Peripatetic health-care workers as potential superspreaders

被引:93
作者
Temime, Laura [1 ]
Opatowski, Lulla [2 ,3 ]
Pannet, Yohan [1 ,3 ]
Brun-Buisson, Christian [2 ,4 ,5 ]
Boelle, Pierre Yves [6 ,7 ,8 ]
Guillemot, Didier [2 ,3 ,9 ,10 ]
机构
[1] Conservatoire Natl Arts & Metiers, F-75141 Paris, France
[2] INSERM, U657, F-75015 Paris, France
[3] PhEMI, Inst Pasteur, F-75015 Paris, France
[4] Univ Paris 12, Fac Med, F-94000 Creteil, France
[5] Hop Henri Mondor, AP HP, Serv Reanimat Med, F-94000 Creteil, France
[6] INSERM, U707, F-75015 Paris, France
[7] Univ Paris 06, UMR S 707, Paris, France
[8] Hop St Antoine, AP HP, F-75012 Paris, France
[9] Univ Versailles St Quentin, Fac Med Paris Ile France Ouest, F-78035 Versailles, France
[10] Hop Raymond Poincare, AP HP, Serv Med Aigue, F-92380 Garches, France
关键词
hygiene; nosocomial infections; superspreading; agent-based modeling; RESISTANT STAPHYLOCOCCUS-AUREUS; INTENSIVE-CARE; HAND HYGIENE; TRANSMISSION DYNAMICS; NOSOCOMIAL INFECTIONS; RISK-FACTORS; ENTEROCOCCI; EPIDEMIC; IMPACT; TIME;
D O I
10.1073/pnas.0900974106
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Many nosocomial outbreaks exhibit "superspreading events" in which cross-transmission occurs via a single individual to a large number of patients. We investigated how heterogeneity in Health-Care Worker (HCW) behaviors, especially compliance to hand hygiene, may cause superspreading events. In particular, we compared the superspreading potential of peripatetic (noncohorted) HCWs with that of other HCWs. We developed an agent-based model for hand transmission of a pathogen in a hospital ward. Three HCW profiles were allowed: 2 assigned profiles, one with frequent contacts with a limited number of patients, another with fewer contacts but with more patients; and one peripatetic profile, with a single daily contact with all patients. We used data from the literature on common nosocomial pathogens (Staphylococcus aureus, Enterococci). The average number of patients colonized over 1 month increases with noncompliance to hand hygiene. Importantly, we show that this increase depends on the profile of noncompliant HCWs; for instance, it remains low for a single noncompliant assigned HCW but can be quite large for a single noncompliant peripatetic HCW. Outbreaks with this single fully noncompliant peripatetic HCW (representing only 4.5% of the staff) are similar to those predicted when all HCWs are noncompliant following 23% of patient contacts. Noncompliant peripatetic HCWs may play a disproportionate role in disseminating pathogens in a hospital ward. Their unique profile makes them potential superspreaders. This suggests that average compliance to hygiene may not be a good indicator of nosocomial risk in real life health care settings with several HCW profiles.
引用
收藏
页码:18420 / 18425
页数:6
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