按设施类型实施的多重耐药生物预防包的区域影响:一个建模研究
Samuel E Cincotta1, Maroya S Walters1, D Cal Ham1
1Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
在长期急症医院 (LTACH) 和具有呼吸器能力的熟练护理设施 (vSNFs) 中,有针对性的查和感染控制显著减少了多药耐药生物体 (MDROs) 的区域传播. 这些干预措施是控制疫情的关键.
科学领域:
- 流行病学 流行病学
- 传染病控制和控制传染病
- 数学建模的数学建模
背景情况:
- 多种耐药生物 (MDROs),包括耐卡巴胺肠道细菌 (CRE),由于它们的迅速区域传播,构成了严重的公共卫生威胁.
- 管理高急性患者和长期住院的医疗保健设施,如长期急性护理医院 (LTACH) 和具有呼吸器能力的熟练护理设施 (vSNF),可以不成比例地为MDRO传播做出贡献.
研究的目的:
- 评估实施针对性预防干预措施对MDROs区域流行率的有效性.
- 评估特定干预措施的影响,包括查和加强感染预防和控制 (IPC) 实践,在不同类型的医疗机构内.
主要方法:
- 开发一种模拟美国州内CRE传播的确定性隔间模型.
- 包括社区和各种医疗机构设置 (急症医院,LTACH,vSNF).
- 模拟入院查,定期流行调查 (PPSs),增强的IPC和设施间通信对感染性和传染性的影响.
主要成果:
- 在vSNFs和LTACHs中结合PPS和增强的IPC的干预捆绑显示了区域MDRO流行率的最显著降低.
- 在急症护理医院,LTACH和vSNF的有针对性的入院查,以及改善的设施间通信,带来了更适度的好处.
- 各种设施类型的每日传播量大幅减少,特别是针对LTACHs和vSNFs的干预措施.
结论:
- 旨在限制未被认可的MDRO引入或从LTACHs和vSNFs分散的查策略有效地减缓了区域传播.
- 在LTACH和vSNF中将检测 (选) 与增强的IPC实践相结合,提供了一种强有力的方法,可以大幅降低MDROs的整体区域负担.
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