Modeling Interventions to Reduce the Spread of Multidrug-Resistant Organisms Between Health Care Facilities in a Region

Abstract

IMPORTANCE Multidrug-resistant organisms (MDROs) can spread across health care facilities in a region. Because of limited resources, certain interventions can be implemented in only some facilities; thus, decision-makers need to evaluate which interventions may be best to implement. OBJECTIVE To identify a group of target facilities and assess which MDRO intervention would be best to implement in the Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, a large regional public health collaborative in Orange County, California. DESIGN, SETTING, AND PARTICIPANTS An agent-based model of health care facilities was developed in 2016 to simulate the spread of methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteriaceae (CRE) for 10 years starting in 2010 and to simulate the use of various MDRO interventions for 3 years starting in 2017. All health care facilities (23 hospitals, 5 long-term acute care hospitals, and 74 nursing homes) serving adult inpatients in Orange County, California, were included, and 42 target facilities were identified via network analyses.EXPOSURES Increasing contact precaution effectiveness, increasing interfacility communication about patients' MDRO status, and performing decolonization using antiseptic bathing soap and a nasal product in a specific group of target facilities. MAIN OUTCOMES AND MEASURES MRSA and CRE prevalence and number of new carriers (ie, transmission events).RESULTS Compared with continuing infection control measures used in Orange County as of 2017, increasing contact precaution effectiveness from 40% to 64% in 42 target facilities yielded relative reductions of 0.8% (range, 0.5%-1.1%) in MRSA prevalence and 2.4% (range, 0.8%-4.6%) in CRE prevalence in health care facilities countywide after 3 years, averting 761 new MRSA transmission events (95% CI, 756-765 events) and 166 new CRE transmission events (95% CI, 158-174 events).Increasing interfacility communication of patients' MDRO status to 80% in these target facilities produced no changes in the prevalence or transmission of MRDOs. Implementing decolonization procedures (clearance probability: 39% in hospitals, 27% in long-term acute care facilities, and 3% in nursing homes) yielded a relative reduction of 23.7% (range, 23.5%-23.9%) in MRSA prevalence, averting 3515 new transmission events (95% CI, 3509-3521 events). Increasing the effectiveness of antiseptic bathing soap to 48% yielded a relative reduction of 39.9% (range, 38.5%-41.5%) in CRE prevalence, averting 1435 new transmission events (95% CI, 1427-1442 events). CONCLUSIONS AND RELEVANCEThe findings of this study highlight the ways in which modeling can inform design of regional interventions and suggested that decolonization would be the best (continued) Key Points Question Which multidrug-resistant organism (MDRO) intervention is best to implement in a set of health care facilities to reduce the spread of MDROs regionwide? Findings In this computational simulation modeling study...

Recommendations for change in infection prevention programs and practice

“…While suspending CPs for extended spectrum beta-lactamase (ESBL) Gram-negative organisms without an increase in ESBL infections has been reported, 90 this has not been as commonly reported with carbapenem resistant Enterobacteriaceae (CRE) though modeling in subacute settings suggest decolonization and screening for clearance may yield better results and no evidence to date with the recently emerged Candida auris. 91,92 Per the HICPAC meeting minutes of August 19, 2021, pertaining to the Isolation Precautions Guideline Workgroup and forthcoming efforts to provide further guidance, "Most of this will focus on the framing of transmission processes as opposed to the nitty gritty isolation practices. Airborne and contact isolation practices should not change."…”

Cost-effectiveness of strategies to control the spread of carbapenemase-producing Enterobacterales in hospitals: a modelling study

“…TS + dedicated nursing staff (DNS) + isolation of carriers in a single room, 4. Universal screening (US) + CP without isolation in a single room, Further strategies (7)(8)(9)(10)(11)(12) consisted in the enforcement of previous control measures through the weekly screening of contact patients (WSC), that is, patients cared for by the same HCWs as the CPE-positive patient.…”

“…These models make it possible to test the potential impact of different interventions before real-world implementation, which can save time and resources. Nevertheless, stringent strategies for controlling CPE have rarely been evaluated through mathematical modelling [7][8][9][10].…”

Examining the impact of ICU population interaction structure on modeled colonization dynamics of Staphylococcus aureus

“…The complexity and variation of HAI transmission models, as well as the advancement of methods for model fitting and sensitivity analysis, has increased over time. Methods used in HAI modeling studies vary widely, from adaptations of the classic Ross-McDonald model [6] that are simplified but analytically approachable [7][8][9][10][11] to complex network or agent-based models that include high fidelity representations of patient-to-staff interactions but are correspondingly more complex and vulnerable to results arising from subtle and unintuitive interactions between agents [12][13][14][15][16][17]. However, a 2013 systematic review by van Kleef et al found that most HAI modeling studies used homogenous mixing compartmental models with limited hospital structure [18].…”