Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-25T20:33:19.032Z Has data issue: false hasContentIssue false
  • English
  • Français

Cost-Benefit Analysis from the Hospital Perspective of Universal Active Screening Followed by Contact Precautions for Methicillin-Resistant Staphylococcus aureus Carriers

Published online by Cambridge University Press:  05 January 2015

James A. McKinnell ,
Sarah M. Bartsch ,
Bruce Y. Lee ,
Susan S. Huang  and
Loren G. Miller
James A. McKinnell*
Affiliation:
Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California Torrance Memorial Medical Center, Torrance, California
Sarah M. Bartsch
Affiliation:
Public Health Computational and Operations Research Group (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
Bruce Y. Lee
Affiliation:
Public Health Computational and Operations Research Group (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Susan S. Huang
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California
Loren G. Miller
Affiliation:
Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California
*
Address correspondence to Yohei Doi, MD, PhD, Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, Torrance Memorial Medical Center, Torrance, California ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To explore the economic impact to a hospital of universal methicillin-resistant Staphylococcus aureus (MRSA) screening.

METHODS

We used a decision tree model to estimate the direct economic impact to an individual hospital of starting universal MRSA screening and contact precautions. Projected costs and benefits were based on literature-derived data. Our model examined outcomes of several strategies including non-nares MRSA screening and comparison of culture versus polymerase chain reaction–based screening.

RESULTS

Under baseline conditions, the costs of universal MRSA screening and contact precautions outweighed the projected benefits generated by preventing MRSA-related infections, resulting in economic costs of $104,000 per 10,000 admissions (95% CI, $83,000–$126,000). Cost-savings occurred only when the model used estimates at the extremes of our key parameters. Non-nares screening and polymerase chain reaction–based testing, both of which identified more MRSA-colonized persons, resulted in more MRSA infections averted but increased economic costs of the screening program.

CONCLUSIONS

We found that universal MRSA screening, although providing potential benefit in preventing MRSA infection, is relatively costly and may be economically burdensome for a hospital. Policy makers should consider the economic burden of MRSA screening and contact precautions in relation to other interventions when choosing programs to improve patient safety and outcomes.

