Abstract

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.

Highlights

  • Rates of multidrug-resistant organisms (MDRO) are among the highest in the population of chronic hemodialysis (CHD) [1,2,3]

  • 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 outpatient 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

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Summary

Introduction

Rates of multidrug-resistant organisms (MDRO) are among the highest in the population of chronic hemodialysis (CHD) [1,2,3]. Infections caused by MDRO are associated with considerable morbidity and mortality, and limited therapeutic options [4,5,6]. It is imperative to curtail the ongoing spread and de novo acquisition of MDRO in the CHD population. In out-patient dialysis units, current guidelines recommend that only those patients at high-risk of disseminating MDRO be placed on additional infection control precautions. These precautions include the use of a separate gown by the healthcare worker (HCW) with removal of PLOS ONE | DOI:10.1371/journal.pone.0153820. These precautions include the use of a separate gown by the healthcare worker (HCW) with removal of PLOS ONE | DOI:10.1371/journal.pone.0153820 May 19, 2016

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