Skip to main content Accessibility help
×
Home

The Role of Nursing Homes in the Spread of Antimicrobial Resistance Over the Healthcare Network

  • Carline van den Dool (a1), Anja Haenen (a1), Tjalling Leenstra (a1) and Jacco Wallinga (a1) (a2)

Abstract

OBJECTIVE

Recerntly, the role of the healthcare network, defined as a set of hospitals linked by patient transfers, has been increasingly considered in the control of antimicrobial resistance. Here, we investigate the potential impact of nursing homes on the spread of antimicrobial-resistant pathogens across the healthcare network and its importance for control strategies.

METHODS

Based on patient transfer data, we designed a network model representing the Dutch healthcare system of hospitals and nursing homes. We simulated the spread of an antimicrobial-resistant pathogen across the healthcare network, and we modeled transmission within institutions using a stochastic susceptible–infected–susceptible (SIS) epidemic model. Transmission between institutions followed transfers. We identified the contribution of nursing homes to the dispersal of the pathogen by comparing simulations of the network with and without nursing homes.

RESULTS

Our results strongly suggest that nursing homes in the Netherlands have the potential to drive and sustain epidemics across the healthcare network. Even when the daily probability of transmission in nursing homes is much lower than in hospitals, transmission of resistance can be more effective because of the much longer length of stay of patients in nursing homes.

CONCLUSIONS

If an antimicrobial-resistant pathogen emerges that spreads easily within nursing homes, control efforts aimed at hospitals may no longer be effective in preventing nationwide outbreaks. It is important to consider nursing homes in planning regional and national infection control and in implementing surveillance systems that monitor the spread of antimicrobial resistance.

Infect Control Hosp Epidemiol 2016;37:761–767

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      The Role of Nursing Homes in the Spread of Antimicrobial Resistance Over the Healthcare Network
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      The Role of Nursing Homes in the Spread of Antimicrobial Resistance Over the Healthcare Network
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      The Role of Nursing Homes in the Spread of Antimicrobial Resistance Over the Healthcare Network
      Available formats
      ×

Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Address correspondence to C. van den Dool, PhD, National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control (CIb), Center for Epidemiology and Surveillance of Infectious Diseases (EPI), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands. (carline.van.den.dool@rivm.nl).

