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Cost Savings of Universal Decolonization to Prevent Intensive Care Unit Infection: Implications of the REDUCE MRSA Trial

Published online by Cambridge University Press:  10 May 2016

Susan S. Huang
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Orange, California
Edward Septimus
Affiliation:
Hospital Corporation of America and Texas A&M Health Science Center College of Medicine, Houston, Texas
Taliser R. Avery
Affiliation:
Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
Grace M. Lee
Affiliation:
Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
Jason Hickok
Affiliation:
Hospital Corporation of America, Nashville, Tennessee
Robert A. Weinstein
Affiliation:
Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois
Julia Moody
Affiliation:
Hospital Corporation of America, Nashville, Tennessee
Mary K. Hayden
Affiliation:
Department of Pathology and Laboratory Medicine, Rush University Medical Center, Chicago, Illinois
Jonathan B. Perlin
Affiliation:
Hospital Corporation of America, Nashville, Tennessee
Richard Platt
Affiliation:
Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
G. Thomas Ray
Affiliation:
Division of Research, Kaiser Permanente Medical Care Program, Northern California Region, Oakland, California
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Objective.

To estimate and compare the impact on healthcare costs of 3 alternative strategies for reducing bloodstream infections in the intensive care unit (ICU): methicillin-resistant Staphylococcus aureus (MRSA) nares screening and isolation, targeted decolonization (ie, screening, isolation, and decolonization of MRSA carriers or infections), and universal decolonization (ie, no screening and decolonization of all ICU patients).

Design.

Cost analysis using decision modeling.

Methods.

We developed a decision-analysis model to estimate the health care costs of targeted decolonization and universal decolonization strategies compared with a strategy of MRSA nares screening and isolation. Effectiveness estimates were derived from a recent randomized trial of the 3 strategies, and cost estimates were derived from the literature.

Results.

In the base case, universal decolonization was the dominant strategy and was estimated to have both lower intervention costs and lower total ICU costs than either screening and isolation or targeted decolonization. Compared with screening and isolation, universal decolonization was estimated to save $171,000 and prevent 9 additional bloodstream infections for every 1,000 ICU admissions. The dominance of universal decolonization persisted under a wide range of cost and effectiveness assumptions.

Conclusions.

A strategy of universal decolonization for patients admitted to the ICU would both reduce bloodstream infections and likely reduce healthcare costs compared with strategies of MRSA nares screening and isolation or screening and isolation coupled with targeted decolonization.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

