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Analyzing pathogen transmission in the dialysis unit: time for a (schedule) change?
John R Hotchkiss1, Paul Holley, Philip S Crooke
1Department of Critical Care Medicine, University of Pittsburgh, and Renal Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania 15261, USA. HotchkissJR@upmc.edu
Background And Objectives:
Infectious diseases and antimicrobial-resistant microorganisms are a growing problem for the dialysis population. The frequency of patient visits and intimate, prolonged physical contact with the inanimate environment during dialysis treatments make these facilities potentially efficient venues for nosocomial pathogen transmission. Isolation measures and infection control practices can be inconvenient and consume limited resources. Quantitative tools for analyzing the effects of different containment strategies can help to identify optimal strategies for further study. However, spatial and temporal considerations germane to the dialysis unit greatly complicate analyses relying on conventional mathematical approaches.
Design, Setting, Participants, & Measurements:
A stochastic, individual-based, Monte Carlo simulation tool that predicts the effects of various infection control strategies on pathogen dissemination through the dialysis unit in the face of diagnostic uncertainty was developed. The model was configured to emulate a medium-sized dialysis unit. The predicted consequences of various policies for scheduling patients who were suspected of being infectious were then explored, using literature-based estimates of pathogen transmissibility, prevalence, and diagnostic uncertainty.
Results:
Environmental decontamination was predicted to be of paramount importance in limiting pathogen dissemination. Temporal segregation (scheduling patients who were suspected of being infectious to dialysis shifts that are later in the day) was predicted to have the greatest effectiveness in reducing transmission, given adequate environmental decontamination between successive days.
Conclusions:
Decontamination of the patient's environment (chair) can markedly attenuate pathogen dissemination. Temporal segregation could be a simple, low-cost, system-level intervention with significant potential to reduce nosocomial transmission in the dialysis unit.
Insights
Environmental decontamination and temporal segregation are key to reducing infectious disease transmission in dialysis units. These strategies can significantly lower the spread of pathogens among patients undergoing dialysis treatments.
Area of Science:
- Infectious disease epidemiology
- Healthcare-associated infections
- Mathematical modeling in public health
Background:
- Dialysis patients are at high risk for infectious diseases and antimicrobial-resistant organisms.
- Dialysis facilities present efficient venues for nosocomial pathogen transmission due to frequent patient contact and environmental exposure.
- Conventional mathematical models struggle with spatial and temporal complexities in dialysis units.
Purpose of the Study:
- To develop a quantitative tool for analyzing infection control strategies in dialysis units.
- To evaluate the effectiveness of different containment strategies against pathogen dissemination.
- To identify optimal infection control interventions for further study.
Main Methods:
- Developed a stochastic, individual-based, Monte Carlo simulation tool.
- Modeled pathogen dissemination in a medium-sized dialysis unit.
- Explored consequences of patient scheduling policies using literature-based data on transmissibility, prevalence, and diagnostic uncertainty.
Main Results:
- Environmental decontamination is crucial for limiting pathogen spread.
- Temporal segregation of infectious patients to later dialysis shifts showed high effectiveness.
- Effectiveness of temporal segregation is dependent on adequate environmental decontamination between days.
Conclusions:
- Patient environment (chair) decontamination significantly reduces pathogen dissemination.
- Temporal segregation offers a simple, low-cost intervention to decrease nosocomial transmission in dialysis units.
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