Prioritizing healthcare worker vaccinations on the basis of social network analysis.
OBJECTIVE
To use social network analysis to design more effective strategies for vaccinating healthcare workers against influenza.


METHODS
An agent-based simulation.


METHODS
A simulation based on a 700-bed hospital.


METHODS
We first observed human contacts (defined as approach within approximately 0.9 m) performed by 15 categories of healthcare workers (eg, floor nurses, intensive care unit nurses, staff physicians, phlebotomists, and respiratory therapists). We then constructed a series of contact graphs to represent the social network of the hospital and used these graphs to run agent-based simulations to model the spread of influenza. A targeted vaccination strategy that preferentially vaccinated more "connected" healthcare workers was compared with other vaccination strategies during simulations with various base vaccination rates, vaccine effectiveness, probability of transmission, duration of infection, and patient length of stay.


RESULTS
We recorded 6,654 contacts by 148 workers during 606 hours of observations from January through December 2006. Unit clerks, X-ray technicians, residents and fellows, transporters, and physical and occupational therapists had the most contacts. When repeated contacts with the same individual were excluded, transporters, unit clerks, X-ray technicians, physical and occupational therapists, and social workers had the most contacts. Preferentially vaccinating healthcare workers in more connected job categories yielded a substantially lower attack rate and fewer infections than a random vaccination strategy for all simulation parameters.


CONCLUSIONS
Social network models can be used to derive more effective vaccination policies, which are crucial during vaccine shortages or in facilities with low vaccination rates. Local vaccination priorities can be determined in any healthcare facility with only a modest investment in collection of observational data on different types of healthcare workers. Our findings and methods (ie, social network analysis and computational simulation) have implications for the design of effective interventions to control a broad range of healthcare-associated infections.
Polgreen
Philip M
PM
Department of Internal Medicine, The University of Iowa, Iowa City, Iowa 52242, USA
Tassier
Troy Leo
TL
Pemmaraju
Sriram Venkata
SV
Segre
Alberto Maria
AM
D004196:Disease Outbreaks / Q000517:prevention & control*; D006282:Health Personnel; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007251:Influenza, Human / Q000517:prevention & control*; D007484:Iowa; D008432:Mathematical Computing; D008962:Models, Theoretical; D018570:Risk Assessment / Q000379:methods