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An agent-based model to simulate the transmission of vancomycin-resistant enterococci according different prevention and control measures

Published online by Cambridge University Press:  18 December 2020

Stéphanie Deboscker Open the ORCID record for Stéphanie Deboscker [Opens in a new window] ,
François Séverac ,
Jean Gaudart ,
Céline Ménard ,
Nicolas Meyer  and
Thierry Lavigne
Stéphanie Deboscker*
Affiliation:
Service d’hygiène hospitalière, Hôpitaux universitaires de Strasbourg, Strasbourg, France ICube, UMR7357, Universitè de Strasbourg, Strasbourg, France
François Séverac
Affiliation:
ICube, UMR7357, Universitè de Strasbourg, Strasbourg, France Groupe Méthode en Recherche Clinique (GMRC), Service de Santé Publique, Hôpitaux universitaires de Strasbourg, Strasbourg, France
Jean Gaudart
Affiliation:
Hôpital La Timone, Service Biostatistique et Technologies de l’Information et de la Communication, APHM, Marseille, France IRD, INSERM, SESSTIM UMR912, Aix Marseille Univ, Marseille, France
Céline Ménard
Affiliation:
Service d’hygiène hospitalière, Hôpitaux universitaires de Strasbourg, Strasbourg, France Laboratoire de bactèriologie, Hôpitaux universitaires de Strasbourg, Strasbourg, France
Nicolas Meyer
Affiliation:
ICube, UMR7357, Universitè de Strasbourg, Strasbourg, France Groupe Méthode en Recherche Clinique (GMRC), Service de Santé Publique, Hôpitaux universitaires de Strasbourg, Strasbourg, France
Thierry Lavigne
Affiliation:
Service d’hygiène hospitalière, Hôpitaux universitaires de Strasbourg, Strasbourg, France
*
Author for correspondence: Dr Stéphanie Deboscker, E-mail: stephanie.deboscker@chru-strasbourg.fr
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Abstract

Objective:

Despite the existence of various levels of infection prevention and control (IPC) measures aimed at limiting the transmission of vancomycin-resistant enterococci (VRE) in hospitals, these measures are sometimes difficult to implement. Using an agent-based model (ABM), we simulated the transmission of VRE within and between 3 care units according to different IPC measures.

Methods:

The ABM was modelled on short-stay medical wards, represented by 2 conventional care units and 1 intensive care unit. The scenarios consisted of the simulation of various compliance rates of caregivers with regard to hand hygiene (HH) in different contexts of IPC measures: (1) standard precautions for all patients, (2) additional contact precautions for VRE-carrier patients, (3) geographical cohorting of carrier patients, and (4) creation of an isolation unit with dedicated staff.

Results:

With <50% HH compliance, the dissemination of VRE was not adequately controlled. With 80% compliance for all patients (ie, standard precautions scenario), there were no secondary VRE cases in 50% of the simulations, which represented the best scenario. A more realistic rate, 60% HH compliance for all patients, revealed interesting results. Implementing an isolation unit was effective only if the level of HH compliance was low. Patient cohorting was less effective.

Conclusions:

The present ABM showed that while contact precautions, geographic cohorting, and an isolation unit may represent good complements to standard precautions, they may theoretically not be necessary if HH is followed at a high level of compliance.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 7 , July 2021 , pp. 857 - 863
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Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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