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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

Published online by Cambridge University Press:  21 June 2016

Megan Clancy ,
Amy Graepler ,
Michael Wilson ,
Ivor Douglas ,
Jeff Johnson  and
Connie Savor Price
Megan Clancy
Affiliation:
Divisions of Infectious Diseases, Denver Health Medical Center, University of Colorado Health Sciences Center, Denver, Colorado Divisions of Infectious Diseases, University of Colorado Health Sciences Center, Denver, Colorado
Amy Graepler
Affiliation:
Department of Medicine, the Pathology and Laboratory Service, Denver Health Medical Center, University of Colorado Health Sciences Center, Denver, Colorado
Michael Wilson
Affiliation:
Department of Medicine, the Pathology and Laboratory Service, Denver Health Medical Center, University of Colorado Health Sciences Center, Denver, Colorado Department of Medicine, the Department of Pathology, University of Colorado Health Sciences Center, Denver, Colorado
Ivor Douglas
Affiliation:
Pulmonary/Critical Care Medicine, Denver Health Medical Center, University of Colorado Health Sciences Center, Denver, Colorado Pulmonary Sciences, University of Colorado Health Sciences Center, Denver, Colorado
Jeff Johnson
Affiliation:
Department of Surgery, University of Colorado Health Sciences Center, Denver, Colorado Department of Surgery, University of Colorado Health Sciences Center, Denver, Colorado
Connie Savor Price*
Affiliation:
Divisions of Infectious Diseases, Denver Health Medical Center, University of Colorado Health Sciences Center, Denver, Colorado Divisions of Infectious Diseases, University of Colorado Health Sciences Center, Denver, Colorado
*
660 Bannock MC-4000, Denver, CO 80204, ([email protected])
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Extract

Objective.

To evaluate the impact of active screening for methicillin-resistant Staphylococcus aureus (MRSA) on MRSA infection rates and cost avoidance in units where the risk of MRSA transmission is high.

Methods.

During a 15-month period, all patients admitted to our adult medical and surgical intensive care units (ICUs) were screened for MRSA nasal carriage on admission and weekly thereafter. The overall rates of all MRSA infections and of nosocomial MRSA infection in the 2 adult ICUs and the general wards were compared with rates during the 15-month period prior to the start of routine screening. The percentage of patients colonized or infected with MRSA on admission and the cost avoidance of the surveillance program were also assessed.

Results.

The overall rate of MRSA infections for all 3 areas combined decreased from 6.1 infections per 1,000 census-days in the preintervention period to 4.1 infections per 1,000 census-days in the postintervention period (P = .01). The decrease remained statistically significant when only nosocomial MRSA infections were examined (4.5 vs 2.8 infections per 1,000 census-days; P<.01), despite a corresponding increase during the postintervention period in the percentage of patients with onset of MRSA infection in the first 72 hours after admission to the general wards (46% to 81%; P<.005). A total of 3.7% of ICU patients were colonized or infected with MRSA on admission; MRSA would not have been detected in 91% of these patients if screening had not been performed. At a cost of $3,475/month for the program, we averted a mean of 2.5 MRSA infections/month for the ICUs combined, avoiding $19,714/month in excess cost in the ICUs.

Conclusions.

Even in a setting of increasing community-associated MRSA, active MRSA screening as part of a multi-factorial intervention targeted to high-risk units may be an effective and cost-avoidant strategy for achieving a sustained decrease of MRSA infections throughout the hospital.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 10 , October 2006 , pp. 1009 - 1017
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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