Infect Control Hosp Epidemiol 2015;36(1): 2–13

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 1 , January 2015 , pp. 2 - 13
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Hidron, AI, Edwards, JR, Patel, J, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol 2008;29:996–1011.CrossRefGoogle Scholar
2.Sader, HS, Streit, JM, Fritsche, TR, Jones, RN. Antimicrobial susceptibility of gram-positive bacteria isolated from European medical centres: results of the Daptomycin Surveillance Programme (2002–2004). Clin Microbiol Infect 2006;12:844–852.Google Scholar
3.Coia, JE, Duckworth, GJ, Edwards, DI, et al. Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect 2006;63:S1–S44.Google Scholar
4.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L, Health Care Infection Control Practices Advisory Council. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35:S65–S164.Google Scholar
5.Muto, CA, Jernigan, JA, Ostrowsky, BE, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol 2003;24:362–386.Google Scholar
6.Huang, SS, Yokoe, DS, Hinrichsen, VL, et al. Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2006;43:971–978.Google Scholar
7.Safdar, N, Marx, J, Meyer, NA, Maki, DG. Effectiveness of preemptive barrier precautions in controlling nosocomial colonization and infection by methicillin-resistant Staphylococcus aureus in a burn unit. Am J Infect Control 2006;34:476–483.Google Scholar
8.Harbarth, S, Masuet-Aumatell, C, Schrenzel, J, et al. Evaluation of rapid screening and pre-emptive contact isolation for detecting and controlling methicillin-resistant Staphylococcus aureus in critical care: an interventional cohort study. Critical Care 2006;10:R25.Google Scholar
9.Harris, AD, Pineles, L, Belton, B, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA 2013;310:1571–1580.Google ScholarPubMed
10.Clancy, M, Graepler, A, Wilson, M, Douglas, I, Johnson, J, Price, CS. Active screening in high-risk units is an effective and cost-avoidant method to reduce the rate of methicillin-resistant Staphylococcus aureus infection in the hospital. Infect Control Hosp Epidemiol 2006;27:1009–1017.Google Scholar
11.Jernigan, JA, Titus, MG, Groschel, DH, Getchell-White, S, Farr, BM. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol 1996;143:496–504.Google Scholar
12.Lawes, T, Edwards, B, Lopez-Lozano, JM, Gould, I. Trends in Staphylococcus aureus bacteraemia and impacts of infection control practices including universal MRSA admission screening in a hospital in Scotland, 2006–2010: retrospective cohort study and time-series intervention analysis. BMJ Open 2012;2.Google Scholar
13.Diekema, DJ, Edmond, MB. Look before you leap: active surveillance for multidrug-resistant organisms. Clin Infect Dis 2007;44:1101–1107.Google Scholar
14. Association for Professionals in Infection Control and Hospital Epidemiology. Map of enacted MRSA laws 2011 [updated 4/21/113/2/2012]. http://www.apic.org/Resource_/TinyMceFileManager/Advocacy-PDFs/Static_map_-_MRSA_revised_4-21-11.gif.Google Scholar
15.Peterson, LR, Diekema, DJ. To screen or not to screen for methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2010;48:683–689.Google Scholar
16.Lee, BY, Bailey, RR, Smith, KJ, et al. Universal methicillin-resistant Staphylococcus aureus (MRSA) surveillance for adults at hospital admission: an economic model and analysis. Infect Control Hosp Epidemiol 2010;31:598–606.CrossRefGoogle ScholarPubMed
17.Hubben, G, Bootsma, M, Luteijn, M, et al. Modelling the costs and effects of selective and universal hospital admission screening for methicillin-resistant Staphylococcus aureus. PLOS ONE 2011;6:e14783.Google Scholar
18.McKinnell, JA, Huang, SS, Eells, SJ, Cui, E, Miller, LG. Quantifying the impact of extranasal testing of body sites for methicillin-resistant Staphylococcus aureus colonization at the time of hospital or intenstive care unit admission. Infect Control Hosp Epidemiol 2013;34:161–170.Google Scholar
19.McKinnell, JA, Miller, LG, Eells, SJ, Cui, E, Huang, SS. A systematic literature review and meta-analysis of factors associated with methicillin-resistant Staphylococcus aureus colonization at time of hospital or intensive care unit admission. Infect Control Hosp Epidemiol 2013;34:1077–1086.Google Scholar
20. Bureau of Labor Statistics. Occupational Employment Statistics: May 2012 National Occupation Employment and Wage Estimtaes. http://www.bls.gov2012 [September 4, 2013].Google Scholar
21.Graves, N. Economics and preventing hospital-acquired infection. Emerg Infect Dis 2004;10:561–566.Google Scholar
22.Dancer, SJ. Considering the introduction of universal MRSA screening. J Hosp Infect 2008;69:315–320.CrossRefGoogle ScholarPubMed
23.Robicsek, A, Beaumont, JL, Paule, SM, et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008;148:409–418.Google Scholar
24.Abramson, MA, Sexton, DJ. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol 1999;20:408–411.Google Scholar
25.Cosgrove, SE, Qi, Y, Kaye, KS, Harbarth, S, Karchmer, AW, Carmeli, Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26:166–174.Google Scholar
26.Engemann, JJ, Carmeli, Y, Cosgrove, SE, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36:592–598.Google Scholar
27.de Kraker, ME, Wolkewitz, M, Davey, PG, et al. Clinical impact of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay related to methicillin-resistant Staphylococcus aureus bloodstream infections. Antimicrob Agents Chemother 2011;55:1598–1605.Google Scholar
28.Rubin, RJ, Harrington, CA, Poon, A, Dietrich, K, Greene, JA, Moiduddin, A. The economic impact of Staphylococcus aureus infection in New York City hospitals. Emerg Infect Dis 1999;5:9–17.Google Scholar
29.Climo, MW, Sepkowitz, KA, Zuccotti, G, et al. The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crit Care Med 2009;37:1858–1865.Google Scholar
30.Huang, SS, Septimus, E, Kleinman, K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med 2013;368:2255–2265.Google Scholar
31.Stelfox, HT, Bates, DW, Redelmeier, DA. Safety of patients isolated for infection control. JAMA 2003;290:1899–1905.Google Scholar
32.Puzniak, LA, Gillespie, KN, Leet, T, Kollef, M, Mundy, LM. A cost-benefit analysis of gown use in controlling vancomycin-resistant Enterococcus transmission: is it worth the price? Infect Control Hosp Epidemiol 2004;25:418–424.Google Scholar
33.Bureau of Labor Statistics. Occupational employment statistics: May 2012 national occupational employment and wage estimates, United States Washington, DC:US Bureau of Labor Statistics Division of Occupational Employment Statistics; 2012 [cited 2013 September 4]. http://www.bls.gov.Google Scholar
34.United States Department of Health and Human Services. HCUP facts and figures: statistics on hospital-based care in the United States, 2011 Rockville, MD: AHRQ: Agency for Healthcare Research and Quality;[cited 2013 September 4]. http://hcupnet.ahrq.gov/HCUPnet.jsp.Google Scholar
35.Harbarth, S, Hawkey, PM, Tenover, F, Stefani, S, Pantosti, A, Struelens, MJ. Update on screening and clinical diagnosis of meticillin-resistant Staphylococcus aureus (MRSA). Int J Antimicrob Agents 2011;37:110–117.Google Scholar
36.Tubbicke, A, Hubner, C, Hubner, NO, Wegner, C, Kramer, A, Flessa, S. Cost comparison of MRSA screening and management—a decision tree analysis. BMC Health Serv Res 2012;12:438.CrossRefGoogle ScholarPubMed
37.Malhotra-Kumar, S, Abrahantes, JC, Sabiiti, W, et al. Evaluation of chromogenic media for detection of methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2010;48:1040–1046. PubMed PMID: 20164268.Google Scholar
38.Tom, TS, Kruse, MW, Reichman, RT. Update: Methicillin-resistant Staphylococcus aureus screening and decolonization in cardiac surgery. Ann Thorac Surg 2009;88:695–702.Google Scholar
39.Murthy, A, De Angelis, G, Pittet, D, Schrenzel, J, Uckay, I, Harbarth, S. Cost-effectiveness of universal MRSA screening on admission to surgery. Clin Microbiol Infect 2010;16:1747–1753.Google Scholar
40.Kunori, T, Cookson, B, Roberts, JA, Stone, S, Kibbler, C. Cost-effectiveness of different MRSA screening methods. J Hosp Infect 2002;51:189–200.Google Scholar
41.Jernigan, JA, Clemence, MA, Stott, GA, et al. Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 1995;16:686–696.Google Scholar