University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
Infect Control Hosp Epidemiol. 2011 Jun;32(6):562-72. doi: 10.1086/660014.
Since hospitals in a region often share patients, an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in one hospital could affect other hospitals.
Using extensive data collected from Orange County (OC), California, we developed a detailed agent-based model to represent patient movement among all OC hospitals. Experiments simulated MRSA outbreaks in various wards, institutions, and regions. Sensitivity analysis varied lengths of stay, intraward transmission coefficients (β), MRSA loss rate, probability of patient transfer or readmission, and time to readmission.
Each simulated outbreak eventually affected all of the hospitals in the network, with effects depending on the outbreak size and location. Increasing MRSA prevalence at a single hospital (from 5% to 15%) resulted in a 2.9% average increase in relative prevalence at all other hospitals (ranging from no effect to 46.4%). Single-hospital intensive care unit outbreaks (modeled increase from 5% to 15%) caused a 1.4% average relative increase in all other OC hospitals (ranging from no effect to 12.7%).
MRSA outbreaks may rarely be confined to a single hospital but instead may affect all of the hospitals in a region. This suggests that prevention and control strategies and policies should account for the interconnectedness of health care facilities.
由于一个地区的医院经常共享患者，一家医院发生耐甲氧西林金黄色葡萄球菌（MRSA）感染爆发，可能会影响其他医院。
我们利用从加利福尼亚州奥兰治县（OC）收集的大量数据，开发了一个详细的基于代理的模型，以代表所有 OC 医院之间的患者流动。实验模拟了不同病房、机构和地区的 MRSA 爆发。敏感性分析包括住院时间、病房内传播系数（β）、MRSA 失效率、患者转院或再入院的概率以及再入院时间。
每个模拟的爆发最终都会影响到网络中的所有医院，其影响取决于爆发的规模和地点。单个医院的 MRSA 流行率（从 5%增加到 15%）会导致所有其他医院的相对流行率平均增加 2.9%（从无影响到 46.4%）。单个医院重症监护病房的爆发（模型中从 5%增加到 15%）会导致所有其他 OC 医院的相对流行率平均增加 1.4%（从无影响到 12.7%）。
MRSA 爆发很少局限于单个医院，而是可能影响到一个地区的所有医院。这表明，预防和控制策略和政策应考虑到医疗机构的互联性。
