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. 2019 Jan 11;19(1):52.
doi: 10.1186/s12889-018-6376-7.

Collaborative emergency preparedness and response to cross-institutional outbreaks of multidrug-resistant organisms: a scenario-based approach in two regions of the Netherlands

Marion de Vries  1   2 , Patrick Kenis  3 , Marleen Kraaij-Dirkzwager  4 , Elis Joost Ruitenberg  5 , Jörg Raab  6 , Aura Timen  7   5
Affiliations

Collaborative emergency preparedness and response to cross-institutional outbreaks of multidrug-resistant organisms: a scenario-based approach in two regions of the Netherlands

Marion de Vries et al. BMC Public Health. .

Abstract

Background: The likelihood of large-scale outbreaks of multidrug-resistant organisms (MDRO) is growing. MDRO outbreaks can affect a wide range of healthcare institutions. Control of such outbreaks requires structured collaboration between professionals from all involved healthcare institutions, but guidelines for cross-institutional procedures are, however, often missing. Literature indicates that such multi-actor collaboration is most promising when effective network brokers are present, and when the collaborative actors have clarity about the different roles and responsibilities in the outbreak response network, including collaborative structures and coordination roles. Studying these factors in an imaginary MDRO outbreak scenario, we gained insights into the expectations that health professionals in the Netherlands have in regard to the procedures required to best respond to any future cross-institutional MDRO outbreaks.

Methods: For exploration purpose, a focus group discussion with ten healthcare professionals was held. Subsequently, an online-survey was conducted among 56 healthcare professionals in two Dutch regions. The survey data was analysed using social network analyses (clique analysis and centrality analysis), which provided insights into the collaborative structures and potential brokers in the outbreak response networks. Additionally, respondents were asked which healthcare institutions and which professions they would prefer as coordinating actors in the collaborative network.

Results: Our results show a relatively high level of perceived clarity about the roles and responsibilities that healthcare professionals have during a joint outbreak response. The regional outbreak response networks which were studied appeared inclusive and integrated, with many overlapping groups of fully-connected healthcare actors. Social network analyses resulted in the identification of several central actors from different healthcare institutions with the potential to take on a brokerage role in the collaboration. Actors in the outbreak response networks also showed to prefer several healthcare professionals to take on the coordination roles.

Conclusion: Expected collaborative structures during an imaginary regional MDRO outbreak response are relatively dense and integrated. In regard to the coordination of an MDRO outbreak response, based on both the network analysis results and the preferred coordination roles, our findings support a governance structure with several healthcare institutions involved in responding to future cross-institutional MDRO outbreaks.

Keywords: Antimicrobial resistance; Multidrug-resistant organisms; Network analysis; Outbreak management; Outbreak response.

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Conflict of interest statement

Authors’ information

Marion de Vries, MSc is a PhD student at the RIVM, with an academic background in Sociology and Global Health.

Prof. Patrick Kenis is Professor of Public Governance at the School of Economics and Management and Director of the Tilburg Institute of Governance (TIG) at Tilburg University, the Netherlands. He has extensive experience of Social Science research in the field of organisations, inter- and intra-organisational relationships and policy networks. His research is currently focused on the governance and effectiveness of networks.

Marleen Kraaij-Dirkzwager is a Medical Doctor who has worked for many years as policy advisor in Infectious Disease Control. She has a special interest in the involvement of stakeholders in policy and research.

Prof. Joost Ruitenberg is a Professor specialised in International Public Health at the Athena Institute for Innovative and Transdisciplinary Research in Health Sciences at the VU University, Amsterdam.

Jörg Raab, PhD is Associate Professor for Policy and Organization Studies at the Department of Organization Studies/School of Social and Behavioral Sciences at Tilburg University. His current research focuses predominantly on the management and effectiveness of inter-organisational networks and wicked policy problems.

Prof. Aura Timen, MD, PhD is head of the National Coordination Centre for Communicable Disease Control (LCI) at the National Institute for Public Health and the Environment (RIVM) in the Netherlands and Professor of Responses to Communicable Diseases. She is an expert in the fields of outbreak management, guideline development, response to threat and crisis, and crises preparedness.

Ethical approval and consent to participate

Not applicable: In the Netherlands, a study needs ethical approval when it falls under the scope of the Medical Research Involving Human Subjects Act (WMO). Then it must undergo a review by an accredited MREC or the CCMO. As, in general, research with human subjects only falls under the WMO if there is an infringement of the physical and/or psychological integrity of the subject, we had strong reasons to believe that our study did not require ethical approval. The respondents in our study all accepted the informed consent after having been informed about the purpose of the study and the voluntary nature of their participation. Anonymity of participation was ensured.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Social network visualization of indicated information flows during the outbreak in region A. Circles and squares indicate healthcare professions, subsequently healthcare professions included as respondents and healthcare professions not included as respondents. The numbers in the circles and squares correspond with the numbers of healthcare professions in Table 2 (except for number 23, which represents the RIVM as institution). The colours indicate the healthcare institutions in which the healthcare professionals operate. The direction of the arrows visualizes the information flow as indicated by the sender of the arrow. Purple arrows visualize reciprocated information flows
Fig. 2
Fig. 2
Social network visualization of indicated information flows during the outbreak in region B. Circles and squares indicate healthcare professions, subsequently healthcare professions included as respondents and healthcare professions not included as respondents. The numbers in the circles and squares correspond with the numbers of healthcare professions in Table 2 (except for number 23, which represents the RIVM as institution). The colours indicate the healthcare institutions in which the healthcare professionals operate. The direction of the arrows visualizes the information flow as indicated by the sender of the arrow. Purple arrows visualize reciprocated information flows
See this image and copyright information in PMC

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