References

Hide All
1. Antimicrobial resistance Fact sheet N°194. World Health Organization website. http://www.who.int/mediacentre/factsheets/fs194/en/. Published 2015. Accessed October 22, 2015.
2. Kluytmans-Vandenbergh, MF, Kluytmans, JA, Voss, A. Dutch guideline for preventing nosocomial transmission of highly resistant microorganisms (HRMO). Infection 2005;33:309313.
3. Donker, T, Ciccolini, M, Wallinga, J, Kluytmans, JA, Grundmann, H, Friedrich, AW. [Analysis of patient flows: basis for regional control of antibiotic resistance]. Ned Tijdschr Geneeskd 2015;159:A8468.
4. Datta, R, Brown, S, Nguyen, VQ, et al. Quantifying the exposure to antibiotic-resistant pathogens among patients discharged from a single hospital across all california healthcare facilities. Infect Control Hosp Epidemiol 2015;36:12751282.
5. Ciccolini, M, Donker, T, Kock, R, et al. Infection prevention in a connected world: the case for a regional approach. Int J Med Microbiol 2013;303:380387.
6. Lee, BY, McGlone, SM, Wong, KF, et al. Modeling the spread of methicillin-resistant Staphylococcus aureus (MRSA) outbreaks throughout the hospitals in Orange County, California. Infect Control Hosp Epidemiol 2011;32:562572.
7. Donker, T, Wallinga, J, Grundmann, H. Dispersal of antibiotic-resistant high-risk clones by hospital networks: changing the patient direction can make all the difference. J Hosp Infect 2014;86:3441.
8. Donker, T, Wallinga, J, Grundmann, H. Patient referral patterns and the spread of hospital-acquired infections through national health care networks. PLoS Comput Biol 2010;6:e1000715.
9. Donker, T, Wallinga, J, Slack, R, Grundmann, H. Hospital networks and the dispersal of hospital-acquired pathogens by patient transfer. PLoS One 2012;7:e35002.
10. Huang, SS, Avery, TR, Song, Y, et al. Quantifying interhospital patient sharing as a mechanism for infectious disease spread. Infect Control Hosp Epidemiol 2010;31:11601169.
11. Ke, W, Huang, SS, Hudson, LO, et al. Patient sharing and population genetic structure of methicillin-resistant Staphylococcus aureus . Proc Natl Acad Sci U S A 2012;109:67636768.
12. Werkgroep Infectie Preventie. WIP-Richtlijn BRMO [VWK]. Leiden, 2014.
13. Schweon, SJ, Edmonds, SL, Kirk, J, Rowland, DY, Acosta, C. Effectiveness of a comprehensive hand hygiene program for reduction of infection rates in a long-term care facility. Am J Infect Control 2013;41:3944.
14. Liu, WI, Liang, SY, Wu, SF, Chuang, YH. Hand hygiene compliance among the nursing staff in freestanding nursing homes in Taiwan: a preliminary study. Int J Nurs Pract 2014;20:4652.
15. Smith, PW, Bennett, G, Bradley, S, et al. SHEA/APIC Guideline: infection prevention and control in the long-term care facility. Am J Infect Control 2008;36:504535.
16. Weterings, V, Zhou, K, Rossen, JW, et al. An outbreak of colistin-resistant Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae in the Netherlands (July to December 2013), with inter-institutional spread. Eur J Clin Microbiol Infect Dis 2015;34:16471655.
17. Greenland, K, Rijnders, MI, Mulders, M, et al. Low prevalence of methicillin-resistant Staphylococcus aureus in Dutch nursing homes. J Am Geriatr Soc 2011;59:768769.
18. Hoogendoorn, M, Smalbrugge, M, Stobberingh, EE, van Rossum, SV, Vlaminckx, BJ, Thijsen, SF. Prevalence of antibiotic resistance of the commensal flora in Dutch nursing homes. J Am Med Dir Assoc 2013;14:336339.
19. Willemsen, I, Nelson-Melching, J, Hendriks, Y, et al. Measuring the quality of infection control in Dutch nursing homes using a standardized method; the Infection prevention RIsk Scan (IRIS). Antimicrob Resist Infect Control 2014;3:26.
20. Platteel, TN, Leverstein-van Hall, MA, Cohen Stuart, JW, et al. Predicting carriage with extended-spectrum beta-lactamase-producing bacteria at hospital admission: a cross-sectional study. Clin Microbiol Infect 2015;21:141146.
21. Cheng, VC, Tai, JW, Wong, ZS, et al. Transmission of methicillin-resistant Staphylococcus aureus in the long term care facilities in Hong Kong. BMC Infect Dis 2013;13:205.
22. McKinnell, JA, Miller, LG, Eells, SJ, Cui, E, Huang, SS. A systematic literature review and meta-analysis of factors associated with methicillin-resistant Staphylococcus aureus colonization at time of hospital or intensive care unit admission. Infect Control Hosp Epidemiol 2013;34:10771086.
24. Surveillance Netwerk Infectieziekten in Verpleeghuizen (SNIV). RIVM. http://www.rivm.nl/Onderwerpen/S/Surveillance van_infectieziekten/Surveillance_Netwerk_Infectieziekten_in_Verpleeghuizen_SNIV Published 2009. Accessed February, 2015.
25. Anderson, R, May, R. Infectious diseases of humans: dynamics and control. Oxford: Oxford University Press, 1991.
26. Huang, SS, Rifas-Shiman, SL, Warren, DK, et al. Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units. J Infect Dis 2007;195:330338.
27. Scanvic, A, Denic, L, Gaillon, S, Giry, P, Andremont, A, Lucet, JC. Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage. Clin Infect Dis 2001;32:13931398.
28. Birgand, G, Armand-Lefevre, L, Lolom, I, Ruppe, E, Andremont, A, Lucet, JC. Duration of colonization by extended-spectrum beta-lactamase-producing Enterobacteriaceae after hospital discharge. Am J Infect Control 2013;41:443447.
29. Hetem, DJ, Westh, H, Boye, K, Jarlov, JO, Bonten, MJ, Bootsma, MC. Nosocomial transmission of community-associated methicillin-resistant Staphylococcus aureus in Danish Hospitals. J Antimicrob Chemother 2012;67:17751780.
30. Lesosky, M, McGeer, A, Simor, A, Green, 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;32:136147.
31. Barnes, SL, Harris, AD, Golden, BL, Wasil, EA, Furuno, JP. Contribution of interfacility patient movement to overall methicillin-resistant Staphylococcus aureus prevalence levels. Infect Control Hosp Epidemiol 2011;32:10731078.
32. Lee, BY, Bartsch, SM, Wong, KF, et al. The importance of nursing homes in the spread of methicillin-resistant Staphylococcus aureus (MRSA) among hospitals. Med Care 2013;51:205215.
33. Centers for Disease Control and Prevention. Vital signs: estimated effects of a coordinated approach for action to reduce antibiotic-resistant infections in health care facilities—United States. MMWR Morb Mortal Wkly Rep 2015;64:17.
34. Watts, DJ, Strogatz, SH. Collective dynamics of ‘small-world’ networks. Nature 1998;393:440442.
35. Gruteke, P, Ho, PL, Haenen, A, Lo, WU, Lin, CH, de Neeling, AJ. MRSA spa t1081, a highly transmissible strain endemic to Hong Kong, China, in the Netherlands. Emerg Infect Dis 2015;21:10741076.
Type Description Title
WORD
Supplementary materials

Van den Dool supplementary material
Revision Supplementary Information

 Word (234 KB)
234 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed