Financial Implications of Plans to Combat Methicillin-Resistant Staphylococcus aureus (MRSA) in an Orthopaedic Department

Abstract

INTRODUCTION The aim of this study was to calculate retrospectively the cost of MRSA infections in the elective and trauma orthopaedic population in Rotherham District General Hospital in a 3-month period during 2005.PATIENTS AND METHODS A total of 686 patients were admitted to the orthopaedic wards and the surgical wounds 10 patients became infected with MRSA. RESULTS The cost of these infections when extrapolated over 12 months was £384,000 excluding staff costs. CONCLUSIONS The key in the fight against MRSA in the hospital setting is multifactorial and requires a combination of measures. Our solution is: cohort nursing; non-selective screening of all admissions to the orthopaedic wards; use of a polymerase chain reaction as a diagnostic tool; ring-fencing of beds; and separate wound dressing rooms for each ward. The total cost is projected to be £301,000.

Staphylococcus aureus Screening and Decolonization in Orthopaedic Surgery and Reduction of Surgical Site Infections

“…Lee et al [34] showed that screening and decolonization was still the most cost-effective choice even when the following parameters were changed to make the protocol less desirable: a second body site was screened, there was a low prevalence of MRSA, and the decolonization success rates were low. Studies in orthopaedic patients [22,36,52] and those having total joint arthroplasty [19,42,43] also showed that implementing a S. aureus screening and decolonization protocol resulted in cost savings, because the cost of treating patients with SSIs with readmission was greater than the costs of instituting the screening and treatment protocol. Hassan et al [22] evaluated the costeffectiveness of instituting PCR as the method of detection for S. aureus colonization.…”

“…Studies in orthopaedic patients [22,36,52] and those having total joint arthroplasty [19,42,43] also showed that implementing a S. aureus screening and decolonization protocol resulted in cost savings, because the cost of treating patients with SSIs with readmission was greater than the costs of instituting the screening and treatment protocol. Hassan et al [22] evaluated the costeffectiveness of instituting PCR as the method of detection for S. aureus colonization. Their economic analysis separated the cost of setting up PCR detection for the first year and performing S. aureus screening and decolonization in subsequent years.…”

“…We could not determine if a superficial, deep, or organ space/joint infection was associated with increased cost of treatment, because the three studies [19,42,43] that evaluated economic outcomes of the screening and decolonization protocol did not differentiate the types of SSI regarding costs. It also is difficult to determine the most efficacious way to detect S. aureus colonization, although Hassan et al [22] reported that implementing PCR over culture can still save money when comparing the cost of treating SSIs in nonscreened patients with the cost of implementing the decolonization protocol. Additionally, PCR can provide results quicker than routine culture, but this was not studied from a cost-savings perspective.…”

“…Ten studies (Table 3) examined the cost of implementing a S. aureus screening and decolonization protocol [10,19,22,34,36,42,43,48,52,55]. The method of evaluating costs differed among studies, because four of the studies were based on economic models [10,34,48,55], whereas ITT = intention to treat; MSSA = methicillin-sensitive S. aureus; MRSA = methicillin-resistant S. aureus; RCT = randomized controlled trial; RR = relative risk; SSI = surgical site infection.…”

Methicillin-resistant Staphylococcus aureus in orthopaedic trauma

“…Hospital-acquired MRSA infections are a drain on the health services by increasing the length of in-patient stay with consequent nursing, medical and therapeutic costs. [14][15][16] The increased morbidity as a result of surgical infection after traumatic injury also incurs a cost to the patient, family and workplace. 17 Orthopaedic patients who acquire infection incur costs which are 2.6 times greater than those of non-infected counterparts.…”