548. MRSA Infection Reduction Program Can Improve Patient Outcome and Reduces Cost
Session: Poster Abstract Session: MRSA Surveillance and Infection Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Background:  Methicillin resistant Staphylococcus aureus surgical site infections (MRSA SSI) are associated with increased morbidity, mortality, and significant cost.  A patient risk factor for MRSA SSI is colonization.  Timely and accurate identification of patients with MRSA is key to successful MRSA SSI prevention strategies. 

Methods: Patients undergoing implantable device surgery were tested for MRSA prior to surgery using target enriched multiplex polymerase chain reaction technology (TEM-PCR). TEM-PCR is unique technology which detects the MecA gene specifically. Technologies which detect the staphylococcal cassette chromosome (SCC) containing the MecA gene, have reduced sensitivity because MecA is frequently deleted from SCC.   Positive patients were placed in a MRSA SSI prevention protocol of mupiricin decolonization and chlorhexidine baths.  After treatment, patients were retested.  If the patient remained MRSA positive at the time of incision, vancomycin prophylaxis was administered and the patient placed in contact precautions.   Perioperative vancomycin and contact precautions were eliminated if repeat test was negative.

Results: Between August 2010 and March 2011, 3833 patients were tested.  568 were positive (15%).  483 of these patients were successfully decolonized and none developed MRSA SSI.  Four patients who tested negative for MRSA developed infection which was a decrease from 9 in the six months prior.  MRSA SSI in non-protocol patients was also reduced from 16 to 6.  1449 isolation days were eliminated.  Realized annualized revenue from program was $339,753. Additional cost benefit related to fewer vancomycin doses and reduced infections was also realized.   

Conclusion: These data suggest preoperative testing for MRSA using TEM-PCR and the infection reduction protocol of decolonization and chlorhexidine baths, can improve patient outcome by reducing MRSA SSI.  Successful decolonization prevents unnecessary isolation and can eliminate the need for perioperative vancomycin resulting in cost savings.


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Catherine D. Bacheller, MD, Medicine, Kettering Medical Center/Wright State University, Kettering, OH and Carol Quinter, PhD, Microbiology, Kettering Medical Center, Kettering, OH

Disclosures:

C. D. Bacheller, None

C. Quinter, Diatherix Clinical Laboratories: Consultant, Consulting fee

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.