Cost Effectiveness of Screening for Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus (VRE) in an Intensive Care Unit at a 200-Bed Community Hospital with Low Prevalence of These Antibiotic-Resistant Organisms

Abstract

BACKGROUND/OBJECTIVES: Antibiotic-resistant organisms are a common cause of hospital-acquired infections. Infections caused by MRSA and VRE are a source of morbidity and mortality, prolonged hospital stay, and higher costs of care when compared to antibiotic-susceptible strains. The mean attributable cost per MRSA infection was reported to be $35,367 in one meta-analysis. A Society for Healthcare Epidemiology of America (SHEA) guideline recommends screening of high-risk patients for colonization or infection with MRSA and VRE as a means of isolating reservoirs and preventing transmission to others. The cost/benefit of implementing this strategy in a community hospital setting with relatively low prevalence of these epidemiologically significant organisms was uncertain. METHODS: A screening protocol was implemented with the opening of a new 12-bed medical/surgical intensive care unit (M/SICU). Surveillance cultures (MRSA - nares and open chronic wounds if present; VRE - rectal) were collected on admission, every seven days, and on discharge from the unit when length of stay was ≥ to 4 days. Contact Precautions were instituted pending report of negative initial screening cultures. RESULTS: During the protocol period (July 2004-July 2005), one patient acquired a MRSA infection (0.47 patients/1000 patient days). In the one-year period preceding protocol implementation, five patients developed nosocomial infection related to MRSA in the critical care unit (3.3 infections/1000 patient days). Using the pre-protocol rate of infection (3.3 infections/1000 patient days) applied to patient days during the protocol period (2117), an estimated six MRSA infections were averted. No VRE infections were identified during either the pre-protocol or protocol periods. With the mean attributable cost associated with MRSA infection of $35,367, an estimated $212,000 in excess infection-associated cost was averted. The estimated direct cost (material and labor) for conducting the surveillance protocol was $40,000. CONCLUSIONS: Even in the setting of a community hospital with relatively low prevalence of MRSA (34%), implementation of an active surveillance program for MRSA was shown to be a cost-effective strategy, reducing the risk of acquiring MRSA infection and avoiding associated excess cost of care. Although VRE colonization was identified, VRE was not found to be a significant nosocomial pathogen in our institution. The cost associated with VRE screening represented 50% of the protocol cost and was not considered a cost-effective strategy in this setting.