Contribution of interfacility patient movement to overall methicillin-resistant Staphylococcus aureus prevalence levels.
OBJECTIVE
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.
Department of Mathematics, School of Computer, Mathematical, and Natural Sciences, University of Maryland, College Park, Maryland, USA.
Sean L
SL
Barnes
Anthony D
AD
Harris
Bruce L
BL
Golden
Edward A
EA
Wasil
Jon P
JP
Furuno
D003198:Computer Simulation; D003428:Cross Infection / Q000453:epidemiology* / Q000635:transmission; D006276:Health Facility Size; D006801:Humans; D017053:Infection Control; D055624:Methicillin-Resistant Staphylococcus aureus; D009735:Nursing Homes; D010351:Patient Discharge; D010359:Patient Readmission; D010360:Patient Transfer; D015995:Prevalence; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission