An agent-based modeling approach to estimate pathogen exposure risks from wheelchairs

Amanda M. Wilson, Marc P. Verhougstraete, Curtis J. Donskey, Kelly A. Reynolds

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Contributions of contaminated wheelchairs to nosocomial pathogen transmission are relatively unknown. Our aim was to develop a model predicting pathogen exposures for patients utilizing wheelchairs and estimate exposure reduction potential of wheelchair disinfection between rides. Methods: An agent-based model was informed by wheelchair location data from a connected 215-bed acute care and 250-bed long-term care facility. Simulated scenarios varied in frequencies of patient wheelchair contamination and wheelchair disinfection in between trips. Clostridioides difficile and methicillin-resistant Staphylococcus aureus concentrations on patient hands at the end of wheelchair trips were estimated. Exposure reductions due to disinfection, assuming low real-world efficacies (50%, 70%, and 90%), were compared. Results: In the simulation, when few patients introduced contamination to wheelchairs, disinfection in between patients 50% of the time decreased baseline (no disinfection) estimated exposures for the 50th wheelchair rider by >99.999%. When patients had a 50% chance of being contaminated before the wheelchair ride, disinfection did not reduce exposures consistently. Discussion: The efficacy of disinfection in between patient rides as an exposure mitigation strategy likely depends on the frequency of infected patient wheelchair use. Conclusions: During outbreak, high contamination conditions, disinfection, alone, is not enough to protect patients from wheelchair-mediated exposures.

Original languageEnglish (US)
Pages (from-to)206-214
Number of pages9
JournalAmerican Journal of Infection Control
Issue number2
StatePublished - Feb 2021


  • C difficile
  • Fomites
  • Infection control
  • MRSA
  • Portable equipment

ASJC Scopus subject areas

  • Epidemiology
  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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