title: Modeling the regional spread and control of vancomycin-resistant enterococci.
abstract: BACKGROUND
  Because patients can remain colonized with vancomycin-resistant enterococci (VRE) for long periods of time, VRE may spread from one health care facility to another.
  
  
  METHODS
  Using the Regional Healthcare Ecosystem Analyst, an agent-based model of patient flow among all Orange County, California, hospitals and communities, we quantified the degree and speed at which changes in VRE colonization prevalence in a hospital may affect prevalence in other Orange County hospitals.
  
  
  RESULTS
  A sustained 10% increase in VRE colonization prevalence in any 1 hospital caused a 2.8% (none to 62%) average relative increase in VRE prevalence in all other hospitals. Effects took from 1.5 to >10 years to fully manifest. Larger hospitals tended to have greater affect on other hospitals.
  
  
  CONCLUSIONS
  When monitoring and controlling VRE, decision makers may want to account for regional effects. Knowing a hospital's connections with other health care facilities via patient sharing can help determine which hospitals to include in a surveillance or control program.
authors.affiliation: Public Health Computational and Operations Research, University of Pittsburgh, Pittsburgh, PA 15213, USA. BYL1@pitt.edu
authors.forename: Bruce Y
authors.initials: BY
authors.lastname: Lee
authors.forename: S Levent
authors.initials: SL
authors.lastname: Yilmaz
authors.forename: Kim F
authors.initials: KF
authors.lastname: Wong
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Bartsch
authors.forename: Stephen
authors.initials: S
authors.lastname: Eubank
authors.forename: Yeohan
authors.initials: Y
authors.lastname: Song
authors.forename: Taliser R
authors.initials: TR
authors.lastname: Avery
authors.forename: Richard
authors.initials: R
authors.lastname: Christie
authors.forename: Shawn T
authors.initials: ST
authors.lastname: Brown
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Epstein
authors.forename: Jon I
authors.initials: JI
authors.lastname: Parker
authors.forename: Susan S
authors.initials: SS
authors.lastname: Huang
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002140:California / Q000453:epidemiology; D003198:Computer Simulation; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*; D016983:Enterococcus / Q000187:drug effects*; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D015995:Prevalence; D014640:Vancomycin / Q000494:pharmacology; D020713:Vancomycin Resistance / Q000187:drug effects*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Health care-associated infections; Hospitals; Modeling; Simulation; Vancomycin-resistant Enterococcus
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