Modeling the regional spread and control of vancomycin-resistant enterococci

Area of Science:

• Healthcare epidemiology
• Infectious disease transmission
• Computational modeling

Background:

• Patients can carry vancomycin-resistant enterococci (VRE) for extended periods.
• VRE poses a risk for transmission between healthcare facilities.

Purpose of the Study:

• To quantify the impact of VRE colonization prevalence changes in one hospital on other hospitals within a region.
• To assess the speed at which these regional effects manifest.

Main Methods:

• Utilized the Regional Healthcare Ecosystem Analyst, an agent-based model.
• Simulated patient flow across all hospitals and communities in Orange County, California.
• Quantified VRE prevalence changes and their spread.

Main Results:

• A sustained 10% increase in VRE colonization prevalence in one hospital led to an average 2.8% relative increase in other hospitals.
• The full impact of these changes took 1.5 to over 10 years to materialize.
• Larger hospitals demonstrated a more significant influence on VRE prevalence in other facilities.

Conclusions:

• Regional VRE transmission dynamics are significant and should be considered in surveillance and control strategies.
• Understanding inter-facility patient sharing is crucial for designing effective VRE containment programs.
• Targeting specific hospitals based on their connectivity can optimize VRE control efforts.