Evaluating Infection Prevention Strategies in Out-Patient Dialysis Units Using Agent-Based Modeling.

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PloS one, ISSN: 1932-6203, Vol: 11, Issue: 5, Page: e0153820

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https://scholarship.richmond.edu/mathcs-faculty-publications/165; https://scholarship.richmond.edu/mathcs-faculty-publications/164
10.1371/journal.pone.0153820; 10.1371/journal.pone.0153820.g002; 10.1371/journal.pone.0153820.t002; 10.1371/journal.pone.0153820.t001; 10.1371/journal.pone.0153820.g004; 10.1371/journal.pone.0153820.t003; 10.1371/journal.pone.0153820.g003; 10.1371/journal.pone.0153820.g001
Joanna R. Wares; Barry Lawson; Douglas Shemin; Erika M. C. D’Agata; Yong Deng
Public Library of Science (PLoS); Figshare
Biochemistry, Genetics and Molecular Biology; Agricultural and Biological Sciences; Medical dialysis; Antimicrobials; Agent-based modeling; Hospitals; Hygiene; Nosocomial infections; Skin infections; MDRO; multidrug-resistant organisms; CHD; Chronic hemodialysis; out-patient dialysis; environmental decontamination; Medicine; Biotechnology; Ecology; Cancer; Science Policy; Infectious Diseases; 69999 Biological Sciences not elsewhere classified; antimicrobial treatment; contamination; patient dialysis treatments; mdro; infection prevention strategies; chd; dialysis unit; future infection prevention strategies; Mathematics; Medical Sciences; Medicine and Health Sciences; Physical Sciences and Mathematics; Environmental Health and Protection; Immunology and Infectious Disease; Pharmacology, Toxicology and Environmental Health
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Patients receiving chronic hemodialysis (CHD) are among the most vulnerable to infections caused by multidrug-resistant organisms (MDRO), which are associated with high rates of morbidity and mortality. Current guidelines to reduce transmission of MDRO in the out-patient dialysis unit are targeted at patients considered to be high-risk for transmitting these organisms: those with infected skin wounds not contained by a dressing, or those with fecal incontinence or uncontrolled diarrhea. Here, we hypothesize that targeting patients receiving antimicrobial treatment would more effectively reduce transmission and acquisition of MDRO. We also hypothesize that environmental contamination plays a role in the dissemination of MDRO in the dialysis unit. To address our hypotheses, we built an agent-based model to simulate different treatment strategies in a dialysis unit. Our results suggest that reducing antimicrobial treatment, either by reducing the number of patients receiving treatment or by reducing the duration of the treatment, markedly reduces overall colonization rates and also the levels of environmental contamination in the dialysis unit. Our results also suggest that improving the environmental decontamination efficacy between patient dialysis treatments is an effective method for reducing colonization and contamination rates. These findings have important implications for the development and implementation of future infection prevention strategies.