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Universal, Extensive MRSA Screening Too Expensive for Hospitals

by | Apr 10, 2015 | Clinical Diagnostic Insider, Diagnostic Testing and Emerging Technologies

Many policymakers have called for universal, hospital-based screening for methicillin-resistant Staphylococcus aureus (MRSA) as a means of potentially preventing hospital acquired infections. While some states have gone so far as to enact laws requiring MRSA screening upon admission, new research shows that such screening is too costly for hospitals. “Screening for MRSA is becoming an accepted weapon against the spread of these antibiotic-resistant infections, but little thought has been given to how a hospital would actually implement such a program,” said James McKinnell, M.D., from the Los Angeles Biomedical Research Institute, in a statement. McKinnell and colleagues presented two abstracts at the ID Week conference (Oct. 7-12, 2014; Philadelphia). In the first study the researchers modeled the economic impact for a hospital to start universal MRSA screening for all inpatients and contact precautions for MRSA carriers. The models incorporated several screening strategies including the addition of non-nares MRSA screening and comparison of chromatogenic agar versus PCR-based screening. The researchers found the cost of universal MRSA screening and contact precautions outweighed the projected benefits generated by preventing MRSA-related infections, resulting in a cost of $103,000 per 10,000 admissions. More MRSA-colonized patients were identified with non-nares screening and PCR-based testing. This averted […]

Many policymakers have called for universal, hospital-based screening for methicillin-resistant Staphylococcus aureus (MRSA) as a means of potentially preventing hospital acquired infections. While some states have gone so far as to enact laws requiring MRSA screening upon admission, new research shows that such screening is too costly for hospitals. “Screening for MRSA is becoming an accepted weapon against the spread of these antibiotic-resistant infections, but little thought has been given to how a hospital would actually implement such a program,” said James McKinnell, M.D., from the Los Angeles Biomedical Research Institute, in a statement. McKinnell and colleagues presented two abstracts at the ID Week conference (Oct. 7-12, 2014; Philadelphia). In the first study the researchers modeled the economic impact for a hospital to start universal MRSA screening for all inpatients and contact precautions for MRSA carriers. The models incorporated several screening strategies including the addition of non-nares MRSA screening and comparison of chromatogenic agar versus PCR-based screening. The researchers found the cost of universal MRSA screening and contact precautions outweighed the projected benefits generated by preventing MRSA-related infections, resulting in a cost of $103,000 per 10,000 admissions. More MRSA-colonized patients were identified with non-nares screening and PCR-based testing. This averted more MRSA infections, but at an increased cost. Relatedly, the researchers further modeled the economic impact of MRSA screening using three body sites (nares, pharynx, and inguinal folds) and presumptive isolation for high-risk admissions. The costs of screening and isolation exceeded savings generated by preventing MRSA infections. Nares screening and contact precautions prevented 0.6 infections per 1,000 high-risk admissions, with a net financial loss of $36,899. More extensive screening using three body-sites prevented 0.8 infections per 1,000 high-risk admissions, but at an even greater financial loss of $51,478. Three body-site surveillance, the researchers say, could be cost-neutral in targeted populations at risk for high-complexity infections (e.g., prosthetic joint infections or post-operative mediastinitis), when incorporating “optimistic estimates” for the efficacy of isolation for preventing new MRSA infections. “Our results are surprising because we know that preventing MRSA infections is better for the health care system as a whole, but the rewards of this effort do not seem to come back to the hospital in a meaningful way,” said McKinnell. Takeaway: Employing universal MRSA screening is not a cost effective, infection control strategy. The cost of employing either universal screening or more extensive, three-site screening outweighs a hospital’s savings from prevented cases.

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