Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in many hospital settings, including nursing homes. It is an important nosocomial pathogen that causes mortality and an economic burden to patients, hospitals, and the community. The epidemiology of the bacteria in nursing homes is both hospital- and community-like. Transmission occurs via hands of health care workers (HCWs) and direct contacts among residents during social activities. In this work, mathematical modeling in both deterministic and stochastic frameworks is used to study dissemination of MRSA among residents and HCWs, persistence and prevalence of MRSA in a population, and possible means of controlling the spread of this pathogen in nursing homes. The model predicts that: without strict screening and decolonization of colonized individuals at admission, MRSA may persist; decolonization of colonized residents, improving hand hygiene in both residents and HCWs, reducing the duration of contamination of HCWs, and decreasing the resident∶staff ratio are possible control strategies; the mean time that a resident remains susceptible since admission may be prolonged by screening and decolonization treatment in colonized individuals; in the stochastic framework, the total number of colonized residents varies and may increase when the admission of colonized residents, the duration of colonization, the average number of contacts among residents, or the average number of contacts that each resident requires from HCWs increases; an introduction of a colonized individual into an MRSA-free nursing home has a much higher probability of leading to a major outbreak taking off than an introduction of a contaminated HCW.
Highlights
Methicillin-resistant Staphylococcus aureus (MRSA) has been recognized as a major nosocomial pathogen responsible for morbidity and mortality in hospitals and other healthcare settings globally [1,2]
In case there is no admission of colonized individuals (l~0), two possibilities can occur, either MRSA dying out or persisting in the population
When there is no admission of colonized individuals, whether the prevalence of MRSA approaches the endemic steady state or the disease-free steady state depends on R0 and the threshold value 1
Summary
Methicillin-resistant Staphylococcus aureus (MRSA) has been recognized as a major nosocomial pathogen responsible for morbidity and mortality in hospitals and other healthcare settings globally [1,2]. The pathogen causes a wide range of syndromes: skin and soft tissue infections, bloodstream infection, and pneumonia, for instance. Colonization of MRSA may take place in many parts of the body: axillae, perineum, groin, rectum, skin, and anterior nares. It has been suggested that individuals who are persistently colonized with MRSA have a greater propensity to develop infection than uncolonized and short-term colonized individuals [3]. Infections with MRSA were reported two years after using methicillin to treat individuals infected with penicillin-resistant S. aureus [4]. MRSA has since become endemic in hospitals and healthcare settings globally [5,6]
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