Value of Discontinuation of Contact Precautions (CP) for Methicillin-Resistant Staphylococcus aureus (MRSA)
Methods: We conducted a prospective observational study of PCR-based MRSA screening from 6/1/2012-12/31/2013 in the Emergency Department (ED) of the Massachusetts General Hospital, Boston, MA. Patients were eligible if they had a history of a MRSA-positive culture, but not more recent than 90d prior to the ED visit. Eligible subjects were enrolled upon screening for nasal colonization with PCR (subject-visit). PCR- subjects had CP discontinued; PCR+ subjects did not. The primary outcome was the proportion of enrolled subjects with CP-discontinuation. For subjects admitted to MGH within 30d of screening, we measured the time from ED arrival to inpatient bed arrival. When subjects were admitted to semi-private rooms and the paired bed remained vacant due to CP-status, we identified idle beds and compared attributable idle bed hours between PCR- and PCR+ subjects. Program costs (i.e, direct testing costs, personnel) minus decreased implementation of CP were estimated and compared to revenue from associated changes in idle bed hours affecting capacity.
Results: There were 2,864 eligible patients; 648 (23%) visits were enrolled. Of these, 65.1% (422/648) were PCR- and MRSA CP were discontinued. Among the 476 admissions, the PCR- (291) and PCR+ (185) admissions had similar mean hours-to-bed arrival (9.1 ± 5.7 vs 9.7 ± 6.4, p=0.29). PCR- subjects had shorter mean idle bed hours compared to PCR+ (28.6 ± 25.2 vs 75.3 ± 70.5, p<0.001). At representative hospital occupancy levels (75-99%), the expected revenues from increased capacity plus averted CP implementation costs exceeded program costs by a ratio of 2:1 (surplus: $181,000 - $271,000).
Conclusion: The majority of subjects were MRSA-negative by PCR and had MRSA CP discontinued. Among admitted subjects, PCR screening for MRSA with real-time removal of CP led to a substantial and significant reduction in idle bed hours. Estimates of program cost were outweighed by decreases in CP implementation costs and increased revenues from increased hospital capacity.
E. S. Shenoy,
J. Cotter, None
W. Ware, None
D. Kelbaugh, None
E. Weil, None
R. Walensky, None
D. Hooper, None