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The importance of nursing homes in the spread of methicillin-resistant Staphylococcus aureus (MRSA) among hospitals. Med Care 2013 Mar;51(3):205-15

Date

01/30/2013

Pubmed ID

23358388

Pubmed Central ID

PMC3687037

DOI

10.1097/MLR.0b013e3182836dc2

Scopus ID

2-s2.0-84874109959   72 Citations

Abstract

BACKGROUND: Hospital infection control strategies and programs may not consider control of methicillin-resistant Staphylococcus aureus (MRSA) in nursing homes in a county.

METHODS: Using our Regional Healthcare Ecosystem Analyst, we augmented our existing agent-based model of all hospitals in Orange County (OC), California, by adding all nursing homes and then simulated MRSA outbreaks in various health care facilities.

RESULTS: The addition of nursing homes substantially changed MRSA transmission dynamics throughout the county. The presence of nursing homes substantially potentiated the effects of hospital outbreaks on other hospitals, leading to an average 46.2% (range, 3.3%-156.1%) relative increase above and beyond the impact when only hospitals are included for an outbreak in OC's largest hospital. An outbreak in the largest hospital affected all other hospitals (average 2.1% relative prevalence increase) and the majority (~90%) of nursing homes (average 3.2% relative increase) after 6 months. An outbreak in the largest nursing home had effects on multiple OC hospitals, increasing MRSA prevalence in directly connected hospitals by an average 0.3% and in hospitals not directly connected through patient transfers by an average 0.1% after 6 months. A nursing home outbreak also had some effect on MRSA prevalence in other nursing homes.

CONCLUSIONS: Nursing homes, even those not connected by direct patient transfers, may be a vital component of a hospital's infection control strategy. To achieve effective control, a hospital may want to better understand how regional nursing homes and hospitals are connected through both direct and indirect (with intervening stays at home) patient sharing.

Author List

Lee BY, Bartsch SM, Wong KF, Singh A, Avery TR, Kim DS, Brown ST, Murphy CR, Yilmaz SL, Potter MA, Huang SS

Author

Ashima Singh PhD Assistant Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
California
Cross Infection
Disease Outbreaks
Health Facility Size
Hospitals
Humans
Infection Control
Interinstitutional Relations
Methicillin-Resistant Staphylococcus aureus
Nursing Homes
Patient Transfer
Prevalence
Staphylococcal Infections