title: Effect of patterns of transferring patients among healthcare institutions on rates of nosocomial methicillin-resistant Staphylococcus aureus transmission: a Monte Carlo simulation.
abstract: OBJECTIVE
  To determine the effect of the rate and pattern of patient transfers among institutions within a single metropolitan area on the rates of methicillin-resistant Staphylococcus aureus (MRSA) transmission among patients in hospitals and nursing homes.
  
  
  METHODS
  A stochastic, discrete-time, Monte Carlo simulation was used to model the rate and spread of MRSA transmission among patients in medical institutions within a single metropolitan area. Admission, discharges, transfers, and nosocomial transmission were simulated with respect to different interinstitutional transfer strategies and various situational scenarios, such as outlier institutions with high transmission rates.
  
  
  RESULTS
  The simulation results indicated that transfer patterns and transfer rate changes do not affect nosocomial MRSA transmission. Outlier institutions with high transmission rates affect the system wide rate of nosocomial infections differently, depending on institution type.
  
  
  CONCLUSIONS
  It is worth effort to understanding disease-transmission dynamics and interinstitutional transfer patterns for the management of recently introduced diseases or strains. Once endemic in a system, other strategies for transmission control need to be implemented.
authors: Aalto University, Helsinki, Finland. lesosky@gmail.com
authors: Maia
authors: M
authors: Lesosky
authors: Allison
authors: A
authors: McGeer
authors: Andrew
authors: A
authors: Simor
authors: Karen
authors: K
authors: Green
authors: Don E
authors: DE
authors: Low
authors: Janet
authors: J
authors: Raboud
mesh_terms: D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission*; D006801:Humans; D007902:Length of Stay; D055624:Methicillin-Resistant Staphylococcus aureus; D009010:Monte Carlo Method; D010360:Patient Transfer; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000635:transmission*; D014505:Urban Population