Budget Impact Analysis of Rapid Screening for <i>Staphylococcus aureus</i> Colonization Among Patients Undergoing Elective Surgery in US Hospitals

Noskin, Gary A.; Rubin, Robert J.; Schentag, Jerome J.; Kluytmans, Jan; Hedblom, Edwin C.; Jacobson, Cassie; Smulders, Maartje; Gemmen, Eric; Bharmal, Murtuza

doi:10.1086/524327

Cited by 24 publications

(18 citation statements)

References 38 publications

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“…This economic analysis of three different strategies of combating MRSA HAIs in a hospital setting can help policy‐makers trying to decide on an effective strategy. Since the adoption of the VHA’s National MRSA Prevention Initiative, a nascent literature has arisen evaluating the effectiveness of a strategy of AS [7,8,28]. Our study contributes to this literature by not only evaluating an AS strategy in comparison with the common strategy of NS, but also by comparing a proposed extension to the AS strategy.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of adding decolonization to a surveillance strategy of screening and isolation for methicillin-resistant Staphylococcus aureus carriers

Nelson

Samore

Harbarth

et al. 2010

Clinical Microbiology and Infection

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We compared the cost-effectiveness of a methicillin-resistant Staphylococcus aureus (MRSA) programme of active surveillance plus decolonization with the current Veterans Health Administration (VHA) strategy of active surveillance alone, as well as a common strategy of no surveillance. A decision-analytical model was developed for an inpatient stay time horizon, using the VHA's perspective. Model inputs were taken from published literature where available, and supplemented with expert opinion when necessary. Effectiveness outcomes were hospital-acquired MRSA infections and deaths avoided. One-way and two-way sensitivity analyses and Monte Carlo simulations were performed. In the base-case analysis, the strategy of active surveillance plus decolonization dominated (i.e. lower cost and greater effectiveness) both the comparison strategies of active surveillance and no surveillance. In addition, the active surveillance strategy dominated the strategy of no surveillance. One-way and two-way sensitivity analyses demonstrated that at low levels of direct benefit of decolonization (1-4%), the strategy of active surveillance plus decolonization would no longer be dominant. In the probabilistic sensitivity analysis, active surveillance plus decolonization dominated both the other two strategies, and the active surveillance strategy dominated no surveillance in all of 1000 Monte Carlo simulations. These results provide a strong economic argument for adding an MRSA decolonization protocol to the current VHA active surveillance strategy.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of adding decolonization to a surveillance strategy of screening and isolation for methicillin-resistant Staphylococcus aureus carriers

Nelson

Samore

Harbarth

et al. 2010

Clinical Microbiology and Infection

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“…It has been reported that identifying asymptomatically colonized individuals and placing them into contact isolation within a short time frame are a good management tool for reducing the spread of these pathogens and for lowering health care-associated infections (5,11,16,18). Furthermore, there is rising interest in identifying all S. aureus carriers prior to surgery to decolonize them to reduce postoperative S. aureus surgical-site infections (4,10).…”

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confidence: 99%

Optimization of a Laboratory-Developed Test Utilizing Roche Analyte-Specific Reagents for Detection of Staphylococcus aureus , Methicillin-Resistant S. aureus , and Vancomycin-Resistant Enterococcus Species

