An agent-based model to simulate the transmission dynamics of bloodborne pathogens within hospitals

Bloodborne pathogens are a major public health concern as they can lead to a variety of medical conditions, including cirrhosis and cancers with significant mortality and morbidity. Three viruses are of major concern: HCV, HBV and HIV. Their transmission is mostly community-associated but the iatrogenic risk of infection is not negligible, even today. Mathematical models are widely used to describe and assess pathogens transmission, within communities and hospitals. Nevertheless, few are focusing on the transmission of pathogens through blood and even fewer on their transmission within hospital as they usually study the risk of community-associated infection in vulnerable populations such as MSM or drug users. Herein, we propose an agent- based SEI (Susceptible-Exposed-Infected) model to explore the transmission dynamics of bloodborne pathogens within hospitals. This model simulates the dynamics of patients between hospital wards, from their admission to discharge, as well as the dynamics of the devices used during at-risk invasive procedures, considering that patient contamination occurs after exposure to a contaminated device. Multiple parameters of the model, such as HCV prevalence, transition probabilities between wards or ward-specific probabilities of undergoing different invasive procedures, were informed with data collected in the University Hospital of Ain Shams in Cairo, Egypt in 2017. We explored the effect of device shortage as well as the effect of random and systematic screening with associated modification in disinfection practices on the risk of infection for patients. By modifying some parameters of the model, we then explored the case of HBV in Ethiopia. In the future, this model could be used to assess the risk of transmission of other bloodborne pathogens in other contexts. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by INSERM-ANRS (France Recherche Nord and Sud Sida-HIV Hepatites), grant number 12320 B115. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Approval from the Institutional Review Board of the Faculty of Medicine of Ain Shams University (Ain Shams-IRB) was obtained.Ethical approval from Sheffield University, School of Health and Related Research (ScHARR) was also obtained. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data analysed in this study is available upon request only. Individual data requests may be sent to the CorC (secr-CORC@pasteur.fr).