Hostname: page-component-7c8c6479df-p566r Total loading time: 0 Render date: 2024-03-27T15:21:48.374Z Has data issue: false hasContentIssue false

Contribution of Interfacility Patient Movement to Overall Methicillin-Resistant Staphylococcus aureus Prevalence Levels

Published online by Cambridge University Press:  02 January 2015

Sean L. Barnes
Affiliation:
Department of Mathematics, School of Computer, Mathematical, and Natural Sciences, University of Maryland, College Park, Maryland Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Anthony D. Harris*
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Bruce L. Golden
Affiliation:
Department of Decision, Operations, and Information Technologies, Robert H. Smith School of Business, University of Maryland, College Park, Maryland
Edward A. Wasil
Affiliation:
Department of Information Technology, Kogod School of Business, American University, Washington, DC
Jon P. Furuno
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
*
Department of Epidemiology and Public Health, University of Maryland School of Medicine, 685 West Baltimore Street, MSTF-Room 330, Baltimore, MD 21201 (aharris@epi.umaryland.edu)

Abstract

Objectives.

The effect of patient movement between hospitals and long-term care facilities (LTCFs) on methicillin-resistant Staphylococcus aureus (MRSA) prevalence levels is unknown. We investigated these effects to identify scenarios that may lead to increased prevalence in either facility type.

Methods.

We used a hybrid simulation model to simulate MRSA transmission among hospitals and LTCFs. Transmission within each facility was determined by mathematical model equations. The model predicted the long-term prevalence of each facility and was used to assess the effects of facility size, patient turnover, and decolonization.

Results.

Analyses of various healthcare networks suggest that the effect of patients moving from a LTCF to a hospital is negligible unless the patients are consistently admitted to the same unit. In such cases, MRSA prevalence can increase significantly regardless of the endemic level. Hospitals can cause sustained increases in prevalence when transferring patients to LTCFs, where the population size is smaller and patient turnover is less frequent. For 1 particular scenario, the steady-state prevalence of a LTCF increased from 6.9% to 9.4% to 13.8% when the transmission rate of the hospital increased from a low to a high transmission rate.

Conclusions.

These results suggest that the relative facility size and the patient discharge rate are 2 key factors that can lead to sustained increases in MRSA prevalence. Consequendy, small facilities or those with low turnover rates are especially susceptible to sustaining increased prevalence levels, and they become more so when receiving patients from larger, high-prevalence facilities. Decolonization is an infection-control strategy that can mitigate these effects.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Furuno, JP, Hebden, JN, Standiford, HC, et al. Prevalence of methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii in a long-term acute care facility. Am J Infect Control 2008;36(7):468471.Google Scholar
2.Griffin, FA. 5 Million Lives Campaign: reducing methicillin-resistant Staphylococcus aureus (MRSA) infections. Jt Comm J Qual Patient Saf 2007;33(12):726731.Google ScholarPubMed
3.Smith, PW, Bennett, G, Bradley, S, et al. SHEA/APIC guideline: infection prevention and control in the long-term care facility, July 2008. Infect Control Hosp Epidemiol 2008;29(9):785814.Google Scholar
4.Caffrey, C. Potentially preventable emergency department visits by nursing home residents: United States, 2004. NCHS Data Brief 2010;33:18.Google Scholar
5.Lesosky, M, McGeer, A, Simor, A, Gren, K, Low, DE, Raboud, J. Effect of patterns of transferring patients among healthcare institutions on rates of nosocomial methicillin-resistant Staphylococcus aureus transmission: a Monte Carlo simulation. Infect Control Hosp Epidemiol 2011;32(2):136147.Google Scholar
6.Smith, DL, Dushoff, J, Perencevich, EN, Harris, AD, Levin, SA. Persistent colonization and the spread of antibiotic resistance in nosocomial pathogens: resistance is a regional problem. Proc Natl Acad Sci USA 2004;101(10):37093714.CrossRefGoogle ScholarPubMed
7.Austin, DJ, Anderson, RM. Studies of antibiotic resistance within the patient, hospitals and the community using simple mathematical models. Philos Trans R Soc B 1999;354(1384):721738.Google Scholar
8.Watanakunakorn, C, Axelson, C, Bota, B, Stahl, C. Mupirocin ointment with and without Chlorhexidine baths in the eradication of Staphylococcus aureus nasal carriage in nursing home residents. Am J Infect Control 1995;23(5):306309.CrossRefGoogle ScholarPubMed
9.Milstone, AM, Passaretti, CL, Perl, TM. Chlorhexidine: expanding the armamentarium for infection control and prevention. Clin Infect Dis 2008;46(2):274281.Google ScholarPubMed
10.Buehlmann, M, Frei, R, Fenner, L, Dangel, M, Fluckiger, U, Widmer, AF. Highly effective regimen for decolonization of methicillin-resistant Staphylococcus aureus carriers. Infect Control Hosp Epidemiol 2008;29(6):510516.Google Scholar
11.French, GL. Methods for screening for methicillin-resistant Staphylococcus aureus carriage. Clin Microbiol Infect 2009; 15(Suppl 7):1016.CrossRefGoogle ScholarPubMed
12.Hall, MJ, DeFrances, CJ, Williams, SN, Golosinskiy, A, Schwartzman, A. National Hospital Discharge Survey: 2007 summary. Nat Health Stat Rep 2010:(29):1-20, 24.Google ScholarPubMed
13.National Center for Health Statistics (NCHS). Health, United States, 2010. Hyattsville, MD: NCHS, 2011. http://www.cdc.gov/nchs/fastats/hospital.htm. Accessed July 5, 2011.Google Scholar
14.National Center for Health Statistics (NCHS). 2004 National Nursing Home Survey. Hyattsville, MD: NCHS, 2006. http://www.cdc.gov/nchs/fastats/nursingh.htm. Accessed July 5, 2011.Google Scholar