The University of Kentucky (UK) HealthCare System maintains an active surveillance program to detect MRSA and other multi-drug resistant organisms such as Carbapenem Resistant Enterobacteriacae (CRE) in patients admitted to Intensive Care Units (ICUs). In November 2016, UK Healthcare discontinued contact precautions for patients with MRSA and VRE and simultaneously implemented universal decolonization of all adult ICU patients using a onetime application of nasal povidone iodine to the nares and a daily application of 2% chlorhexidine gluconate (CHG). Although viewed primarily an MRSA prevention intervention, chlorhexidine bathing is also a recommended strategy for preventing transmission of CRE. In this study, we analyzed the cost effectiveness of this intervention for preventing MRSA and CRE infections.
This study retrospectively reviewed MRSA and CRE infection and colonization data for adult patients admitted to an ICU between November 2015 and October 2017 as well as material costs associated with discontinuing isolation and instituting universal decolonization. Materials evaluated included gowns, nasal povidone iodine, and chlorhexidine gluconate. Descriptive analysis was performed to determine the hospital acquired MRSA and CRE rates of infection and colonization as well as the total number of infections. Cost analysis was determined by comparing the total cost of materials and the estimated cost of infections (determined by literature estimates) pre and post intervention.
The combined MRSA and CRE infection rate fell 48% (3.88 per 10,000 patient days vs. 2.00 per 10,000 patient days; p=0.083). We estimated a reduction of 11 infections (8 MRSA and 3 CRE) in the post intervention period. The opportunity cost associated with preventing those 11 infections was estimated to be $410,027. When incorporating all materials and infection costs, we demonstrated a total savings of $152,096.
The intervention of discontinuing contact precautions for MRSA and VRE and implementing universal decolonization in adult ICUs was associated with a significant decrease of MRSA and CRE infections and was determined to be cost effective.
A. Schadler, None
L. Olafsdottir, None
K. Sekhon, None
J. Pennington, None
D. Forster, None