Abstract
BackgroundMost hospitals have a hierarchical design with beds positioned within cubicles and cubicles positioned within wards. Transmission of MRSA may be facilitated by patient proximity and thus the spatial arrangements of beds, cubicles and wards could be important in understanding MRSA transmission risk. Identifying high-risk areas of transmission may be useful in the design of more effective, targeted MRSA interventions.MethodsRetrospective data on numbers of multi-resistant and non-multiresistant MRSA acquisitions were collected for 52 weeks in 2007 in a tertiary hospital in Brisbane, Australia. A hierarchical Bayesian spatio-temporal modelling approach was used to investigate spatial correlation in the hierarchically arranged datasets. The spatial component of the model decomposes cubicle-level variation into a spatially structured component and a spatially unstructured component, thereby encapsulating the influence of unmeasured predictor variables that themselves are spatially clustered and/or random. A fixed effect for the presence of another patient with the same type of MRSA in the cubicles two weeks prior was included.ResultsThe best-fitting model for non-multiresistant MRSA had an unstructured random effect but no spatially structured random effect. The best-fitting model for multiresistant MRSA incorporated both spatially structured and unstructured random effects. While between-cubicle variability in risk of MRSA acquisition within the hospital was significant, there was only weak evidence to suggest that MRSA is spatially clustered. Presence of another patient with the same type of MRSA in the cubicles two weeks prior was a significant predictor of both types of MRSA in all models.ConclusionsWe found weak evidence of clustering of MRSA acquisition within the hospital. The presence of an infected patient in the same cubicle two weeks prior may support the importance of environmental contamination as a source of MRSA transmission.
Highlights
Most hospitals have a hierarchical design with beds positioned within cubicles and cubicles positioned within wards
Methicillin-resistant Staphylococcus aureus (MRSA) screening data were extracted from the eICAT database (Center for Healthcare Related Infection Surveillance and Prevention (CHRISP), Brisbane, Australia), which is maintained by the Infection Management Services (IMS) of the Princess Alexandra Hospital (PAH) for surveillance purposes
The infectious disease ward had the highest number of newly acquired MRSA, including 24.1% of nonmultiresistant MRSA (nmMRSA) and 14.4% of multiresistant MRSA (mMRSA) detected in patients
Summary
Most hospitals have a hierarchical design with beds positioned within cubicles and cubicles positioned within wards. Transmission of MRSA may be facilitated by patient proximity and the spatial arrangements of beds, cubicles and wards could be important in understanding MRSA transmission risk. Identifying high-risk areas of transmission may be useful in the design of more effective, targeted MRSA interventions. Close proximity to a previously colonized or infected patient in the same cubicle is a known risk. Hospitals have an inherently hierarchical structure, with beds positioned within cubicles and cubicles positioned within wards. Patient proximity may facilitate the transmission of MRSA. The spatial arrangements of beds, cubicles and wards could be important in understanding MRSA transmission risk. Identifying high-risk areas within the hospital could be useful in the design of more effective, targeted MRSA interventions
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