et al. 2008

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Nasal and perianal swab specimens were tested for detection of Staphylococcus aureus and vancomycinresistant Enterococcus species (VRE) using a laboratory-developed real-time PCR test and microbiological cultures. The real-time PCR and culture results for S. aureus were similar. PCR had adequate sensitivity, but culture was more specific for the detection of VRE.Staphylococcus aureus, especially methicillin-resistant S. aureus (MRSA), and vancomycin-resistant Enterococcus species (VRE) are important pathogens associated with health care facility outbreaks worldwide (1,2,8,21). It has been reported that identifying asymptomatically colonized individuals and placing them into contact isolation within a short time frame are a good management tool for reducing the spread of these pathogens and for lowering health care-associated infections (5,11,16,18). Furthermore, there is rising interest in identifying all S. aureus carriers prior to surgery to decolonize them to reduce postoperative S. aureus surgical-site infections (4, 10).Reliable surveillance requires accurate testing (17), and cultures can take from 2 to 5 days to obtain the final results (3a). PCR offers detection of S. aureus and VRE directly from swab specimens within a few hours (4,12,14) and can help with the rapid deployment of infection control and prevention measures (16,18).The purpose of our study was to develop an optimized test using Roche analyte-specific reagents (ASRs) for detection of S. aureus and VRE by real-time PCR with a single set of amplification conditions and to compare the PCR results to the results of conventional culture.Inpatients at Evanston Northwestern Healthcare during August 2004 made up the patient population. Premoistened, double-headed swabs (culture swab; BBL, Becton Dickinson, Franklin Lakes, NJ) were used to collect paired anterior nasal specimens and paired perianal specimens as part of an infection control activity to determine colonization prevalence. There were 387 nasal specimens (for S. aureus) and 309 perianal specimens (for VRE). This investigation was approved by the Institutional Review Board of Evanston Northwestern Healthcare.For S. aureus, one of the paired nasal swabs was plated onto Columbia colistin-nalidixic agar with 5% sheep blood (Remel, Inc., Lenexa, KS) (3a) and incubated at 35°C for 48 h. S. aureus was identified by colony morphology and Staphaurex latex agglutination testing (Remel, Inc.). Methicillin resistance was determined on colonies by using PCR as described below. For any swabs that were PCR positive only for S. aureus (n ϭ 13), the original cultures were reexamined beyond their initial 48-hour incubation, with five additional swab samples yielding S. aureus after reexamination (two yielded MRSA).VRE was cultured by plating one of the paired perianal swabs on bile esculin azide agar containing 6 g of vancomycin/ml agar (Remel, Inc.) and by incubation at 35°C for 72 h. Colonies black in color (bile esculin positive) were confirmed to be Enterococcus faecium or Enterococcus faecalis by usi...

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“…Thus, our estimated eight fewer S. aureus SSIs would have resulted in two avoided rehospitalizations and a savings of over $34,000, with a likely higher expense if all of the infections had been MRSA, for a net benefit of $6,000 to the program. The financial benefit of this practice if expanded to the entire United States was recently estimated at more than $231 million, should all 7.2 million patients undergoing elective surgery be screened for S. aureus and those positive decolonized before their operation [13]. Additionally important is the emotional, physical and economic burden of repeated doctors' office visits, additional medication, impaired healing, prolonged therapy and delay in return to normal living that was avoided for eight patients [2].…”

Section: Discussionmentioning

confidence: 99%

Staphylococcus aureus Nasal Decolonization in Joint Replacement Surgery Reduces Infection

Hacek

Robb

Paule

et al. 2008

Clinical Orthopaedics &Amp; Related Research

151

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Surgical site infections (SSIs) with Staphylococcus aureus are a recognized adverse event of hip and knee replacements. We evaluated the impact of a program to detect S. aureus nasal carriers before surgery with preoperative decolonization (using mupirocin twice daily for 5 days prior to surgery) of carriers. Nasal swab samples were obtained from patients prior to surgery from 8/1/2003 through 2/28/2005. Samples were tested using real-time PCR technology to detect S. aureus. The group that developed S. aureus SSI was compared to a combined concurrent and historical control for one year following the operation. S. aureus caused 71% of SSIs in the combined control groups. Of the 1495 surgical candidates evaluated, 912 (61.0%) were screened for S. aureus; 223 of those screened (24.5%) were positive and then decolonized with mupirocin. Among the 223 positive and decolonized patients, three (1.3%) developed a SSI. Among the 689 screen-negative patients, four (0.6%) developed SSIs for an overall rate of 0.77%. Among the 583 control patients who were not screened or decolonized, 10 (1.7%) developed S. aureus SSIs. SSIs from other organisms were 0.44% and 0.69%, respectively.

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Budget Impact Analysis of Rapid Screening for Staphylococcus aureus Colonization Among Patients Undergoing Elective Surgery in US Hospitals

Abstract: The addition of preadmission testing and decolonization therapy to standard care would result in significant cost savings, even after accounting for variations in the model input values.

Cited by 24 publications

References 38 publications

Cost-effectiveness of adding decolonization to a surveillance strategy of screening and isolation for methicillin-resistant Staphylococcus aureus carriers

Cost-effectiveness of adding decolonization to a surveillance strategy of screening and isolation for methicillin-resistant Staphylococcus aureus carriers

Optimization of a Laboratory-Developed Test Utilizing Roche Analyte-Specific Reagents for Detection of Staphylococcus aureus , Methicillin-Resistant S. aureus , and Vancomycin-Resistant Enterococcus Species

Staphylococcus aureus Nasal Decolonization in Joint Replacement Surgery Reduces Infection

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