Cost and Effects of Different Admission Screening Strategies to Control the Spread of Methicillin-resistant Staphylococcus aureus

Abstract

Nosocomial infection rates due to antibiotic-resistant bacteriae, e.g., methicillin-resistant Staphylococcus aureus (MRSA) remain high in most countries. Screening for MRSA carriage followed by barrier precautions for documented carriers (so-called screen and isolate (S&I)) has been successful in some, but not all settings. Moreover, different strategies have been proposed, but comparative studies determining their relative effects and costs are not available. We, therefore, used a mathematical model to evaluate the effect and costs of different S&I strategies and to identify the critical parameters for this outcome. The dynamic stochastic simulation model consists of 3 hospitals with general wards and intensive care units (ICUs) and incorporates readmission of carriers of MRSA. Patient flow between ICUs and wards was based on real observations. Baseline prevalence of MRSA was set at 20% in ICUs and hospital-wide at 5%; ranges of costs and infection rates were based on published data. Four S&I strategies were compared to a do-nothing scenario: S&I of previously documented carriers (“flagged” patients); S&I of flagged patients and ICU admissions; S&I of flagged and group of “frequent” patients; S&I of all hospital admissions (universal screening). Evaluated levels of efficacy of S&I were 10%, 25%, 50% and 100%. Our model predicts that S&I of flagged and S&I of flagged and ICU patients are the most cost-saving strategies with fastest return of investment. For low isolation efficacy universal screening and S&I of flagged and “frequent” patients may never become cost-saving. Universal screening is predicted to prevent hardly more infections than S&I of flagged and “frequent” patients, albeit at higher costs. Whether an intervention becomes cost-saving within 10 years critically depends on costs per infection in ICU, costs of screening and isolation efficacy.

Epidemiology of Staphylococcus aureus Harboring the mecA or Panton-Valentine Leukocidin Genes in Hospitals in Java and Bali, Indonesia

“…Recent studies reported that selective MRSA screening to high-risk colonization patients (e.g., patients at intensive care unit admission) and patients detected as MRSA carrier previously will reduce the prevalence of MRSA more efficiently than universal screening at hospital admission. 6,39 Such a strategy should also be developed for other settings. In addition, it is necessary to study clinical isolates and the burden of disease caused by MRSA in Indonesian hospitals.…”

Nasal carriage rate of methicillin resistant Staphylococcus aureus among Iranian healthcare workers: a systematic review and meta-analysis

“…Over the past decades, the incidence of methicillin-resistant S. aureus (MRSA) in surgical site infections, bloodstream infections, and pneumonia has increased significantly 2,3 . MRSA strains are considered to be endemic in many hospitals throughout the world and are now responsible for approximately 40-60% of healthcare-associated infections 4 .…”

Simulation models for transmission of health care–associated infection: A systematic review

“…Recently published studies incorporated the interaction between ICUs and general wards, or between general wards within a hospital. 35,40,49,72,73 Donker et al 74 was the first study to look at the impact of different referral patterns among various categories of hospitals on MRSA infection rates. One year later, 2 additional studies examined the interaction between the settings for MRSA.…”

“…83,84 Recently published studies paid more attention to the economic aspect of HAIs. They have estimated costeffectiveness for different IPC strategies and investments, mainly for MRSA 59,[71][72][73]85,86 followed by CD. 82,87 Economic analyses were carried out for a single intervention (ie, hand hygiene, 59,71 isolation, 59 vaccination, 70,87 patient room design 56 ), combination of 2 59,73 or 3 interventions, 85,86 and a bundled strategy.…”