title: Infection prevention in a connected world: the case for a regional approach.
abstract: Results from microbiological and epidemiological investigations, as well as mathematical modelling, show that the transmission dynamics of nosocomial pathogens, especially of multiple antibiotic-resistant bacteria, is not exclusively amenable to single-hospital infection prevention measures. Crucially, their extent of spread depends on the structure of an underlying "healthcare network", as determined by inter-institutional referrals of patients. The current trend towards centralized healthcare systems favours the spread of hospital-associated pathogens, and must be addressed by coordinated regional or national approaches to infection prevention in order to maintain patient safety. Here we review recent advances that support this hypothesis, and propose a "next-generation" network-approach to hospital infection prevention and control.
authors.affiliation: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Mariano
authors.initials: M
authors.lastname: Ciccolini
authors.forename: Tjibbe
authors.initials: T
authors.lastname: Donker
authors.forename: Robin
authors.initials: R
authors.lastname: Köck
authors.forename: Martin
authors.initials: M
authors.lastname: Mielke
authors.forename: Ron
authors.initials: R
authors.lastname: Hendrix
authors.forename: Annette
authors.initials: A
authors.lastname: Jurke
authors.forename: Janette
authors.initials: J
authors.lastname: Rahamat-Langendoen
authors.forename: Karsten
authors.initials: K
authors.lastname: Becker
authors.forename: Hubert G M
authors.initials: HG
authors.lastname: Niesters
authors.forename: Hajo
authors.initials: H
authors.lastname: Grundmann
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Friedrich
mesh_terms: D003140:Communicable Disease Control / Q000379:methods*; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D003695:Delivery of Health Care / Q000458:organization & administration*; D006291:Health Policy; D006801:Humans
keywords: Healthcare networks; Infection prevention and control; Network analysis; Regional networks