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Three Surveillance Strategies for Vancomycin-Resistant Enterococci in Hospitalized Patients: Detection of Colonization Efficiency and a Cost-Effectiveness Model

Published online by Cambridge University Press:  21 June 2016

Todd A. Lee ,
Donna M. Hacek ,
Kevin T. Stroupe ,
Susan M. Collins  and
Lance R. Peterson
Todd A. Lee*
Affiliation:
Midwest Center for Health Services and Policy Research, Hines VA Hospital, Hines; and the Center for Healthcare Studies, Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois Department of Pharmacy Practice and Center for Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
Donna M. Hacek
Affiliation:
Evanston Northwestern Healthcare, Evanston, Illinois
Kevin T. Stroupe
Affiliation:
Midwest Center for Health Services and Policy Research, Hines VA Hospital, Hines; and the Center for Healthcare Studies, Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Susan M. Collins
Affiliation:
Northwestern Memorial Hospital, Chicago, Illinois
Lance R. Peterson
Affiliation:
Evanston Northwestern Healthcare, Evanston, Illinois Division of Clinical Microbiology and the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
*
Midwest Center for Health Services and Policy Research, Hines VA Hospital, PO Box 5000 (151-H), Hines, IL 60141todd.lee@med.va.gov
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Abstract

Objective:

To evaluate the cost-effectiveness and detection sensitivity associated with three active surveillance strategies for the identification of patients harboring vancomycin-resistant enterococci (VRE) to determine which is the most medically and economically useful.

Design:

Culture for VRE from 200 consecutive stool specimens submitted for Clostridium difficile culture. Following this, risk factors were assessed for patients whose culture yielded VRE, and a cost-effectiveness evaluation was performed using a decision analytic model with a probabilistic analysis.

Setting:

A 688-bed, tertiary-care facility in Chicago, Illinois, with approximately 39,000 annual admissions, 7,000 newborn deliveries, 56,000 emergency department visits, and 115,000 home care and 265,000 outpatient visits.

Subjects:

All stool specimens submitted to the clinical microbiology laboratory for C. difficile culture from hospital inpatients.

Results:

From 200 stool samples submitted for C. difficile testing, we identified 5 patients with VRE in non-high-risk areas not screened as part of our routine patient surveillance. Medical record review revealed that all 5 had been hospitalized within the prior 2 years. Three of 5 had a history of renal impairment. The strategy that would involve screening the greatest number of patients (all those with a history of hospital admission in the prior 2 years) resulted in highest screening cost per patient admitted ($2.48), lower per patient admission costs ($480), and the best survival rates.

Conclusion:

An expanded VRE surveillance program that encompassed all patients hospitalized within the prior 2 years was a cost-effective screening strategy compared with a more traditional one focused on high-risk units.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 1 , January 2005 , pp. 39 - 46
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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