Agent-Based Modeling of C. Difficile Spread in Hospitals: Assessing Contribution of High-Touch vs. Low-Touch Surfaces and Inoculations' Containment Impact
Sina Abdidizaji, Ali Khodabandeh Yalabadi, Mehdi Yazdani-Jahromi, Ozlem Ozmen Garibay, Ivan Garibay
TL;DR
The study addresses hospital CDI transmission, focusing on how contamination spreads via high-touch versus low-touch fomites and how cleaning strategies constrain spread. It uses an agent-based, spatially explicit simulation that extends the SIR framework with four patient states and explicit fomite dynamics to replicate and augment prior ODE-based findings. Key results show high-touch surfaces dominate containment dynamics (approximately $75 ext%$ of surface-driven infections) and that cleaning frequency is the primary lever for reducing transmission, with disinfectant potency and full-room cleaning playing secondary roles; inoculations can further reduce infections by over $90 ext%$. The work offers practical infection-control guidance by highlighting the importance of frequent cleaning of high-touch surfaces and demonstrates the value of spatial ABMs for evaluating containment strategies in healthcare settings.
Abstract
Health issues and pandemics remain paramount concerns in the contemporary era. Clostridioides Difficile Infection (CDI) stands out as a critical healthcare-associated infection with global implications. Effectively understanding the mechanisms of infection dissemination within healthcare units and hospitals is imperative to implement targeted containment measures. In this study, we address the limitations of prior research by Sulyok et al., where they delineated two distinct categories of surfaces as high-touch and low-touch fomites, and subsequently evaluated the viral spread contribution of each surface utilizing mathematical modeling and Ordinary Differential Equations (ODE). Acknowledging the indispensable role of spatial features and heterogeneity in the modeling of hospital and healthcare settings, we employ agent-based modeling to capture new insights. By incorporating spatial considerations and heterogeneous patients, we explore the impact of high-touch and low-touch surfaces on contamination transmission between patients. Furthermore, the study encompasses a comprehensive assessment of various cleaning protocols, with differing intervals and detergent cleaning efficacies, in order to identify the most optimal cleaning strategy and the most important factor amidst the array of alternatives. Our results indicate that, among various factors, the frequency of cleaning intervals is the most critical element for controlling the spread of CDI in a hospital environment.