Abstract
Hospital patients who are colonised with methicillin-resistant Staphylococcus aureus (MRSA), may transmit the bacteria to other patients. An agent-based simulation is designed to determine how the problem might be managed and the risk of transmission reduced. Most MRSA modelling studies have applied mathematical compartmental models or Monte Carlo simulations. In the agent-based model, each patient is identified on admission as being colonised or not, has a projected length of stay and may be more or less susceptible to colonisation. Patient states represent colonisation, detection, treatment, and location within the ward. MRSA transmission takes place between pairs of individuals in successive time slices. Various interventions designed to reduce MRSA transmission are embedded in the model including: admission and repeat screening tests, shorter test turnaround time, isolation, and decolonisation treatment. These interventions can be systematically evaluated by model experimentation.
Similar content being viewed by others
References
Austin DJ and Anderson RM (1999). Studies of antibiotic resistance within the patient, hospitals and the community using simple mathematical models. Philos Trans R Soc Lond B Biol Sci 354 (1384): 721–738.
Bobashev GV, Goedecke DM, Yu F and Epstein JM (2007). A hybrid epidemic model: Combining the advantages of agent-based and equation-based approaches. In: Henderson SG, Biller B, Hsieh MH, Shortle J, Tew JD and Barton RR (eds) Proceedings of the 2007 Winter Simulation Conference. IEEE Press: Washington, DC, pp 1532–1537.
Bonabeau E (2001). Agent-based modelling: Methods and techniques for simulating human systems. Proc Natl Acad Sci USA 99 (3): 7280–7287.
Bootsma MCJ, Diekmann O and Bonten MJM (2006). Controlling methicillin-resistant Staphylococcus aureus: Quantifying the effects of interventions and rapid diagnostic testing. Proc Natl Acad Sci USA 103 (14): 5620–5625.
Brennan A, Chick SE and Davies R (2006). A taxonomy of model structures for economic evaluation of health technologies. Health Econ 15: 1295–1310.
Cooper BS and Lipsitch M (2004). The analysis of hospital infection data using hidden Markov models. Biostatistics 5 (2): 223–237.
Cooper BS, Medley GF and Scott GM (1999). Preliminary analysis of the transmission dynamics of nosocomial infections: Stochastic and management effects. J Hosp Infect 43: 131–147.
Cooper K, Davies R, Raftery J and Roderick P (2008). Use of a coronary heart disease simulation model to evaluate the costs and effectiveness of drugs for the prevention of heart disease. J Opl Res Soc 59: 1173–1181.
Cooper BS et al (2004). Methicillin-resistant Staphylococcus aureus in hospital and the community: Stealth dynamics and control catastrophes. Proc Natl Acad Sci USA 101 (27): 10223–10228.
Cosgrove S et al (2005). The impact of methicillin-resistant in Staphylococcus aureus bacteremia on patient outcomes: Mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 26 (2): 166–174.
Cunningham R et al (2007). Effect on MRSA transmission of rapid PCR testing of patients admitted to critical care. J Hosp Infect 65: 24–28.
Davies R and Davies HTO (1994). Modelling patient flows and resource provision in health systems. Omega 22 (2): 123–131.
Department of Health (2002). Getting Ahead of the Curve: A Strategy for Combating and Infectious Disease. Department of Health: London.
Forrester M and Pettitt AN (2005). Use of stochastic epidemic modelling to quantify transmission rates of colonization with Mehicillin-resistant Staphylococcus Aureus in an intensive care unit. Infect Control Hosp Epidemiol 26: 598–606.
Jun JB, Jacobson SH and Swisher JR (1999). Application of discrete-event simulation in health care clinics: A survey. J Opl Res Soc 50 (2): 109–123.
Grundmann H et al (2002). Risk factors for the transmission of methicillin-resistant Staphylococcus aureus in an adult intensive care unit: Fitting a model to the data. J Infect Dis 185: 481–488.
Keeling MJ and Rohani P (2008). Modelling Infectious Diseases in Humans and Animals. Princeton: New Jersey.
Koopman JS et al (2002). Stochastic effects on endemic infection levels of disseminating versus local contacts. Math Biosci 180: 49–71.
