Robotham, Julie (2007) The epidemiology, transmission dynamics and control of healthcare-associated infections. PhD thesis, University of Warwick.

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Abstract

This thesis presents research on the epidemiology and transmission dynamics of
healthcare-associated infections (HCAI) and focuses on the antibiotic resistant
hospital pathogen methicillin-resistant Staphylococcits aureus (MRSA).
First, a stochastic mathematical model of MRSA transmission dynamics is
developed in which patient movement within and between both hospital and
community populations is considered. The effects on transmission of both
surveillance and control within this setting are explored. Significant interplay is
found to exist between surveillance and control; surveillance is shown to be
essential to control success and in addition allows quantification of the level of
control achieved. Furthermore, patient movement between hospital and
community populations is shown to have a considerable impact on transmission
dynamics and on the success of infection control strategies.
Analyses of the demographics of a hospital population using a real hospital
dataset are presented and the heterogeneous nature of the patient population
described. Differences in admission patterns and length of hospital stay between
age groups, gender and speciality are explored. Combining these analyses
highlights the patient groups constituting the majority of patient days. Further to
this, the heterogeneous nature of patient readmissions is described and the
existence of a 'core group' of most frequently readmitted patients is illustrated.
Overall, readmissions are found to be far more likely than previously thought,
with the majority of patient admissions to hospital being readmissions.
Given this finding of increased readmission, the hospital admission data is used to
inform the development of a model in which real patient movements between the
hospital and community are simulated and transmission within this setting
explored. Endemic behaviour results and the change in movement patterns is
found to influence control strategy success. Further to this, the model is extended
to simulate transmission within a multi-centre setting where patient movements
within a three-hospital and community network are simulated. This increase in
heterogeneity within the patient population appears to allow endemic behaviour
throughout all hospitals 11 within the network.

Item Type:	Thesis or Dissertation (PhD)
Subjects:	R Medicine > RA Public aspects of medicine
Library of Congress Subject Headings (LCSH):	Staphylococcus aureus infections, Nosocomial infections -- Transmission -- Mathematical models, Hospitals -- Admission and discharge -- Statistics
Official Date:	May 2007
Dates:	Date Event May 2007 Submitted
Institution:	University of Warwick
Theses Department:	Department of Biological Sciences
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Medley, Graham
Sponsors:	Biotechnology and Biological Sciences Research Council (Great Britain) (BBSRC)
Extent:	xiv, 172 leaves
Language:	eng

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