Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-29T01:14:48.090Z Has data issue: false hasContentIssue false
  • English
  • Français

Screening High-Risk Patients for Methicillin-Resistant Staphylococcus Aureus on Admission to the Hospital Is It Cost Effective?

Published online by Cambridge University Press:  02 January 2015

Giuseppe Papia ,
Marie Louie ,
Arnold Tralla ,
Claudette Johnson ,
Veronica Collins  and
Andrew E. Simor
Giuseppe Papia
Affiliation:
Department of Microbiology, SD Laboratory Services, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Marie Louie
Affiliation:
Department of Microbiology, SD Laboratory Services, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Arnold Tralla
Affiliation:
Department of Microbiology, SD Laboratory Services, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Claudette Johnson
Affiliation:
Department of Microbiology, SD Laboratory Services, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Veronica Collins
Affiliation:
Department of Microbiology, SD Laboratory Services, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Andrew E. Simor*
Affiliation:
Department of Microbiology, SD Laboratory Services, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
*
Department of Microbiology, Sunnybrook and Women's College Health Sciences Centre, B121-2075 Bayview Ave, North York, Ontario M4N 3M5, Canada
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To determine the cost-effectiveness of a policy of screening high-risk patients for methicillin-resistant Staphylococcus aureus (MRSA) colonization on admission to hospital.

Setting:

980-bed university-affiliated tertiary-care hospital.

Patients:

Between June 1996 and May 1997, patients directly transferred from another hospital or nursing home, or who had been hospitalized in the previous 3 months, were screened for MRSA within 72 hours of hospital admission.

Design:

Nasal, perineal, and wound swabs were obtained for MRSA screening using standard laboratory methods. Laboratory and nursing costs associated with screening patients for MRSA on admission to hospital were calculated. The costs associated with the implementation of recommended infection control measures for patients with MRSA also were determined.

Results:

3,673 specimens were obtained from 1,743 patients. MRSA was found on admission in 23 patients (1.3%), representing 36% of the 64 patients with MRSA identified in the hospital during the year. MRSA-colonized patients were more likely to have been transferred from a nursing home (odds ratio [OR], 6.4; P=.04) or to have had a previous history of MRSA colonization (OR, 13.1; P=.05). Laboratory and nursing costs were found to be $8.34 per specimen, for a total cost of $30,632 during the year. The average cost of implementing recommended infection control measures for patients colonized with MRSA was approximately $5,235 per patient.

Conclusion:

If early identification of MRSA in colonized patients prevents nosocomial transmission of the organism to as few as six new patients, the screening program would save money.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 7 , July 1999 , pp. 473 - 477
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

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

1.Simor, A, Ofner-Agostini, M, Paton, S, Canadian Hospital Epidemiology Committee, Bureau of Infectious Diseases, Laboratory Centre for Disease Control. The Canadian Nosocomial Infection Surveillance Program: results of the first two years of surveillance for methicillin-resistant Staphylococcus aureus in Canadian hospitals. Can Comtnun Dis Rep 1997:23:41–45.Google Scholar
2.McGeer, A, Low, D, Conly, J, Campbell, I, Devlin, R, Simor, A, et al. Methicillin-resistant Staphylococcus aureus in Ontario. Can Comtnun Dis Rep 1997;23:45–46.Google ScholarPubMed
3.Boyce, JM. Should we vigorously try to contain and control methicillin-resistant Staphylococcus aureus? Infect Control Hosp Epidemiol 1991;12:46–54.CrossRefGoogle ScholarPubMed
4.Boyce, JM, Jackson, MM, Pugliese, G, Batt, MD, Fleming, D, Garner, JS, et al. Methicillin-resistant Staphylococcus aureus (MRSA): a briefing for acute care hospitals and nursing facilities. Infect Control Hosp Epidemiol 1994;15:105–115.CrossRefGoogle ScholarPubMed
5.Pearman, JW, Christiansen, KJ, Annear, DI, Goodwin, CS, Metealf, C, Donovan, FP, et al. Control of methicillin-resistant Staphylococcus aureus (MRSA) in an Australian metropolitan teaching hospital complex. Med J Aust 1985;142:103–108.CrossRefGoogle Scholar
6.Jernigan, JAClemence, MA, Stott, GA, Titus, MG, Alexander, CH, Palumbo, CM, et al. Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 1995;16:686–696.CrossRefGoogle Scholar
7.National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically. 4th ed. Approved standard M7-A4. Wayne, Pa: NCCLS; 1997.Google Scholar
8.Troillet, N, Carmeli, Y, Samore, MH, Dakos, J, Eichelberger, K, DeGirolami, PC, et al. Carriage of methicillin-resistant Staphylococcus aureus at hospital admission. Infect Control Hosp Epidemiol 1998;19:181–185.CrossRefGoogle Scholar
9.Preheim, LC, Rimland, D, Bittner, MJ. Methicillin-resistant Staphylococcus aureus in Veterans Administration medical centers. Infect Control 1987;8:191–194.CrossRefGoogle ScholarPubMed
10.Haley, RW, Hightower, AW, Khabbaz, RF, Thornsberry, C, Martone, WJ, Allen, JR, et al. The emergence of methicillin-resistant Staphylococcus aureus infections in United States hospitals. Possible role of the house staff-patient transfer circuit. Ann Intern Med 1982;97:297–308.CrossRefGoogle ScholarPubMed
11.Mulligan, ME, Murray-Leisure, KA, Ribner, BS, Standiford, HC, John, JF, Korvick, JA, et al. Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med 1993;94:313–328.CrossRefGoogle ScholarPubMed
12.Sanford, MD, Widmer, AF, Bale, MJ, Jones, RN, Wenzel, RP. Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1994;19:1123–1128.CrossRefGoogle ScholarPubMed
13.Law, MR, Gill, ON, Turner, A. Methicillin-resistant Staphylococcus aureus: associated morbidity and effectiveness of control measures. Epidemiol Infect 1988;101:301–309.CrossRefGoogle ScholarPubMed
14.Walsh, TJ, Vlahov, D, Hansen, SL, Sonnenberg, E, Khabbaz, R, Gadacz, T, et al. Prospective microbiologic surveillance in control of nosocomial methicillin-resistant Staphylococcus aureus. Infect Control 1987;8:7–14.CrossRefGoogle ScholarPubMed
15.Van Enk, RA, Thompson, KD. Use of a primary isolation medium for recovery of methicillin-resistant Staphylococcus aureus. J Clin Microbiol 1992;30:504–505.CrossRefGoogle ScholarPubMed
16.Dacre, J, Emmerson, AM, Jenner, EA. Gentamicin-methicillin-resistant Staphylococcus aureus: epidemiology and containment of an outbreak. J Hosp Infect 1986;7:130–136.CrossRefGoogle ScholarPubMed
17.Cox, RA, Conquest, C, Mallaghan, C, Marples, RR. A major outbreak of methicillin-resistant Staphylococcus aureus caused by a new phage-type (EMRSA-16). J Hosp Infect 1995;29:87–106.CrossRefGoogle Scholar
18.Rao, N, Jacobs, S, Joyce, L. Cost-effective eradication of an outbreak of methicillin-resistant Staphylococcus aureus in a community teaching hospital. Infect Control Hosp Epidemiol 1988;9:255–260.CrossRefGoogle Scholar
19.Wakefield, DS, Helms, CM, Massanari, RM, Mori, M, Pfaller, M. Cost of nosocomial infection: relative contributions of laboratory, antibiotic, and per diem costs in serious Staphylococcus aureus infections. Am J Infect Control 1988;16:185–192.CrossRefGoogle ScholarPubMed