Costs and Benefits Associated with the MRSA Search and Destroy Policy in a Hospital in the Region Kennemerland, The Netherlands

Abstract

ObjectiveThe objective of this study was to analyze the costs and benefits of the MRSA Search and Destroy (S&D) policy between 2008 and 2013 in the Kennemer Gasthuis, a 400 bed teaching hospital in the region Kennemerland, the Netherlands.MethodsA patient registration database was used to retrospectively calculate costs, including screening, isolation, follow-up, contact tracing, cleaning, treatment, deployment of extra healthcare workers, salary for an infection control practitioner (ICP) and service of isolation rooms. The estimated benefits (costs and lives when no MRSA S&D was applied) were based on a varying MRSA prevalence rate (up to 50%).ResultsWhen no MRSA S&D policy was applied, the additional costs and deaths due to MRSA bacteraemia were estimated to be € 1,388,907 and 33 respectively (at a MRSA prevalence rate of 50%). Currently, the total costs were estimated to be € 290,672 (€ 48,445 annually) and a MRSA prevalence rate of 17.3% was considered as break-even point. Between 2008 and 2013, a total of 576 high risk patients were screened for MRSA carriage, of whom 19 (3.3%) were found to be MRSA positive. Forty-nine patients (72.1%) were found unexpectedly.ConclusionsApplication of the MRSA S&D policy saves lives and money, although the high rate of unexpected MRSA cases is alarming.

Methicillin-Resistant Staphylococcus aureus Control in the 21st Century: Laboratory Involvement Affecting Disease Impact and Economic Benefit from Large Population Studies

“…AST, combined with contact precaution isolation or with isolation plus decolonization, was reported to achieve the lowest endpoint rates of clinical MRSA disease: between 0.21 and 0.48 clinical infections per 1,000 patient days for 5,032,023 enrollees (9,(13)(14)17), compared to 2.1 cases per 1,000 patient days for universal decolonization in a 122,464-patient study (11). The low AST disease rate findings are consistent with a recent report from The Netherlands, a country using "search and destroy" since 1988, where 0.11 cases of clinical infection per 1,000 patient days (57 infections in 527,267 patient days) were found during a study from 2008 to 2013 (18). Thus, it would be expected that many health care organizations will use some form of MRSA prevention and control approach that will heavily involve the laboratory.…”

Changing epidemiology of meticillin-resistant Staphylococcus aureus in 42 hospitals in the Dutch–German border region, 2012 to 2016: results of the search-and-follow-policy

“…The higher screening rates on the German side of the border may be ascribed to the fact that in German IPC recommendations, previous hospitalisation in Germany is a risk factor for MRSA carriage. This constitutes a main difference in defined risk factors between Dutch- and German MRSA IPC guidelines, whereby Dutch guidelines mostly consider screening for patients previously hospitalised outside the Netherlands (Tables 1 and 3) [14,24]. In this respect, we observed that although the densities of nosocomial MRSA cases were lower in NL-BRH than in DE-BRH (Table 3), the proportion of nosocomial MRSA cases among all MRSA detected was slightly higher in the Dutch hospitals (Table 2).…”

“…This ‘search-and-follow’ strategy was inspired from the ‘search-and-destroy’ policy implemented in Dutch hospitals since the 1980s. It aimed to improve application of the German national MRSA recommendations, the regional cooperation between hospitals, other healthcare facilities and public health authorities, as well as to create a more robust MRSA surveillance system [9,12-14]. Further to this strategy, screening for MRSA carriage among risk patients at hospital admission increased between 2009 and 2011 in these regional German hospitals and the nosocomial MRSA incidence density significantly decreased [15].…”

High prevalence of MRSA and ESBL among asylum seekers in the Netherlands

“…This policy includes screening of patients from high risk groups, strict isolation at admission of patients suspected to be colonized with MRSA until cultures are shown to be negative, but also eradication treatment of MRSA [ 3 – 5 ]. This strategy was proven to be cost-effective and results in less death due to a bacteraemia [ 6 ].…”