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Updated: May 28, 2026
Methodology for the Study of Horizontal Gene Transfer in Staphylococcus aureus
Published on: March 10, 2017
Contribution of interfacility patient movement to overall methicillin-resistant Staphylococcus aureus prevalence
Sean L Barnes1, Anthony D Harris, Bruce L Golden
1Department of Mathematics, School of Computer, Mathematical, and Natural Sciences, University of Maryland, College Park, Maryland, USA.
Objectives:
The effect of patient movement between hospitals and long-term care facilities (LTCFs) on methicillin-resistant Staphylococcus aureus (MRSA) prevalence levels is unknown. We investigated these effects to identify scenarios that may lead to increased prevalence in either facility type.
Methods:
We used a hybrid simulation model to simulate MRSA transmission among hospitals and LTCFs. Transmission within each facility was determined by mathematical model equations. The model predicted the long-term prevalence of each facility and was used to assess the effects of facility size, patient turnover, and decolonization.
Results:
Analyses of various healthcare networks suggest that the effect of patients moving from a LTCF to a hospital is negligible unless the patients are consistently admitted to the same unit. In such cases, MRSA prevalence can increase significantly regardless of the endemic level. Hospitals can cause sustained increases in prevalence when transferring patients to LTCFs, where the population size is smaller and patient turnover is less frequent. For 1 particular scenario, the steady-state prevalence of a LTCF increased from 6.9% to 9.4% to 13.8% when the transmission rate of the hospital increased from a low to a high transmission rate.
Conclusions:
These results suggest that the relative facility size and the patient discharge rate are 2 key factors that can lead to sustained increases in MRSA prevalence. Consequently, small facilities or those with low turnover rates are especially susceptible to sustaining increased prevalence levels, and they become more so when receiving patients from larger, high-prevalence facilities. Decolonization is an infection-control strategy that can mitigate these effects.
Insights
Patient movement between hospitals and long-term care facilities (LTCFs) impacts methicillin-resistant Staphylococcus aureus (MRSA) spread. Small LTCFs with low turnover are vulnerable to increased MRSA prevalence from hospitals, but decolonization can help.
Area of Science:
- Infectious disease epidemiology
- Healthcare-associated infections
- Mathematical modeling in public health
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant threat in healthcare settings.
- Understanding patient flow between hospitals and long-term care facilities (LTCFs) is crucial for infection control.
- The impact of inter-facility patient movement on MRSA prevalence remains unclear.
Purpose of the Study:
- To investigate how patient transfers between hospitals and LTCFs influence MRSA prevalence.
- To identify specific scenarios that could lead to increased MRSA levels in either facility type.
- To inform infection control strategies by elucidating transmission dynamics.
Main Methods:
- A hybrid simulation model was employed to simulate MRSA transmission.
- Mathematical equations modeled transmission dynamics within each facility.
- The model assessed the influence of facility size, patient turnover, and decolonization strategies.
Main Results:
- Patient transfers from LTCFs to hospitals have minimal impact unless patients are consistently admitted to the same unit.
- Hospitals transferring patients to LTCFs can cause sustained MRSA prevalence increases, especially in smaller facilities with low turnover.
- A simulated LTCF's MRSA prevalence rose from 6.9% to 13.8% with increased hospital transmission rates.
Conclusions:
- Facility size and patient discharge rates are critical factors in sustained MRSA prevalence.
- Smaller LTCFs or those with low patient turnover are more susceptible to increased MRSA prevalence, particularly when receiving patients from high-prevalence hospitals.
- Decolonization interventions can effectively mitigate the rise in MRSA prevalence.
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