Hostname: page-component-6bf8c574d5-w79xw Total loading time: 0 Render date: 2025-02-22T09:52:31.285Z Has data issue: false hasContentIssue false
  • English
  • Français

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, (connie.price@dhha.org)
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Tiemersma, EW, Bronzwaer, SL, Lyytikainen, O, et al. Methicillin-resistant Staphylococcus aureus in Europe, 1999-2002. Emerg Infect Dis 2004;10:1627–1634.Google Scholar
2. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.Google Scholar
3. Wertheim, HF, Vos, MC, Boelens, HA, et al. Low prevalence of methicillin-resistant Staphylococcus aureus (MRSA) at hospital admission in The Netherlands: the value of search and destroy and restrictive antibiotic use. J Hosp Infect 2004;56:321–325.CrossRefGoogle ScholarPubMed
4. Rosdahl, VT, Knudsen, AM. The decline of methicillin resistance among Danish Staphylococcus aureus strains. Infect Control Hosp Epidemiol 1991; 12:83–88.Google Scholar
5. Muto, CA, Jernigan, JA, Ostrowsky, BE, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol 2003;24: 362–386.Google Scholar
6. Farrington, M, Redpath, C, Trundle, C, Coomber, S, Brown, NM. Winning the battle but losing the war: methicillin-resistant Staphylococcus aureus (MRSA) infection at a teaching hospital. QJM 1998;91:539–548.Google Scholar
7. Gonzalez, C, Rubio, M, Romero-Vivas, J, Gonzalez, M, Picazo, JJ. Bacteremic pneumonia due to Staphylococcus aureus: a comparison of disease caused by methicillin-resistant and methicillin-susceptible organisms. Clin Infect Dis 1999;29:1171–1177.CrossRefGoogle ScholarPubMed
8. Harbarth, S, Rutschmann, O, Sudre, P, Pittet, D. Impact of methicillin resistance on the outcome of patients with bacteremia caused by Staphylococcus aureus . Arch Intern Med 1998;158:182–189.Google Scholar
9. Soriano, A, Martinez, JA, Mensa, J, et al. Pathogenic significance of methicillin resistance for patients with Staphylococcus aureus bacteremia. Clin Infect Dis 2000;30:368–373.Google Scholar
10. Nijssen, S, Bonten, MJ, Weinstein, RA. Are active microbiological surveillance and subsequent isolation needed to prevent the spread of methicillin-resistant Staphylococcus aureus? Clin Infect Dis 2005;40:405–409.Google Scholar
11. Cepeda, JA, Whitehouse, T, Cooper, B, et al. Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study. Lancet 2005;365:295–304.Google Scholar
12. Buckingham, SC, McDougal, LK, Cathey, LD, et al. Emergence of community-associated methicillin-resistant Staphylococcus aureus at a Memphis, Tennessee Children's Hospital. Pediatr Infect Dis J 2004;23:619–624.CrossRefGoogle Scholar
13. Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
14. Puzniak, LA, Gillespie, KN, Leet, T, Kollef, M, Mundy, LM. A cost-benefit analysis of gown use in controlling vancomycin-resistant Enterococcus transmission: is it worth the price? Infect Control Hosp Epidemiol 2004;25:418–424.Google Scholar
15. Abramson, MA, Sexton, DJ. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol 1999;20:408–411.Google Scholar
16. Engemann, JJ, Carmeli, Y, Cosgrove, SE, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36:592–598.Google Scholar
17. Chaix, C, Durand-Zaleski, I, Alberti, C, Brun-Buisson, C. Control of endemic methicillin-resistant Staphylococcus aureus: a cost-benefit analysis in an intensive care unit. JAMA 1999;282:1745–1751.Google Scholar
18. Boyce, JM, Potter-Bynoe, G, Chenevert, C, King, T. Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications. Infect Control Hosp Epidemiol 1997;18:622–627.Google Scholar
19. Zachary, KC, Bayne, PS, Morrison, VJ, Ford, DS, Silver, LC, Hooper, DC. Contamination of gowns, gloves, and stethoscopes with vancomycin-resistant enterococci. Infect Control Hosp Epidemiol 2001;22:560–564.Google Scholar
20. Nicolle, LE, Dyck, B, Thompson, G, et al. Regional dissemination and control of epidemic methicillin-resistant Staphylococcus aureus. Manitoba Chapter of CHICA-Canada. Infect Control Hosp Epidemiol 1999;20:202–205.Google Scholar
21. Tomic, V, Svetina Sorli, P, Trinkaus, D, Sorli, J, Widmer, AF, Trampuz, A. Comprehensive strategy to prevent nosocomial spread of methicillin-resistant Staphylococcus aureus in a highly endemic setting. Arch Intern Med 2004;164:2038–2043.Google Scholar
22. Girou, E, Pujade, G, Legrand, P, Cizeau, F, Brun-Buisson, C. Selective screening of carriers for control of methicillin-resistant Staphylococcus aureus (MRSA) in high-risk hospital areas with a high level of endemic MRSA. Clin Infect Dis 1998;27:543–550.Google Scholar
23. Jernigan, JA, Clemence, MA, Stott, GA, et al. Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 1995;16:686–696.Google Scholar
24. Kirkland, KB, Weinstein, JM. Adverse effects of contact isolation. Lancet 1999;354:1177–1178.Google Scholar
25. Stelfox, HT, Bates, DW, Redelmeier, DA. Safety of patients isolated for infection control. JAMA 2003;290:1899–1905.Google Scholar
26. Dettenkofer, M, Seegers, S, Antes, G, Motschall, E, Schumacher, M, Daschner, FD. Does the architecture of hospital facilities influence nosocomial infection rates? A systematic review. Infect Control Hosp Epidemiol 2004; 25:21–25.Google Scholar
27. Huebner, J, Frank, U, Kappstein, I, et al. Influence of architectural design on nosocomial infections in intensive care units—a prospective 2-year analysis. Intensive Care Med 1989;15:179–183.Google Scholar