The Contribution of Community Transmission to the Burden of Hospital-associated Pathogens: A Systematic Scoping Review of Epidemiological Models

Abstract Healthcare-associated infections (HAI), particularly those involving multi-drug resistant organisms (MDRO), pose a significant public health threat. Understanding the transmission of these pathogens in short-term acute care hospitals (STACH) is crucial for effective control. Mathematical and computational models play a key role in studying transmission but often overlook the influence of long-term care facilities (LTCFs) and the broader community on transmission. In a systematic scoping review of 8,811 studies from 2016 to 2022, we explored the modeling landscape of the hospital-community interface in HAI-causing pathogen transmission. Among the 29 eligible studies, 27% (n=8) exclusively modeled LTCFs, 45% (n=13) focused on non-healthcare-related community settings, and 31% (n=9) considered both settings. Studies emphasizing screening and contact precautions were more likely to include LTCFs but tended to neglect the wider community. This review emphasizes the crucial need for comprehensive modeling that incorporates the community's impact on both clinical and public health outcomes.