Cost-Effectiveness Assessment of Potential Financial Savings from Selective Culture Screening as a Strategy To Prevent Nosocomial Transmission of Methicillin-Resistant Staphylococcus aureus (MRSA) in 25 Upstate New York Hospitals

Abstract

BACKGROUND/OBJECTIVES: Nosocomial (N) transmission of MRSA continues to affect hospitals throughout the country despite implementation of enhanced infection control practices. Selective culture screening (CS) has shown decreases in nosocomial MRSA rates. However, standardized selective CS practices are not being widely implemented secondary to reservations regarding N-transmission rate reductions and actual cost savings. METHODS: This study sought to determine potential cost savings in preventing N-cases by using selective CS. The Iroquois Healthcare Association (IHA) recruited Infection Control Practitioners from 25 member hospitals, of varying bed sizes serving both rural and urban communities, to voluntarily participate in standardized inpatient MRSA reporting. N-MRSA was defined as a positive culture obtained greater than 72 hours after admission. Transmission Risk (TR) was defined as the mean number of MRSA isolation days. Using a standardized tool, the direct cost of care (DCC) averages for both intensive care unit (ICU) and non-ICU MRSA patients were collected from each hospital, including calculation of average CS costs. A predictive model was developed to determine the number of potentially preventable cases per hospital using DCC and TR hospital data. The cost savings from case prevention were compared to CS costs. RESULTS: The average N-MRSA incidence rate of participant hospitals from 2000 to 2002 was 0.64 cases/1000 patient days and ranged from 0.11 to 0.98 cases/1000 patient days. The average TR was 9 days. The DCC associated with a MRSA case varied greatly between hospitals. The DCC range for an ICU MRSA patient was $765.86 to $16,778.17 and for non-ICU was $765.86 to $8,296.31. The CS costs varied greatly, from $1.23 to $20.35 per culture. The study found that hospitals with high N-MRSA rates would experience substantial cost savings through prevention of N-MRSA transmission by implementing selective CS. On the other hand, the cost savings of implementing selective CS to identify cases for hospitals experiencing a low incidence of N-MRSA cases was not observed. CONCLUSIONS: The cost assessment model provides an objective method for administration decisions regarding implementing selective CS to reduce N-MRSA transmission within hospitals experiencing an increased incidence of N-MRSA. Each hospital should consider their N-MRSA and community rates, costs of care, and CS costs when deciding whether to implement this control measure strategy. BACKGROUND/OBJECTIVES: Nosocomial (N) transmission of MRSA continues to affect hospitals throughout the country despite implementation of enhanced infection control practices. Selective culture screening (CS) has shown decreases in nosocomial MRSA rates. However, standardized selective CS practices are not being widely implemented secondary to reservations regarding N-transmission rate reductions and actual cost savings. METHODS: This study sought to determine potential cost savings in preventing N-cases by using selective CS. The Iroquois Healthcare Association (IHA) recruited Infection Control Practitioners from 25 member hospitals, of varying bed sizes serving both rural and urban communities, to voluntarily participate in standardized inpatient MRSA reporting. N-MRSA was defined as a positive culture obtained greater than 72 hours after admission. Transmission Risk (TR) was defined as the mean number of MRSA isolation days. Using a standardized tool, the direct cost of care (DCC) averages for both intensive care unit (ICU) and non-ICU MRSA patients were collected from each hospital, including calculation of average CS costs. A predictive model was developed to determine the number of potentially preventable cases per hospital using DCC and TR hospital data. The cost savings from case prevention were compared to CS costs. RESULTS: The average N-MRSA incidence rate of participant hospitals from 2000 to 2002 was 0.64 cases/1000 patient days and ranged from 0.11 to 0.98 cases/1000 patient days. The average TR was 9 days. The DCC associated with a MRSA case varied greatly between hospitals. The DCC range for an ICU MRSA patient was $765.86 to $16,778.17 and for non-ICU was $765.86 to $8,296.31. The CS costs varied greatly, from $1.23 to $20.35 per culture. The study found that hospitals with high N-MRSA rates would experience substantial cost savings through prevention of N-MRSA transmission by implementing selective CS. On the other hand, the cost savings of implementing selective CS to identify cases for hospitals experiencing a low incidence of N-MRSA cases was not observed. CONCLUSIONS: The cost assessment model provides an objective method for administration decisions regarding implementing selective CS to reduce N-MRSA transmission within hospitals experiencing an increased incidence of N-MRSA. Each hospital should consider their N-MRSA and community rates, costs of care, and CS costs when deciding whether to implement this control measure strategy.