Department of Psychology, Health and Technology/Center for eHealth Research and Disease Management, Faculty of Behavioural Sciences, University of Twente, Enschede, The Netherlands.
Department of Earth Observation Sciences, Faculty of Geo-Information Science and Earth Observation (ITC), University of Twente, Enschede, The Netherlands.
BMC Infect Dis. 2021 Mar 12;21(1):260. doi: 10.1186/s12879-021-05954-7.
Hand transmission of harmful microorganisms may lead to infections and poses a major threat to patients and healthcare workers in healthcare settings. The most effective countermeasure against these transmissions is the adherence to spatiotemporal hand hygiene policies, but adherence rates are relatively low and vary over space and time. The spatiotemporal effects on hand transmission and spread of these microorganisms for varying hand hygiene compliance levels are unknown. This study aims to (1) identify a healthcare worker occupancy group of potential super-spreaders and (2) quantify spatiotemporal effects on the hand transmission and spread of harmful microorganisms for varying levels of hand hygiene compliance caused by this group.
Spatiotemporal data were collected in a hospital ward of an academic hospital using radio frequency identification technology for 7 days. A potential super-spreader healthcare worker occupation group was identified using the frequency identification sensors' contact data. The effects of five probability distributions of hand hygiene compliance and three harmful microorganism transmission rates were simulated using a dynamic agent-based simulation model. The effects of initial simulation assumptions on the simulation results were quantified using five risk outcomes.
Nurses, doctors and patients are together responsible for 81.13% of all contacts. Nurses made up 70.68% of all contacts, which is more than five times that of doctors (10.44%). This identifies nurses as the potential super-spreader healthcare worker occupation group. For initial simulation conditions of extreme lack of hand hygiene compliance (5%) and high transmission rates (5% per contact moment), a colonised nurse can transfer microbes to three of the 17 healthcare worker or patients encountered during the 98.4 min of visiting 23 rooms while colonised. The harmful microorganism transmission potential for nurses is higher during weeknights (5 pm - 7 am) and weekends as compared to weekdays (7 am - 5 pm).
Spatiotemporal behaviour and social mixing patterns of healthcare can change the expected number of hand transmissions and spread of harmful microorganisms by super-spreaders in a closed healthcare setting. These insights can be used to evaluate spatiotemporal safety behaviours and develop infection prevention and control strategies.
手部传播有害微生物可能导致感染，对医疗机构中的患者和医护人员构成重大威胁。对抗这些传播的最有效措施是遵守时空手部卫生政策，但遵守率相对较低，且随空间和时间而变化。对于不同的手部卫生合规水平，这些微生物的手部传播和扩散的时空影响尚不清楚。本研究旨在：（1）确定医护人员的潜在超级传播者职业群体；（2）量化由于该群体导致的不同手部卫生合规水平对手部传播和有害微生物扩散的时空影响。
使用射频识别技术在一家学术医院的病房中连续 7 天采集时空数据。使用身份识别传感器的接触数据确定潜在的超级传播者医护人员职业群体。使用动态基于代理的仿真模型模拟了五种手部卫生合规概率分布和三种有害微生物传播率的影响。使用五个风险结果来量化初始模拟假设对模拟结果的影响。
护士、医生和患者共同负责所有接触的 81.13%。护士占所有接触的 70.68%，是医生（10.44%）的五倍多。这表明护士是潜在的超级传播者医护人员职业群体。对于初始模拟条件下的极度缺乏手部卫生合规（5%）和高传播率（每次接触瞬间 5%），处于污染状态的护士在访问 23 个房间的 98.4 分钟内遇到的 17 名医护人员或患者中，可以将微生物传染给三人。处于污染状态的护士在夜间（下午 5 点至早上 7 点）和周末（早上 7 点至下午 5 点）比工作日（下午 5 点至早上 7 点）的有害微生物传播潜力更高。
在封闭的医疗机构中，医护人员的时空行为和社会混合模式可能会改变超级传播者预期的手部传播次数和有害微生物的传播范围。这些见解可用于评估时空安全性行为并制定感染预防和控制策略。
