{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T18:35:46Z","timestamp":1786473346642,"version":"build-2736575974"},"update-to":[{"DOI":"10.1371\/journal.pcbi.1014564","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000}}],"reference-count":70,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001665","name":"Agence Nationale de la Recherche","doi-asserted-by":"publisher","award":["ANR-10-LABX-62-IBEID"],"award-info":[{"award-number":["ANR-10-LABX-62-IBEID"]}],"id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001665","name":"Agence Nationale de la Recherche","doi-asserted-by":"publisher","award":["ANR-10-LABX-62-IBEID"],"award-info":[{"award-number":["ANR-10-LABX-62-IBEID"]}],"id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001665","name":"Agence Nationale de la Recherche","doi-asserted-by":"publisher","award":["ANR-10-LABX-62-IBEID"],"award-info":[{"award-number":["ANR-10-LABX-62-IBEID"]}],"id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.ploscompbiol.org"],"crossmark-restriction":false},"short-container-title":["PLoS Comput Biol"],"abstract":"<jats:p>Nosocomial transmission of respiratory infections poses a major threat to patient safety, while also affecting healthcare workers\u2019 (HCW) health, generating substantial costs for hospitals. These infections spread through both close-proximity interactions at short distances, and via aerosols that remain suspended in the air, enabling long-range transmission within a room when a susceptible individual is at a distance from an infectious individual. The relative contribution of each transmission route is pathogen-dependent. However, models distinguishing them remain scarce, limiting the design of effective intervention strategies. Here, we propose a novel agent-based stochastic model of respiratory pathogen transmission in a hospital ward that integrates both transmission routes together with contact patterns and individual movements. After informing our model with real close-proximity interaction data collected in two French intensive care units, we simulate a range of combinations of short- and long-range transmission levels to investigate their differences. Selecting parameter values that keep overall ward transmission intensity stable across combinations, the model is used to further evaluate the impact of intervention strategies on incidence risk. We find that the predominance of one route over another has little effect on overall outbreak dynamics, though the impact across\u00a0individuals varies markedly. Patients are mostly at risk of short-range transmission from HCWs, while HCWs are mostly affected by whichever route is predominant. This directly influences intervention effectiveness. Universal masking emerges as the most effective strategy, reducing both transmission routes. Its stringency can be relaxed with limited loss of effectiveness when combined with ventilation in relevant rooms. Importantly, interventions targeting HCWs, notably ventilation in rooms not accessible to patients, indirectly reduces incidence in patients, with a stronger effect when coupled with relaxed masking interventions. Finally, intervention ranking remains robust across parameter values, as confirmed by a sensitivity analysis. This new model highlights the importance of explicitly considering physical mechanisms of transmission, and the need for interventions that remain effective irrespective of pathogen characteristics and ward organization.<\/jats:p>","DOI":"10.1371\/journal.pcbi.1014564","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T17:40:51Z","timestamp":1785778851000},"page":"e1014564","update-policy":"https:\/\/doi.org\/10.1371\/journal.pcbi.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Accounting for the long-distance transmission route: An epidemiological model of airborne disease transmission in hospitals"],"prefix":"10.1371","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3378-0070","authenticated-orcid":true,"given":"Olivier","family":"Gaufr\u00e8s","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quentin J.","family":"Leclerc","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Derdevet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Shirreff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solen","family":"Kern\u00e9is","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lulla","family":"Opatowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8850-5403","authenticated-orcid":true,"given":"Laura","family":"Temime","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3092-686X","authenticated-orcid":true,"given":"Maylis","family":"Layan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"pcbi.1014564.ref001","doi-asserted-by":"crossref","first-page":"111015","DOI":"10.1016\/j.jobe.2024.111015","article-title":"Airborne bioaerosols in healthcare facilities \u2013 Transmission routes and mitigation strategies","volume":"97","author":"M Janczarek","year":"2024","journal-title":"J Build Eng"},{"issue":"3","key":"pcbi.1014564.ref002","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1080\/02786826.2024.2312178","article-title":"Air Change Rate and SARS-CoV-2 Exposure in Hospitals and Residences: A Meta-Analysis","volume":"58","author":"Y Zhang","year":"2024","journal-title":"Aerosol Sci Technol"},{"key":"pcbi.1014564.ref003","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/9781118846810.ch1","article-title":"The burden of healthcare-associated infection","volume-title":"Hand hygiene","author":"B Allegranzi","year":"2017"},{"issue":"9","key":"pcbi.1014564.ref004","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1016\/j.ajic.2025.06.004","article-title":"Hospital-acquired COVID-19 is associated with increased length and cost of stay in an Australian health care setting","volume":"53","author":"GP Drewett","year":"2025","journal-title":"Am J Infect Control"},{"issue":"8","key":"pcbi.1014564.ref005","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1038\/s41579-021-00535-6","article-title":"Transmissibility and transmission of respiratory viruses","volume":"19","author":"NHL Leung","year":"2021","journal-title":"Nat Rev Microbiol"},{"issue":"4","key":"pcbi.1014564.ref006","doi-asserted-by":"crossref","first-page":"045001","DOI":"10.1103\/RevModPhys.95.045001","article-title":"Respiratory aerosols and droplets in the transmission of infectious diseases","volume":"95","author":"ML P\u00f6hlker","year":"2023","journal-title":"Rev Mod Phys"},{"issue":"8","key":"pcbi.1014564.ref007","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1038\/s41579-024-01067-5","article-title":"New WHO proposed terminology for respiratory pathogen transmission","volume":"22","author":"NHL Leung","year":"2024","journal-title":"Nat Rev Microbiol"},{"key":"pcbi.1014564.ref008","doi-asserted-by":"crossref","DOI":"10.3396\/ijic.v21.23851","article-title":"Knowledge gaps and research priorities for understanding the transmission of Mycobacterium tuberculosis and other airborne infections","volume":"21","author":"JP Cegielski","year":"2025","journal-title":"Int J Infect control"},{"key":"pcbi.1014564.ref009","doi-asserted-by":"crossref","unstructured":"Killingley B, Nguyen-Van-Tam J. 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