A Model-Based Strategy to Control the Spread of Carbapenem-Resistant Enterobacteriaceae: Simulate and Implement.
OBJECTIVE To reduce transmission of carbapenem-resistant Enterobacteriaceae (CRE) in an intensive care unit with interventions based on simulations by a developed mathematical model. DESIGN Before-after trial with a 44-week baseline period and 24-week intervention period. SETTING Medical intensive care unit of a tertiary care teaching hospital. PARTICIPANTS All patients admitted to the unit. METHODS We developed a model of transmission of CRE in an intensive care unit and measured all necessary parameters for the model input. Goals of compliance with hand hygiene and with isolation precautions were established on the basis of the simulations and an intervention was focused on reaching those metrics as goals. Weekly auditing and giving feedback were conducted. RESULTS The goals for compliance with hand hygiene and contact precautions were reached on the third week of the intervention period. During the baseline period, the calculated R0 was 11; the median prevalence of patients colonized by CRE in the unit was 33%, and 3 times it exceeded 50%. In the intervention period, the median prevalence of colonized CRE patients went to 21%, with a median weekly Rn of 0.42 (range, 0-2.1). CONCLUSIONS The simulations helped establish and achieve specific goals to control the high prevalence rates of CRE and reduce CRE transmission within the unit. The model was able to predict the observed outcomes. To our knowledge, this is the first study in infection control to measure most variables of a model in real life and to apply the model as a decision support tool for intervention. Infect Control Hosp Epidemiol 2016;1-8.
1Infection Control Department and LIM54,Hospital das Clínicas,University of São Paulo,São Paulo,Brazil.
Mirian de Freitas
MF
DalBen
1Infection Control Department and LIM54,Hospital das Clínicas,University of São Paulo,São Paulo,Brazil.
Elisa
E
Teixeira Mendes
1Infection Control Department and LIM54,Hospital das Clínicas,University of São Paulo,São Paulo,Brazil.
Maria Luisa
ML
Moura
1Infection Control Department and LIM54,Hospital das Clínicas,University of São Paulo,São Paulo,Brazil.
Dania
D
Abdel Rahman
1Infection Control Department and LIM54,Hospital das Clínicas,University of São Paulo,São Paulo,Brazil.
Driele
D
Peixoto
1Infection Control Department and LIM54,Hospital das Clínicas,University of São Paulo,São Paulo,Brazil.
Sania
S
Alves Dos Santos
3Nursing Division, Faculty of Medicine,Hospital das Clinicas,University of São Paulo,São Paulo,Brazil.
Walquiria
W
Barcelos de Figueiredo
4Intensive Care Unit,Emergency Medicine Discipline,Hospital das Clínicas,University of São Paulo,São Paulo,Brazil.
Pedro
P
Vitale Mendes
4Intensive Care Unit,Emergency Medicine Discipline,Hospital das Clínicas,University of São Paulo,São Paulo,Brazil.
Leandro
L
Utino Taniguchi
5Discipline of Medical Informatics,School of Medicine,University of São Paulo,São Paulo,Brazil.
Francisco Antonio
FA
Bezerra Coutinho
5Discipline of Medical Informatics,School of Medicine,University of São Paulo,São Paulo,Brazil.
Eduardo
E
Massad
1Infection Control Department and LIM54,Hospital das Clínicas,University of São Paulo,São Paulo,Brazil.
Anna Sara
AS
Levin
D000073182:Carbapenem-Resistant Enterobacteriaceae; D003198:Computer Simulation; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*; D019983:Guideline Adherence; D063373:Hand Hygiene; D006282:Health Personnel; D006784:Hospitals, Teaching; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D015233:Models, Statistical; D011481:Protective Clothing