TY - JOUR
T1 - How Long-Term Acute Care Hospitals Can Play an Important Role in Controlling Carbapenem-Resistant Enterobacteriaceae in a Region
T2 - A Simulation Modeling Study
AU - Lee, Bruce Y.
AU - Bartsch, Sarah M.
AU - Lin, Michael Y.
AU - Asti, Lindsey
AU - Welling, Joel
AU - Mueller, Leslie E.
AU - Leonard, Jim
AU - Brown, Shawn T.
AU - Doshi, Kruti
AU - Kemble, Sarah K.
AU - Mitgang, Elizabeth A.
AU - Weinstein, Robert A.
AU - Trick, William E.
AU - Hayden, Mary K.
N1 - Publisher Copyright:
© 2020 The Author(s) 2020. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
PY - 2021/3/1
Y1 - 2021/3/1
N2 - Typically, long-term acute care hospitals (LTACHs) have less experience in and incentives to implementing aggressive infection control for drug-resistant organisms such as carbapenem-resistant Enterobacteriaceae (CRE) than acute care hospitals. Decision makers need to understand how implementing control measures in LTACHs can impact CRE spread regionwide. Using our Chicago metropolitan region agent-based model to simulate CRE spread and control, we estimated that a prevention bundle in only LTACHs decreased prevalence by a relative 4.6%-17.1%, averted 1,090-2,795 new carriers, 273-722 infections and 37-87 deaths over 3 years and saved 30.5-69.1 million, compared with no CRE control measures. When LTACHs and intensive care units intervened, prevalence decreased by a relative 21.2%. Adding LTACHs averted an additional 1,995 carriers, 513 infections, and 62 deaths, and saved 47.6 million beyond implementation in intensive care units alone. Thus, LTACHs may be more important than other acute care settings for controlling CRE, and regional efforts to control drug-resistant organisms should start with LTACHs as a centerpiece.
AB - Typically, long-term acute care hospitals (LTACHs) have less experience in and incentives to implementing aggressive infection control for drug-resistant organisms such as carbapenem-resistant Enterobacteriaceae (CRE) than acute care hospitals. Decision makers need to understand how implementing control measures in LTACHs can impact CRE spread regionwide. Using our Chicago metropolitan region agent-based model to simulate CRE spread and control, we estimated that a prevention bundle in only LTACHs decreased prevalence by a relative 4.6%-17.1%, averted 1,090-2,795 new carriers, 273-722 infections and 37-87 deaths over 3 years and saved 30.5-69.1 million, compared with no CRE control measures. When LTACHs and intensive care units intervened, prevalence decreased by a relative 21.2%. Adding LTACHs averted an additional 1,995 carriers, 513 infections, and 62 deaths, and saved 47.6 million beyond implementation in intensive care units alone. Thus, LTACHs may be more important than other acute care settings for controlling CRE, and regional efforts to control drug-resistant organisms should start with LTACHs as a centerpiece.
KW - Carbapenem-resistant Enterobacteriaceae
KW - hospitals
KW - long-term acute care hospitals
KW - prevention and control
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U2 - 10.1093/aje/kwaa247
DO - 10.1093/aje/kwaa247
M3 - Article
C2 - 33145594
AN - SCOPUS:85102657581
SN - 0002-9262
VL - 190
SP - 448
EP - 458
JO - American journal of epidemiology
JF - American journal of epidemiology
IS - 3
ER -