title: Spatial and temporal analyses to investigate infectious disease transmission within healthcare settings.
abstract: BACKGROUND
  Healthcare-associated infections (HCAIs) cause significant morbidity and mortality worldwide, and outbreaks are often only identified after they reach high levels. A wide range of data is collected within healthcare settings; however, the extent to which this information is used to understand HCAI dynamics has not been quantified.
  
  
  OBJECTIVE
  To examine the use of spatiotemporal analyses to identify and prevent HCAI transmission in healthcare settings, and to provide recommendations for expanding the use of these techniques.
  
  
  METHODS
  A systematic review of the literature was undertaken, focusing on spatiotemporal examination of infectious diseases in healthcare settings. Abstracts and full-text articles were reviewed independently by two authors to determine inclusion.
  
  
  RESULTS
  In total, 146 studies met the inclusion criteria. There was considerable variation in the use of data, with surprisingly few studies (N = 22) using spatiotemporal-specific analyses to extend knowledge of HCAI transmission dynamics. The remaining 124 studies were descriptive. A modest increase in the application of statistical analyses has occurred in recent years.
  
  
  CONCLUSIONS
  The incorporation of spatiotemporal analysis has been limited in healthcare settings, with only 15% of studies including any such analysis. Analytical studies provided greater data on transmission dynamics and effective control interventions than studies without spatiotemporal analyses. This indicates the need for greater integration of spatiotemporal techniques into HCAI investigations, as even simple analyses provide significant improvements in the understanding of prevention over simple descriptive summaries.
authors.affiliation: National Centre for Infection Prevention and Management, Division of Infectious Diseases, Section of Infectious Diseases and Immunity, Department of Medicine, Imperial College London, London, UK. Electronic address: g.davis10@imperial.ac.uk.
authors.forename: G S
authors.initials: GS
authors.lastname: Davis
authors.affiliation: Centre for Patient Safety and Service Quality, Department of Surgery and Cancer, Imperial College London, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Sevdalis
authors.affiliation: National Centre for Infection Prevention and Management, Division of Infectious Diseases, Section of Infectious Diseases and Immunity, Department of Medicine, Imperial College London, London, UK.
authors.forename: L N
authors.initials: LN
authors.lastname: Drumright
mesh_terms: D003428:Cross Infection / Q000635:transmission*; D018562:Disease Transmission, Infectious; D006268:Health Facilities; D006801:Humans; D062211:Spatio-Temporal Analysis
keywords: Analysis; Geographic information systems; Healthcare-associated infection; Hospital; Infection; Spatiotemporal analysis