Hostname: page-component-7c8c6479df-fqc5m Total loading time: 0 Render date: 2024-03-29T15:22:39.968Z Has data issue: false hasContentIssue false

Prioritizing Healthcare Worker Vaccinations on the Basis of Social Network Analysis

Published online by Cambridge University Press:  02 January 2015

Philip M. Polgreen
Affiliation:
Department of Internal Medicine, The University of Iowa, Iowa City, Iowa
Troy Leo Tassier
Affiliation:
Economics Department, Fordham University, Bronx, New York
Sriram Venkata Pemmaraju
Affiliation:
Department of Computer Science, The University of Iowa, Iowa City, Iowa
Alberto Maria Segre*
Affiliation:
Department of Computer Science, The University of Iowa, Iowa City, Iowa
*
Department of Computer Science, 101B MacLean Hall, The University of Iowa, Iowa City, IA 52242 (alberto-segre@uiowa.edu)

Abstract

Objective.

To use social network analysis to design more effective strategies for vaccinating healthcare workers against influenza.

Design.

An agent-based simulation.

Setting.

A simulation based on a 700-bed hospital.

Methods.

We first observed human contacts (defined as approach within approximately 0.9 m) performed by 15 categories of healthcare workers (eg, floor nurses, intensive care unit nurses, staff physicians, phlebotomists, and respiratory therapists). We then constructed a series of contact graphs to represent the social network of the hospital and used these graphs to run agent-based simulations to model the spread of influenza. A targeted vaccination strategy that preferentially vaccinated more “connected” healthcare workers was compared with other vaccination strategies during simulations with various base vaccination rates, vaccine effectiveness, probability of transmission, duration of infection, and patient length of stay.

Results.

We recorded 6,654 contacts by 148 workers during 606 hours of observations from January through December 2006. Unit clerks, X-ray technicians, residents and fellows, transporters, and physical and occupational therapists had the most contacts. When repeated contacts with the same individual were excluded, transporters, unit clerks, X-ray technicians, physical and occupational therapists, and social workers had the most contacts. Preferentially vaccinating healthcare workers in more connected job categories yielded a substantially lower attack rate and fewer infections than a random vaccination strategy for all simulation parameters.

Conclusions.

