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- Title
Using contact network dynamics to implement efficient interventions against pathogen spread in hospital settings: A modelling study.
- Authors
Leclerc, Quentin J.; Duval, Audrey; Guillemot, Didier; Opatowski, Lulla; Temime, Laura
- Abstract
Background: Long-term care facilities (LTCFs) are hotspots for pathogen transmission. Infection control interventions are essential, but the high density and heterogeneity of interindividual contacts within LTCF may hinder their efficacy. Here, we explore how the patient–staff contact structure may inform effective intervention implementation. Methods and findings: Using an individual-based model (IBM), we reproduced methicillin-resistant Staphylococcus aureus colonisation transmission dynamics over a detailed contact network recorded within a French LTCF of 327 patients and 263 staff over 3 months. Simulated baseline cumulative colonisation incidence was 21 patients (prediction interval: 11, 31) and 35 staff (prediction interval: 19, 54). We examined the potential impact of 3 types of interventions against transmission (reallocation reducing the number of unique contacts per staff, reinforced contact precautions, and hypothetical vaccination protecting against acquisition), targeted towards specific populations. All 3 interventions were effective when applied to all nurses or healthcare assistants (median reduction in MRSA colonisation incidence up to 35%), but the benefit did not exceed 8% when targeting any other single staff category. We identified "supercontactor" individuals with most contacts ("frequency-based," overrepresented among nurses, porters, and rehabilitation staff) or with the longest cumulative time spent in contact ("duration-based," overrepresented among healthcare assistants and patients in elderly care or persistent vegetative state (PVS)). Targeting supercontactors enhanced interventions against pathogen spread in the LTCF. With contact precautions, targeting frequency-based staff supercontactors led to the highest incidence reduction (20%, 95% CI: 19, 21). Vaccinating a mix of frequency- and duration-based staff supercontactors led to a higher reduction (23%, 95% CI: 22, 24) than all other approaches. Although based on data from a single LTCF, when varying epidemiological parameters to extend to other pathogens, our results suggest that targeting supercontactors is always the most effective strategy, indicating this approach could be applied to prevent transmission of other nosocomial pathogens. Conclusions: By characterising the contact structure in hospital settings and identifying the categories of staff and patients more likely to be supercontactors, with either more or longer contacts than others, interventions against nosocomial spread could be more effective. We find that the most efficient implementation strategy depends on the intervention (reallocation, contact precautions, vaccination) and target population (staff, patients, supercontactors). Importantly, both staff and patients may be supercontactors, highlighting the importance of including patients in measures to prevent pathogen transmission in LTCF. Authors model contact colonisation dynamics of methicillin-resistant Staphylococcus aureus (MRSA) and simulate different interventions to evaluate their effectiveness at optimising infection control measures in long term care facilities. Author summary: Why was this study done?: Infection control in healthcare centres such as long-term facilities (LCTFs) is challenging due to high-density and varied contact patterns among individuals. Understanding the contact structure between and within patients and healthcare workers and its impact on transmission could offer new perspectives to improve the effectiveness of infection control interventions. What did the researchers do and find?: We developed an individual-based model (IBM) of methicillin-resistant Staphylococcus aureus (MRSA) colonisation dynamics, informed by a detailed contact network and epidemiological data collected within an LTCF over 3 months. We used simulations to evaluate 3 intervention types: reallocation assigning patients to a given staff member of each category throughout their entire stay, reinforced contact precautions, and hypothetical vaccination reducing acquisition risk. We identified "supercontactors" with the most contacts (frequency-based, overrepresented among nurses, porters, and rehabilitation staff) or longest time spent in contact (duration-based, overrepresented among healthcare assistants and patients in elderly care or persistent vegetative state (PVS)). Simulations revealed that targeting supercontactors enhanced intervention efficacy, with contact precautions reducing MRSA colonisation incidence by up to 20% (95% CI: 19, 21) and vaccination by up to 23% (95% CI: 22, 24). What do these findings mean?: Infection control measures can be optimised by identifying and targeting supercontactors among staff and patients. Both staff and patients can be supercontactors, highlighting the need to include both groups in infection prevention strategies. The most effective strategy depends on both the intervention (reallocation, contact precautions, vaccination) and the subpopulation targeted (staff, patients, supercontactors). Although our quantitative conclusions are informed by data from a single LTCF by varying epidemiological parameters to explore other pathogens, we suggest that interventions targeting supercontactors could be applied to prevent the spread of other nosocomial pathogens.
- Subjects
MEDICAL personnel; LONG-term care facilities; PERSISTENT vegetative state; COLONIZATION (Ecology); METHICILLIN-resistant staphylococcus aureus
- Publication
PLoS Medicine, 2024, Vol 21, Issue 7, p1
- ISSN
1549-1277
- Publication type
Article
- DOI
10.1371/journal.pmed.1004433