Web-Based Interactive Tool to Identify Facilities at Risk of Receiving Patients With Multidrug-Resistant Organisms

Rany Octaria; Allison Chan; Hannah Wolford; Rose Devasia; Troy D. Moon; Yuwei Zhu; Rachel B. Slayton; Marion A. Kainer


Emerging Infectious Diseases. 2020;26(9):2046-2053. 

In This Article

Abstract and Introduction


To identify facilities at risk of receiving patients colonized or infected with multidrug-resistant organisms (MDROs), we developed an interactive web-based interface for visualization of patient-sharing networks among healthcare facilities in Tennessee, USA. Using hospital discharge data and the Centers for Medicare and Medicaid Services' claims and Minimum Data Set, we constructed networks among hospitals and skilled nursing facilities. Networks included direct and indirect transfers, which accounted for ≤365 days in the community outside of facility admissions. Authorized users can visualize a facility of interest and tailor visualizations by year, network dataset, length of time in the community, and minimum number of transfers. The interface visualizes the facility of interest with its connected facilities that receive or send patients, the number of interfacility transfers, and facilities at risk of receiving transfers from the facility of interest. This tool will help other health departments enhance their MDRO outbreak responses.


Antimicrobial resistance (AMR) is an urgent public health threat causing an estimated 2,868,700 infections and 35,900 deaths each year in the United States.[1] Multidrug-resistant organisms (MDROs), including carbapenem-resistant Enterobacteriaceae (CRE), methicillin-resistant Staphylococcus aureus (MRSA), and organisms related to antimicrobial drug use and resistance, such as Clostridioides difficile, often are the causative agents in healthcare-associated infections.[1,2] Studies show that these pathogens can colonize patients for extended periods of time.[3] One study found that 38% of patients colonized with CRE were still colonized even a year after discharge from a facility;[4] such patients can serve as reservoirs for MDROs in the community or in healthcare facilities.

Previous healthcare exposure is a known risk factor for MDRO infections.[5,6] Older adults, patients with underlying medical conditions, and residents of long-term care facilities (LTCFs) are more likely to have multiple healthcare exposures, making them more likely to develop infections.[7] Movement of patients across healthcare facilities can serve as a means of spreading MDROs across a community and introducing new pathogens into a region. Interfacility patient sharing has been associated with higher incidence of both CRE and C. difficile infections.[5,8]

A mathematical modeling study found that facility-level infection prevention measures alone are insufficient to prevent transmissions.[9] A coordinated approach to contain MDROs among interconnected healthcare facilities and public health reduced acquisition by 74% in a small network model over 5 years and 55% in a large network over 15 years.[9] Beginning in 2017, the Centers for Disease Control and Prevention (CDC) issued guidance for state and local health departments and healthcare facilities to contain novel MDROs.[10] The guidance classifies organisms into 3 tiers based on public health threat and outlines the recommended containment approach, which includes a coordinated approach among healthcare facilities, public health, and laboratories.[10]

Despite numerous research publications on the role patient-sharing networks play in elucidating MDRO transmission, few address the application of these networks in public health practice. We used patient-sharing networks to design tailored strategies to help public health contain the spread of MDROs. We developed an interactive tool to visualize networks of patient sharing among hospitals and skilled nursing facilities (SNFs) in the state of Tennessee. Our tool enabled the Tennessee Department of Health (TDH) to identify facilities at risk of receiving patients suspected to be colonized with AMR pathogens.