Efficient surveillance for healthcare-associated infections spreading between hospitals.
Early detection of new or novel variants of nosocomial pathogens is a public health priority. We show that, for healthcare-associated infections that spread between hospitals as a result of patient movements, it is possible to design an effective surveillance system based on a relatively small number of sentinel hospitals. We apply recently developed mathematical models to patient admission data from the national healthcare systems of England and The Netherlands. Relatively short detection times are achieved once 10-20% hospitals are recruited as sentinels and only modest reductions are seen as more hospitals are recruited thereafter. Using a heuristic optimization approach to sentinel selection, the same expected time to detection can be achieved by recruiting approximately half as many hospitals. Our study provides a robust evidence base to underpin the design of an efficient sentinel hospital surveillance system for novel nosocomial pathogens, delivering early detection times for reduced expenditure and effort.
Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh EH9 3JT, United Kingdom, Department of Medical Microbiology, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ, The Netherlands, Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, 3721 MA, The Netherlands, and Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, 3584 CX, The Netherlands.
Mariano
M
Ciccolini
Tjibbe
T
Donker
Hajo
H
Grundmann
Marc J M
MJ
Bonten
Mark E J
ME
Woolhouse
D003428:Cross Infection / Q000453:epidemiology* / Q000635:transmission; D004739:England / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance
network; patient referrals