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Cost-effectiveness of pre-operative Staphylococcus aureus screening and decolonization

Published online by Cambridge University Press:  20 September 2018

Susan E. Kline ,
Erinn C. Sanstead ,
James R. Johnson  and
Shalini L. Kulasingam
Susan E. Kline*
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
Erinn C. Sanstead
Affiliation:
Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, Minnesota
James R. Johnson
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota Veterans Affairs Medical Center, Minneapolis, Minnesota
Shalini L. Kulasingam
Affiliation:
Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, Minnesota
*
Author for correspondence: Susan Kline MD, MPH, 420 Delaware St SE, MMC# 250, Minneapolis, MN 55455. E-mail: kline003@umn.edu
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Abstract

Objective

We developed a decision analytic model to evaluate the impact of a preoperative Staphylococcus aureus decolonization bundle on surgical site infections (SSIs), health-care–associated costs (HCACs), and deaths due to SSI.

Methods

Our model population comprised US adults undergoing elective surgery. We evaluated 3 self-administered preoperative strategies: (1) the standard of care (SOC) consisting of 2 disinfectant soap showers; (2) the “test-and-treat” strategy consisting of the decolonization bundle including chlorhexidine gluconate (CHG) soap, CHG mouth rinse, and mupirocin nasal ointment for 5 days) if S. aureus was found at any of 4 screened sites (nasal, throat, axillary, perianal area), otherwise the SOC; and (3) the “treat-all” strategy consisting of the decolonization bundle for all patients, without S. aureus screening. Model parameters were derived primarily from a randomized controlled trial that measured the efficacy of the decolonization bundle for eradicating S. aureus.

Results

Under base-case assumptions, the treat-all strategy yielded the fewest SSIs and the lowest HCACs, followed by the test-and-treat strategy. In contrast, the SOC yielded the most SSIs and the highest HCACs. Consequently, relative to the SOC, the average savings per operation was $217 for the treat-all strategy and $123 for the test-and-treat strategy, and the average savings per per SSI prevented was $21,929 for the treat-all strategy and $15,166 for the test-and-treat strategy. All strategies were sensitive to the probability of acquiring an SSI and the increased risk if SSI if the patient was colonized with SA.

Conclusion

We predict that the treat-all strategy would be the most effective and cost-saving strategy for preventing SSIs. However, because this strategy might select more extensively for mupirocin-resistant S. aureus and cause more medication adverse effects than the test-and-treat approach or the SOC, additional studies are needed to define its comparative benefits and harms.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 11 , November 2018 , pp. 1340 - 1346
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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