Program Schedule

901
Presumptive Isolation or Screen and Isolate for Patients at High Risk for Methicillin-resistant Staphylococcus aureus: A Monte Carlo Simulation of the Economic Impact to the Individual Hospital

Session: Poster Abstract Session: HAI Surveillance and Public Reporting
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC

Background: A common strategy for preventing nosocomial MRSA transmission is reactive isolation after positive nares surveillance. However, nares screening has low sensitivity for MRSA carriage. In high-risk patients, some have considered non-nares screening or presumptive isolation without surveillance. We sought to model the economic implementation cost, from a hospital perspective, of strategies for high-risk admissions.

Methods:  We modeled the economic impact of three body-site MRSA screening (nares, pharynx, and inguinal folds) and presumptive isolation for high-risk admissions from a hospital perspective. Projected costs and benefits were derived from the literature. We examined threshold values for 1) probability of MRSA carriage in an admitted patient and 2) impact of MRSA infection (in terms of increased length of stay) that would be cost-neutral (costs=benefits).

Results: In our baseline model, the costs of both screening and isolation and presumptive isolation exceeded savings generated by preventing MRSA infections.  Nares screening and contact precautions prevented 0.6 infections (95% CR, 0.5-0.7) per 1,000 high-risk admissions, and yielded a net financial loss of $36,899 (95% CR, $31,525 to $42,690). Three body-site surveillance prevented 0.8 infections (95% CR, 0.7-0.9) per 1,000 high-risk admissions, but resulted in even greater higher financial loss $51,478 (95% CR, $45,566 to $57,821). Presumptive isolation prevented the most infections (1.0 infections; 95% CR, 0.9-1.1), but resulted in large financial losses $300,765 (95% CR, $296,155 to $304,835) of any model tested. Using optimistic estimates for the efficacy of isolation in terms of preventing new MRSA infections, three body-site surveillance could be cost-neutral in targeted populations at risk for high-complexity infections, e.g. prosthetic joint infections or post-operative mediastinitis. Presumptive isolation was never cost-neutral.

Conclusion: Although multiple body site surveillance or presumptive isolation for high-risk patients could reduce nosocomial MRSA infections, the program's overall cost exceeds any savings generated from infections prevented. For an individual hospital, the cost of screening and isolation needs to weighed against other infection control interventions and patient safety efforts.

James a. Mckinnell, MD1,2, Sarah M. Bartsch, MPH3, Bruce Lee, MD, MBA3, Susan S. Huang, MD, MPH, FIDSA4 and Loren Miller, MD, MPH2, (1)Torrance Memorial Medical Center, Torrance, CA, (2)Infectious Disease Clinical Outcomes Research Unit (ID-CORE) at Los Angeles Biomedical Research Institute, Torrance, CA, (3)Public Health Computational and Operations Research (PHICOR) Group, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (4)Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA

Disclosures:

J. A. Mckinnell, None

S. M. Bartsch, None

B. Lee, None

S. S. Huang, Sage Products: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed Product
Molnlycke: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed product

L. Miller, None

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