Assessment of the Influence of Test Characteristics on the Clinical and Cost Impacts of Methicillin-ResistantStaphylococcus aureusScreening Programs in US Hospitals

Abstract

All screening options showed reductions in infection rates and cost impact improvement over no screening program. Among the options, same-day PCR testing for high-risk patients slightly edges out the others in terms of fewest infections and greatest potential cost savings.

Response to McKinnell et al’s Original Article “Cost-Benefit Analysis From the Hospital Perspective of Universal Active Screening Followed by Contact Precautions for Methicillin-Resistant Staphylococcus aureus Carriers”

“…3,4 The fundamental dilemma is that the costs of hospital-based screening and isolation are borne by the individual hospital performing the screening, but the individual benefits of screening may be reaped only later or by external beneficiaries (eg, other hospitals or non-hospital-based care entities). We suggest that the payment and incentive structure in the US system should be changed to support the expenditures necessary for infection prevention programs to realize both local and regional benefit.…”

“…7 In hospitals where MRSA is endemic, screening (targeted or universal) reduced infection rates and was cost saving compared with a policy of no screening. 3,4 Universal MRSA screening strategies were more effective but also more cost-intensive than targeted screening. 4,6,7 In a retrospective review of a 3-year MRSA screening program that was implemented from 2006 to 2009 in the United Kingdom, only 7 extra MRSA cases were detected using universal screening compared with targeted screening, and in 1 month, universal screening generated 4,200 negative screens that incurred an additional €25,488 in laboratory costs.…”

Utility of Surveillance Cultures for Antimicrobial Resistant Organisms in Infants Transferred to the Neonatal Intensive Care Unit

“…Prediction rules, [34][35][36] cost-efficiency analyses 37,38 and reviews 8,39 regarding universal surveillance for AROs have been performed primarily in the adult population. Cost-efficacy data for surveillance cultures for neonates are limited.…”

Strategies to Prevent Methicillin-ResistantStaphylococcus aureusTransmission and Infection in Acute Care Hospitals: 2014 Update

“…178-181 Although more costly than culture-based techniques, one potential advantage of these molecular tests is their ability to provide a result in less than 2 hours from the time of specimen collection, although in actual practice the turnaround time may be longer due to batching of samples. Although at least one uncontrolled study 182 and 3 mathematical models [183][184][185] have suggested that rapid testing may allow for more effective use of isolation precautions and enhanced prevention of MRSA transmission, a cluster-randomized crossover trial of universal screening in general wards failed to identify a difference in MRSA acquisition rates with the use of rapid testing compared with the use of a culture-based method. 186…”