A social butterfly that stings like a bee
Networking theory applied to flu immunizations
Epidemiologists applying social networking theory in simulated disease transmission models are finding that a hospital may be able to target interventions to protect patients against flu and other diseases.
"Ideally all health care workers should be vaccinated, but resources are scarce. As you know, rates are consistently low despite recommendations they are hovering around 40%," says Philip M. Polgreen, MD, MPH, a medical epidemiologist at the University of Iowa in Iowa City. "In the event of a shortage, we wanted to create a method for targeting groups that would have the most impact."
So Polgreen and colleagues "shadowed" people from 16 different health care worker groups for 40 hours over different times of the day and counted all contacts with patients and other health care workers. All contacts (direct touch and within 3 feet) were recorded. Using these data, they constructed a network representative of the contact structure at the hospital.
"We measured the social interactions in our hospital between different health care workers one group at a time and we were able to figure out the relative contribution or benefit of vaccinating one person vs. another," Polgreen told Hospital Infection Control recently in Atlanta, where he presented the findings at the International Conference on Infectious Diseases.1 "They are all important, but certain groups may be more influential in spreading [disease] than others."
Social workers, unit clerks
The epidemiologists found it would be effective to vaccinate individuals from groups whose members have large numbers of contacts, including residents, medical students, and floor nurses. Less obvious staff members, such unit clerks, also have contacts within many different hospital groups.
"Unit clerks interact with a wide variety of health care workers. They don't just do clerical work," he says. "We didn't really realize that before. They have people sign releases, go into patient rooms, and sometimes they assist if nurses are shorthanded. Certainly, we expected respiratory therapists would be very important, but social workers were another surprise. They spend a lot of time with people working one on one with patients."
On the other hand, pharmacy and food service workers have less interaction and contact. "If you had a limited amount of vaccine we would encourage hospital epidemiologists and infection control professionals to really figure out what groups in the hospital are most connected," he said. "Those would be the hubs, the targets for vaccination. It provides a framework for thinking about who to vaccinate in a more objective fashion."
Reference
- Polgreen PM, Tastier TL, Pemmaraju, SV. An application of social network theory to optimize influenza vaccination among health care workers. Abstract 327. International Conference on Infectious Diseases. Atlanta; March 16-19.
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