The role of healthcare worker-mediated contact networks in the transmission of vancomycin-resistant enterococci
Date
2020Journal
Open Forum Infectious DiseasesPublisher
Oxford University PressType
Article
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Background. User- and time-stamped data from hospital electronic health records (EHRs) present opportunities to evaluate how healthcare worker (HCW)-mediated contact networks impact transmission of multidrug-resistant pathogens, such as vancomycin-resistant enterococci (VRE). Methods. This is a retrospective analysis of incident acquisitions of VRE between July 1, 2016 and June 30, 2018. Clinical and demographic patient data were extracted from the hospital EHR system, including all recorded HCW contacts with patients. Contacts by an HCW with 2 different patients within 1 hour was considered a “connection”. Incident VRE acquisition was determined by positive clinical or surveillance cultures collected ≥72 hours after a negative surveillance culture. Results. There were 2952 hospitalizations by 2364 patients who had ≥2 VRE surveillance swabs, 112 (4.7%) patients of which had incident nosocomial acquisitions. Patients had a median of 24 (interquartile range [IQR], 18–33) recorded HCW contacts per day, 9 (IQR, 5–16) of which, or approximately 40%, were connections that occurred <1 hour after another patient contact. Patients that acquired VRE had a higher average number of daily connections to VRE-positive patients (3.1 [standard deviation {SD}, 2.4] versus 2.0 [SD, 2.1]). Controlling for other risk factors, connection to a VRE-positive patient was associated with increased odds of acquiring VRE (odds ratio, 1.64; 95% confidence interval, 1.39–1.92). Conclusions. We demonstrated that EHR data can be used to quantify the impact of HCW-mediated patient connections on transmission of VRE in the hospital. Defining incident acquisition risk of multidrug-resistant organisms through HCWs connections from EHR data in real-time may aid implementation and evaluation of interventions to contain their spread. copyright The Author(s) 2020.Sponsors
1U01CK000536; Centers for Disease Control and Prevention, CDC 1U54CK000447Keyword
Antibiotic resistanceElectronic health records
Hospital-acquired infections
Nosocomial
Pathogen surveillance
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https://www.scopus.com/inward/record.uri?eid=2-s2.0-85087418626&doi=10.1093%2fofid%2fofaa056&partnerID=40&md5=11ddbfef5b7969625ac37a2b639b00e8; http://hdl.handle.net/10713/13313ae974a485f413a2113503eed53cd6c53
10.1093/ofid/ofaa056