We compared WGS as it was used in practice (delayed use) with earlier WGS, or not at all, to determine the relative costs and benefits of these strategies. The model was motivated by an evaluation of the impact of WGS in managing an outbreak of a novel Escherichia coli strain (OXA-181). The purpose of this study was to build a hybrid model that simulated hospital processes involved in controlling an infectious disease outbreak.
Hybrid simulation is a growing field in healthcare and AnyLogic® is the only program which can integrate the ABS, DES and system dynamics paradigms. Hybrid ABS/DES models have been sparsely used in hospital settings or outbreak scenarios. Simulation studies within hospitals typically employ DES models. A systematic review on ABS models found seven studies involving interventions for controlling HAIs, 14 on methicillin-resistant Staphylococcus aureus transmission and three on Clostridium difficile.
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The merits of agent-based simulation (ABS) and discrete-event simulation (DES) are often debated in modeling how to manage non-communicable diseases. The model choice depends on the level of detail needed, the level of agent interaction and time scale of the intervention. Designing the appropriate simulation model is integral to predicting the correct outcomes and making use of available data. Simulation modeling has a rich history in answering ‘what-if’ questions in complex environments such as hospitals where prospective trials or cohort studies are difficult, unethical or too expensive. Ineffective decisions could introduce higher costs and reduce opportunities to prevent morbidity or save lives. Information on the direct costs, opportunity costs and patient health benefits for alternative courses of action assists decision-makers to make well-informed choices. Hospitals are continually under pressure to provide efficient and effective services with limited resources. This may increase the risk of high-risk pathogens or novel antibiotic resistance genes becoming established in the population before being recognized. Increase in world travel is also increasing the diversity of bacterial strains present in any one location.
Bacterial whole genome sequencing (WGS) provides infection control teams with more granular information to better discern between different strains of bacteria which, in turn, can improve the way patients are managed during outbreaks, for example, better prioritizing patients for isolation. The lack of specificity in these tests causes inefficient or incorrect use of the limited isolation rooms available in major hospitals, particularly during HAI outbreaks. HAI confirmation currently relies on the results of microbiology cultures and, less frequently, molecular assays. The increasing presence of multidrug resistant pathogens is compounding the importance of reducing nosocomial infections. Nosocomial infections, also known as healthcare-associated infections (HAI), affect 7.1 patients per 100 patients (95% confidence interval: 6.5–7.8) in high-income countries.
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