use of extended decolonization protocols in positive patients, and provides needed data for epidemiological studies.
    05/2014; 3:18. DOI:10.1186/2047-2994-3-18
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    ABSTRACT: Background. We developed and assessed the impact of a regional antimicrobial resistance (AMR) patient registry and electronic admission notification system on regional AMR infection rates over time. We conducted an observational cohort study of all patients identified as infected or colonized with Methicillin-resistant Staphyloccus aureus (MRSA) and/or Vancomycin-resistant enterococci (VRE) on at least one occasion by any of five healthcare systems between 2003 and 2010. The five healthcare systems included a total of 17 hospitals and associated clinics in the Indianapolis , Indiana region. Methods. We developed and standardized a registry of MRSA and VRE patients and created web forms for infection preventionists (IPs) to maintain the lists. We generated email alerts to IPs whenever a patient previously infected or colonized with MRSA or VRE registered for admission to a study hospital from June 2007 through June 2010. Results. Over three years, we delivered 12,748 email alerts on 6,270 unique patients to 24 IPs covering 17 hospitals. One in five (22-23%) of all admission alerts were based on data from a healthcare system different than the admitting hospital; a few hospitals accounted for most of this cross-over between facilities and systems. Conclusions. Regional patient registries identify an important patient cohort with relevant prior antibiotic-resistant infection data from different healthcare institutions. Regional registries can identify trends and inter-institutional movement not otherwise apparent from single institution data. Importantly, electronic alerts can notify of the need to isolate early and to institute other measures to prevent transmission.
    Clinical Infectious Diseases 04/2013; 57(2). DOI:10.1093/cid/cit229 · 9.42 Impact Factor