Harbarth S et al (1999). Randomized, placebo-controlled, double-blind trial to evaluate the efficacy of mupirocin for eradicating carriage of methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 43 (6): 1412–1416.
Harbarth S et al (2006). Evaluation of rapid screening and pre-emptive contact isolation for detecting and controlling methicillin-resistant Staphylococcus aureus in critical care: An interventional cohort study. Crit Care 10 (1): R25.
Hardy KJ et al (2007). A study of the efficacy and cost-effectiveness of MRSA screening and monitoring on surgical wards using a new, rapid molecular test (EMMS). BMC Health Serv Res 7: 160.
Hotchkiss JR et al (2005). An agent-based and spatially explicit model of pathogen dissemination in the intensive care unit. Crit Care Med 33 (1): 168–176.
Macal CM and North MJ (2006). Tutorial on agent-based modelling and simulation part 2: How to model the agents. In: Perrone LF, Wieland FP, Liu J, Lawson BG, Nicol DM and Fujimoto RM (eds) Proceedings of the 2006 Winter Simulation Conference. IEEE Press: Monterey, CA, pp 73–83.
Macfarlane M et al (2007). Successful decolonization of methicillin-resistant Staphylococcus aureus in paediatric patients with cystic fibrosis (CF) using a three-step protocol. J Hosp Infect 65: 231–236.
Massad E, Lundberg S and Yang HM (1993). Modeling and simulating the evolution of resistance against antibiotics. Int J Biomed Comput 33: 65–81.
McBryde ES, Pettitt AN and McElwain DLS (2007). A stochastic mathematical model of methicillin resistant Staphylococcus aureus transmission in an intensive care unit: Predicting the impact of interventions. J Theor Biol 245: 470–481.
Morrison L and Stolarek I (2000). Does MRSA affect patient outcomes in the elderly? A retrospective pilot study. J Hosp Infect 45: 169–171.
Noah N (2006). Controlling Communicable Disease. Open University Press: Maidenhead.
North MJ and Macal CM (2007). Managing Business Complexity: Discovering Strategic Solutions with Agent-based Modeling and Simulation. Oxford University Press, Oxford.
Raboud J et al (2005). Modeling transmission of methicillin-resistant Staphylococcus aureus among patients admitted to a hospital. Infect Control Hosp Epidemiol 26 (7): 607–615.
Robotham JV, Jenkins DR and Medley GF (2006). Screening strategies in surveillance and control of methicillin-resistant Staphylococcus aureus. Epidemiol Infect 135 (2): 328–342.
Sanchez SM and Lucas TW (2002). Exploring the world of agent-based simulations: Simple models, complex analyses. In: Yucesan E, Chen CH, Snowdon JL and Charnes JM (eds) Proceedings of the 2002 Winter Simulation Conference. IEEE Press: San Diego, CA, pp 116–126.
Sebille V and Valleron AJ (1997). A computer simulation model for the spread of nosocomial infections caused by multidrug-resistant pathogens. Comput Biomed Res 30: 307–322.
Sebille V, Cheveret S and Valleron AJ (1997). Modelling the spread of resistant nosocomial pathogens in an intensive-care unit. Infect Control Hosp Epidemiol 18 (2): 84–92.
Vasilakis C and Marshall AH (2005). Modelling nationwide hospital length of stay: Opening the black box. J Opl Res Soc 56 (7): 862–869.
Wooldridge M (2002). A Introduction to Multiagent Systems. Wiley: Chichester.
Acknowledgements
The authors thank the following individuals who have made a significant contribution to the project and to the collection and/or analysis of the data. These are: Ala Szczepura, Charlotte Price and Nigel Stallard of Warwick Medical School, University of Warwick, Andrew Bradbury and Savita Gossain of Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham. The research has been supported by the Department of Health. The views expressed are those of the authors and do not necessarily reflect the views of the Department of Health. The research project has also been supported by Beckton, Dickinson and Company.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Meng, Y., Davies, R., Hardy, K. et al. An application of agent-based simulation to the management of hospital-acquired infection. J Simulation 4, 60–67 (2010). https://doi.org/10.1057/jos.2009.17
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1057/jos.2009.17