Clinical and Financial Implications for Discontinuing Active Surveillance Culturing (ASC) for Methicillin-resistant Staphylococcus Aureus & Vancomycin-resistant Enterococcus in Community Hospitals

Abstract

Background Active surveillance culturing (ASC) is widely used to prevent the spread of select multi-drug resistant organisms. As infection prevalence changes over time, the value and effectiveness of ACS requires periodic re-assessment. The two primary objectives of this study were to determine whether discontinuation of ASC for MRSA and VRE was associated with any increased incidence of hospital-acquired MRSA or VRE infection, and to estimate the financial impact of discontinuing MRSA and VRE ASC. Methods Rates of hospital-acquired (HA) infection or colonization with MRSA & VRE (excluding screening tests) were compared before and after discontinuation of VRE ASC and limitation of MRSA ASC in two separate community hospitals in eastern North Carolina between 2016 and 2019. Financial costs were estimated from direct laboratory costs and personal protective equipment (PPE) use pre- and post-elimination of ASC. Results HA-VRE rates were similar between sites and showed no significant difference following discontinuation of VRE ASC (risk ratio 0.79, 95% CI: 0.24-2.52, p=0.69). HA-MRSA rates were more difficult to interpret as rates differed between sites, and one site only had 2 months of data available following ASC limitation. Despite these limitations, within-site MRSA rates showed no significant change before or after limitation of MRSA ASC. Aggregate HA-MRSA rates actually fell slightly following limitation of MRSA ASC (risk ratio 0.40, 95% CI 0.18-0.91, p=0.04). Complete cost data for PPE usage was available for facility A and complete laboratory cost data for facility B. Both showed significant reductions after limiting ASC (p<0.001). Conclusions Rates of MRSA and VRE infection/colonization were overall low, but showed no significant change following discontinuation of ASC at two separate community hospitals. The discontinuation of ASC lead to cost savings for both facilities with no increased harm observed. Active surveillance culturing (ASC) is widely used to prevent the spread of select multi-drug resistant organisms. As infection prevalence changes over time, the value and effectiveness of ACS requires periodic re-assessment. The two primary objectives of this study were to determine whether discontinuation of ASC for MRSA and VRE was associated with any increased incidence of hospital-acquired MRSA or VRE infection, and to estimate the financial impact of discontinuing MRSA and VRE ASC. Rates of hospital-acquired (HA) infection or colonization with MRSA & VRE (excluding screening tests) were compared before and after discontinuation of VRE ASC and limitation of MRSA ASC in two separate community hospitals in eastern North Carolina between 2016 and 2019. Financial costs were estimated from direct laboratory costs and personal protective equipment (PPE) use pre- and post-elimination of ASC. HA-VRE rates were similar between sites and showed no significant difference following discontinuation of VRE ASC (risk ratio 0.79, 95% CI: 0.24-2.52, p=0.69). HA-MRSA rates were more difficult to interpret as rates differed between sites, and one site only had 2 months of data available following ASC limitation. Despite these limitations, within-site MRSA rates showed no significant change before or after limitation of MRSA ASC. Aggregate HA-MRSA rates actually fell slightly following limitation of MRSA ASC (risk ratio 0.40, 95% CI 0.18-0.91, p=0.04). Complete cost data for PPE usage was available for facility A and complete laboratory cost data for facility B. Both showed significant reductions after limiting ASC (p<0.001). Rates of MRSA and VRE infection/colonization were overall low, but showed no significant change following discontinuation of ASC at two separate community hospitals. The discontinuation of ASC lead to cost savings for both facilities with no increased harm observed.