Relevance of intra-hospital patient movements for the spread of healthcare-associated infections within hospitals - a mathematical modeling study

PLoS Comput Biol. 2021 Feb 3;17(2):e1008600. doi: 10.1371/journal.pcbi.1008600. eCollection 2021 Feb.

Abstract

The aim of this study is to analyze patient movement patterns between hospital departments to derive the underlying intra-hospital movement network, and to assess if movement patterns differ between patients at high or low risk of colonization. For that purpose, we analyzed patient electronic medical record data from five hospitals to extract information on risk stratification and patient intra-hospital movements. Movement patterns were visualized as networks, and network centrality measures were calculated. Next, using an agent-based model where agents represent patients and intra-hospital patient movements were explicitly modeled, we simulated the spread of multidrug resistant enterobacteriacae (MDR-E) inside a hospital. Risk stratification of patients according to certain ICD-10 codes revealed that length of stay, patient age, and mean number of movements per admission were higher in the high-risk groups. Movement networks in all hospitals displayed a high variability among departments concerning their network centrality and connectedness with a few highly connected departments and many weakly connected peripheral departments. Simulating the spread of a pathogen in one hospital network showed positive correlation between department prevalence and network centrality measures. This study highlights the importance of intra-hospital patient movements and their possible impact on pathogen spread. Targeting interventions to departments of higher (weighted) degree may help to control the spread of MDR-E. Moreover, when the colonization status of patients coming from different departments is unknown, a ranking system based on department centralities may be used to design more effective interventions that mitigate pathogen spread.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Computer Simulation
  • Cross Infection / epidemiology*
  • Cross Infection / transmission*
  • Delivery of Health Care
  • Drug Resistance, Multiple
  • Female
  • Hospitalization
  • Hospitals*
  • Humans
  • Male
  • Models, Theoretical
  • Movement*
  • Patient Admission
  • Patient Transfer / methods*
  • Prevalence
  • Programming Languages
  • Reproducibility of Results
  • Risk Assessment
  • Transportation

Grants and funding

This publication was made possible by grants from following national funding agencies: National Science Centre, Poland, Unisono: 2016/22/Z/ST1/00690 (University of Warsaw, Faculty of Mathematics, Informatics and Mechanics, Institute of Applied Mathematics and Mechanics) and 01KI1704C (Martin-Luther-University Halle-Wittenberg, Medical Faculty, Institute of medical epidemiology, biostatistics and informatics) and the Netherlands ZonMw grant number 547001005 (Julius Centre, University Medical Centre Utrecht) within the 3rd JPI AMR framework (Joint Programming Initiative on Antimicrobial Resistance) cofound grant no 681055 for the consortium EMerGE-Net (Effectiveness of infection control strategies against intra- and inter-hospital transmission of MultidruG-resistant Enterobacteriaceae). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.