References

1. Vincent, JL, Relio, J, Marshall, J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009;302:23232329.CrossRefGoogle Scholar
2. United States Government Accountability Office. Healthcare-Associate Infections in Hospitals. Report to the Chairman, Committee on Oversight and Government Reform, House of Representatives, 2008.Google Scholar
3. Umscheid, CA, Mitchell, MD, Doshi, JA, Agarwal, R, Williams, K., Brennan, PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011 ;32:101114.CrossRefGoogle ScholarPubMed
4. Lucet, JC, Paoletti, X, Lolom, I, et al. Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med 2005;31:10511057.CrossRefGoogle ScholarPubMed
5. Huang, SS, Yokoe, DS, Hinrichsen, VL, et al. Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2006;43:971978.CrossRefGoogle ScholarPubMed
6. Bleasdale, SC, Trick, WE, Gonzalez, IM, Lyles, RD, Hayden, MK, Weinstein, RA. Effectiveness of chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Intern Med 2007;167:20732079.CrossRefGoogle ScholarPubMed
7. Ridenour, G, Lampen, R, Federspiel, J, Kritchevsky, S, Wong, E, Climo, M. Selective use of intranasal mupirocin and chlorhexidine bathing and the incidence of methicillin-resistant Staphylococcus aureus colonization and infection among intensive care unit patients. Infect Control Hosp Epidemiol 2007;28:11551161.CrossRefGoogle ScholarPubMed
8. Huskins, WC, Huckabee, CM, O'Grady, NP, et al. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 2011;364:14071418.CrossRefGoogle ScholarPubMed
9. Huang, SS, Septimus, E, Kleinman, K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med 2013;368:22552265.CrossRefGoogle ScholarPubMed
10. Climo, MW, Yokoe, DS, Warren, DK, et al. Effect of daily chlorhexidine bathing on hospital-acquired infection. N Engl J Med 2013;368:533542.CrossRefGoogle ScholarPubMed
11. Derde, LP, Cooper, BS, Goossens, H, et al. Interventions to reduce colonisation and transmission of antimicrobial-resistant bacteria in intensive care units: an interrupted time series study and cluster randomised trial. Lancet Infect Dis 2013;14:3139.CrossRefGoogle ScholarPubMed
12. Perlin, JB, Hickok, JD, Septimus, EJ, Moody, JA, Englebright, JD, Bracken, RM. A bundled approach to reduce methicillin-resistant Staphylococcus aureus infections in a system of community hospitals. J Healthc Qual 2013;35:5768.CrossRefGoogle Scholar
13. Hassan, M, Tuckman, HP, Patrick, RH, Kountz, DS, Kohn, JL. Cost of hospital-acquired infection. Hosp Top 2010;88:8289.CrossRefGoogle ScholarPubMed
14. Roberts, RR, Frutos, PW, Ciavarella, GG, et al. Distribution of variable vs fixed costs of hospital care. JAMA 1999;281:644649.CrossRefGoogle ScholarPubMed
15. Nelson, RE, Samore, MH, Smith, KJ, Harbarth, S, Rubin, MA. Cost-effectiveness of adding decolonization to a surveillance strategy of screening and isolation for methicillin-resistant Staphylococcus aureus carriers. Clin Microbiol Infect 2010; 16: 17401746.CrossRefGoogle ScholarPubMed
16. Dasta, JF, McLaughlin, TP, Mody, SH, Piech, CT. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med 2005;33:12661271.CrossRefGoogle ScholarPubMed
17. Graves, N. Economics and preventing hospital-acquired infection. Emerg Infect Dis 2004;10:561566.CrossRefGoogle ScholarPubMed
18. Graves, N, Weinhold, D, Tong, E, et al. Effect of healthcare-acquired infection on length of hospital stay and cost. Infect Control Hosp Epidemiol 2007;28:280292.CrossRefGoogle ScholarPubMed
19. Richter, SS, Diekema, DJ, Heilmann, KP, et al. Activities of vancomycin, ceftaroline, and mupirocin against Staphylococcus aureus isolates collected in a 2011 national surveillance study in the United States. Antimicrob Agents Chemother 2014;58(2):740745.CrossRefGoogle Scholar
20. Desroches, M, Potier, J, Laurent, F, et al. Prevalence of mupirocin resistance among invasive coagulase-negative staphylococci and methicillin-resistant Staphylococcus aureus (MRSA) in France: emergence of a mupirocin-resistant MRSA clone harbouring mupA. J Antimicrob Chemother 2013;68(8):17141717.CrossRefGoogle ScholarPubMed
21. Kang, J, Mandsager, P, Biddle, AK, Weber, DJ. Cost-effectiveness analysis of active surveillance screening for methicillin-resistant Staphylococcus aureus in an academic hospital setting. Infect Control Hosp Epidemiol 2012;33:477486.CrossRefGoogle Scholar
22. Puzniak, LA, Gillespie, KN, Leet, T, Kollef, M, Mundy, LM. A cost-benefit analysis of gown use in controlling vancomycin-resistant Enterococcus transmission: is it worth the price? Infect Control Hosp Epidemiol 2004;25:418424.CrossRefGoogle ScholarPubMed
23. Morgan, DJ, Pineles, L, Shardell, M, et al. The effect of contact precautions on healthcare worker activity in acute care hospitals. Infect Control Hosp Epidemiol 2013;34:6973.CrossRefGoogle ScholarPubMed
24. Courville, XF, Tomek, IM, Kirkland, KB, Birhle, M, Kantor, SR, Finlayson, SR. Cost-effectiveness of preoperative nasal mupirocin treatment in preventing surgical site infection in patients undergoing total hip and knee arthroplasty: a cost-effectiveness analysis. Infect Control Hosp Epidemiol 2012;33:152159.CrossRefGoogle ScholarPubMed
25. Kilgore, M, Brossette, S. Cost of bloodstream infections. Am J Infect Control 2008;36:S172S173.CrossRefGoogle ScholarPubMed