Document Detail

The importance of nursing homes in the spread of methicillin-resistant Staphylococcus aureus (MRSA) among hospitals.
MedLine Citation:
PMID:  23358388     Owner:  NLM     Status:  MEDLINE    
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.
Bruce Y Lee; Sarah M Bartsch; Kim F Wong; Ashima Singh; Taliser R Avery; Diane S Kim; Shawn T Brown; Courtney R Murphy; Server Levent Yilmaz; Margaret A Potter; Susan S Huang
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Medical care     Volume:  51     ISSN:  1537-1948     ISO Abbreviation:  Med Care     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-13     Completed Date:  2013-04-08     Revised Date:  2014-03-06    
Medline Journal Info:
Nlm Unique ID:  0230027     Medline TA:  Med Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  205-15     Citation Subset:  IM    
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MeSH Terms
California / epidemiology
Cross Infection / epidemiology,  prevention & control,  transmission*
Disease Outbreaks / prevention & control*
Health Facility Size
Hospitals / statistics & numerical data*
Infection Control
Interinstitutional Relations
Methicillin-Resistant Staphylococcus aureus*
Nursing Homes / statistics & numerical data*
Patient Transfer
Staphylococcal Infections / epidemiology,  prevention & control,  transmission*
Grant Support
1U01GM076672/GM/NIGMS NIH HHS; 5U54GM088491-02/GM/NIGMS NIH HHS; HHSA29020050033I//PHS HHS; U54 GM088491/GM/NIGMS NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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