Social network models can be used to derive more effective vaccination policies, which are crucial during vaccine shortages or in facilities with low vaccination rates. Local vaccination priorities can be determined in any healthcare facility with only a modest investment in collection of observational data on different types of healthcare workers. Our findings and methods (ie, social network analysis and computational simulation) have implications for the design of effective interventions to control a broad range of healthcare-associated infections.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Elder, AG, O'Donnell, B, McCruden, EA, Symington, IS, Carman, WF. Incidence and recall of influenza in a cohort of Glasgow healthcare workers during the 1993-4 epidemic: results of serum testing and questionnaire. BMJ 1996;313:12411242.Google Scholar
2. Horcajada, JR Pumarola, T, Martinez, JA. A nosocomial outbreak of influenza during a period without influenza epidemic activity. Eur Respir J 2003;21:303307.Google Scholar
3. Salgado, CD, Giannetta, ET, Hayden, FG, Farr, BM. Preventing nosocomial influenza by improving the vaccine acceptance rate of clinicians. Infect Control Hosp Epidemiol 2004;25:923928.Google Scholar
4. Harrison, J, Abbott, P. Vaccination against influenza: UK health care workers not on-message. Occup Med (bond) 2002;52:277279.Google Scholar
5. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Washington, DC: Public Health Foundation, 2006.Google Scholar
6. Weingarten, S, Riedinger, M, Bolton, LB, Miles, P, Ault, M. Barriers to influenza vaccine acceptance: a survey of physicians and nurses. Am J Infect Control 1989;17:202207.CrossRefGoogle ScholarPubMed
7. Lester, RT, McGeer, A, Tomlinson, G, Detsky, AS. Use of, effectiveness of, and attitudes regarding influenza vaccine among house staff. Infect Control Hosp Epidemiol 2003;24:839844.Google Scholar
8. Dash, GP, Fauerbach, L, Pfeiffer, J, et al. Improving health care worker influenza immunization rates. Am J Infect Control 2004;32:123125.Google ScholarPubMed
9. Call to action: influenza immunization among health care personnel. National Foundation for Infectious Diseases Web site, http://www.nfid.org/publications/fluhealthcarecta08.pdf. Published 2008. Accessed July 6, 2010.Google Scholar
10. Smith, NM, Bresee, JS; Centers for Disease Control and Prevention. Prevention and control of influenza: recommendations of the advisory committee on immunization practices. MMWR Morb Mortal Wkly Rep 2006;55:112.Google Scholar
11. Meyers, LA. Contact network epidemiology: bond percolation applied to infectious disease prediction and control. Bull New Ser Am Math Soc 2007;44:6386.Google Scholar
12. Newman, MEJ. The spread of epidemic disease on networks. Phys Rev E Stat Nonlin Soft Matter Phys 2002;66:016128.Google Scholar
13. Christley, RM, Pinchbeck, GL, Bowers, RG, et al. Infection in social networks: using network analysis to identify high risk individuals. Am J Epidemiol 2005;162:18.CrossRefGoogle ScholarPubMed
14. Keeling, MJ. The implications of network structure for epidemic dynamics. Theor Popul Biol 2005;67:18.CrossRefGoogle ScholarPubMed
15. Keeling, MJ, Eames, ETD. Networks and epidemic models. J R Soc Interface 2005;2:295307.Google Scholar
16. Read, JM, Keeling, MJ. Disease evolution on networks: the role of contact structure. Proc R Soc bond B Biol Sci 2003;270:699708.Google Scholar
17. Meyers, L, Newman, M, Martin, M, Schrag, S. Applying network theory to epidemics: control measures for Mycoplasma pneumoniae outbreaks. Emerg Infect Dis 2003;9:204210.CrossRefGoogle Scholar
18. Ueno, T, Masuda, N. Controlling nosocomial infection based on the structure of hospital social networks. J Theor Biol 2008;254:655666.CrossRefGoogle ScholarPubMed
19. Van Den Dool, C, Bonten, MJM, Haka, E, Walling, J. Modeling the effects of influenza vaccination of health care workers in hospital departments. Vaccine 2009;27:62616267.Google Scholar
20. Nufto, M, Reichert, TA, Chowell, G, Gumel, AB. Protecting residential care facilities from pandemic influenza. Proc Natl Acad Sci USA 2008;105:1062510630.Google Scholar
21. Erdos, P, Rènyi, A. On random graphs I. Pubi Math 1959;6:290297.Google Scholar
22. Erdos, P, Rènyi, A. On the evolution of random graphs. Pubi Math Inst Hung Acad Sci 1960;5:1761.Google Scholar
23. Carrat, F, Vergu, E, Ferguson, NM, et al. Time lines of infection and disease in human influenza: a review of volunteer challenge studies. Am J Epidemiol 2008;167:775785.Google Scholar
24. Bridges, CB, Kuenhnert, MJ, Hall, CB. Transmission of influenza: implications for control in health care settings. Clin Infect Dis 2003;37:10941101.Google Scholar
25. Ferguson, NM, Mallett, S, Jackson, H, Roberts, N, Ward, P. A population-dynamic model for evaluating the potential spread of drug-reistant influenza virus infections during community-based use of antivirals. J An-timicrob Chemother 2003;51:977990.Google Scholar
26. Everts, R, Hanger, H, Jennings, L, Hawkins, A, Sainsbury, R. Outbreaks of influenza A among elderly hospital inpatients. N Z Med J 1996;109:272274.Google Scholar
27. Evans, M, Hall, K, Berry, S. Influenza control in acute care hospitals. Am J Infect Control 1997;25:357362.Google Scholar
28. Serwint, J, Miller, R. Why diagnose influenza infections in hospitalized pediatric patients? Pediatr Infect Dis J 1993;12:200204.Google Scholar
29. Saxen, H, Virtanen, M. Randomized, placebo-controlled double blind study on the efficacy of influenza immunization on absenteeism of health care workers. Pediatr Infect Dis J 1999;18:779783.CrossRefGoogle ScholarPubMed
30. Polgreen, PM, Pottinger, J, Polgreen, LA, Diekema, DF, Herwaldt, LA. Influenza vaccination rates, feedback, and the Hawthorne effect. Infect Control Hosp Epidemiol 2006;27:9899.Google Scholar
31. Talbot, TR, Bradley, SF, Cosgrove, SE, Ruef, C, Siegel, JD, Weber, DJ. Influenza vaccination of healthcare workers and vaccine allocation for healthcare workers during vaccine shortages. Infect Control Hosp Epidemiol 2005;26:882890.Google Scholar