Modelling pathogen spread in a healthcare network: Indirect patient movements
Piotrowska, Monika J.; Sakowski, Konrad; Karch, Andre; Tahir, Hannan; Horn, Johannes; Kretzschmar, Mirjam E.; Mikolajczyk, Rafael T.
(2020) PLoS Computational Biology, volume 16, issue 11, pp. 1 - 22
(Article)
Abstract
Inter-hospital patient transfers (direct transfers) between healthcare facilities have been shown to contribute to the spread of pathogens in a healthcare network. However, the impact of indirect transfers (patients re-admitted from the community to the same or different hospital) is not well studied. This work aims to study the contribution
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of indirect transfers to the spread of pathogens in a healthcare network. To address this aim, a hybrid network-deterministic model to simulate the spread of multiresistant pathogens in a healthcare system was developed for the region of Lower Saxony (Germany). The model accounts for both, direct and indirect transfers of patients. Intra-hospital pathogen transmission is governed by a SIS model expressed by a system of ordinary differential equations. Our results show that the proposed model reproduces the basic properties of healthcare-associated pathogen spread. They also show the importance of indirect transfers: restricting the pathogen spread to direct transfers only leads to 4.2% system wide prevalence. However, adding indirect transfers leads to an increase in the overall prevalence by a factor of 4 (18%). In addition, we demonstrated that the final prevalence in the individual healthcare facilities depends on average length of stay in a way described by a non-linear concave function. Moreover, we demonstrate that the network parameters of the model may be derived from administrative admission/discharge records. In particular, they are sufficient to obtain inter-hospital transfer probabilities, and to express the patients' transfers as a Markov process. Using the proposed model, we show that indirect transfers of patients are equally or even more important as direct transfers for the spread of pathogens in a healthcare network.
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Keywords: Ecology, Evolution, Behavior and Systematics, Modelling and Simulation, Ecology, Molecular Biology, Genetics, Cellular and Molecular Neuroscience, Computational Theory and Mathematics
ISSN: 1553-734X
Publisher: Public Library of Science
Note: Funding Information: M. J. P., K. S - National Science Centre, Poland, Unisono: 2016/22/Z/ST1/00690, https:// ncn.gov.pl/ H. T., M. E. Kretzschmar - Netherlands ZonMw, grant number 547001005, https://www.zonmw.nl/ A. K., J. H., R. T. M.-Bundesministerium für Bildung und Forschung, grant number 01KI1704C, https://www.bmbf.de/ All sources within the 3rd JPI AMR framework (Joint Programming Initiative on Antimicrobial Resistance) cofound grant no 681055 for the consortium EMerGE-Net (Effectiveness of infection control strategies against intra- and inter-hospital transmission of MultidruG-resistant Enterobacteriaceae). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2020 Piotrowska et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
(Peer reviewed)