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Impact of active screening for methicillin-resistant Staphylococcus aureus (MRSA) and decolonization on MRSA infections, mortality and medical cost: a quasi-experimental study in surgical intensive care unit.

Lee YJ, Chen JZ, Lin HC, Liu HY, Lin SY, Lin HH, Fang CT, Hsueh PR - Crit Care (2015)

Bottom Line: However, there is currently a lack of data on its effect on mortality and medical cost.Regression models were used to adjust for effects of confounding variables.After adjusting for effects of confounding variables, the active screening and decolonization program was independently associated with a decrease in in-hospital MRSA infections (adjusted odds ratio: 0.3; 95% CI: 0.1 to 0.8) and 90-day mortality (adjusted hazard ratio: 0.8; 95% CI: 0.7 to 0.99).

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases, Department of Internal Medicine, Taipei Medical University Hospital, 252 Wusing Street, Taipei, 11031, Taiwan. yuarn438@yahoo.com.tw.

ABSTRACT

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is a leading pathogen of healthcare-associated infections in intensive care units (ICUs). Prior studies have shown that decolonization of MRSA carriers is an effective method to reduce MRSA infections in ICU patients. However, there is currently a lack of data on its effect on mortality and medical cost.

Methods: Using a quasi-experimental, interrupted time-series design with re-introduction of intervention, we evaluated the impact of active screening and decolonization on MRSA infections, mortality and medical costs in the surgical ICU of a university hospital in Taiwan. Regression models were used to adjust for effects of confounding variables.

Results: MRSA infection rate decreased from 3.58 (baseline) to 0.42‰ (intervention period) (P <0.05), re-surged to 2.21‰ (interruption period) and decreased to 0.18‰ (re-introduction of intervention period) (P <0.05). Patients admitted to the surgical ICU during the intervention periods had a lower in-hospital mortality (13.5% (155 out of 1,147) versus 16.6% (203 out of 1,226), P = 0.038). After adjusting for effects of confounding variables, the active screening and decolonization program was independently associated with a decrease in in-hospital MRSA infections (adjusted odds ratio: 0.3; 95% CI: 0.1 to 0.8) and 90-day mortality (adjusted hazard ratio: 0.8; 95% CI: 0.7 to 0.99). Cost analysis showed that $22 medical costs can be saved for every $1 spent on the intervention.

Conclusions: Active screening for MRSA and decolonization in ICU settings is associated with a decrease in MRSA infections, mortality and medical cost.

No MeSH data available.


Related in: MedlinePlus

Study design: period one (baseline), period two (intervention period), period three (interruption period) and period four (re-introduction of intervention period). MRSA: methicillin-resistant Staphylococcus aureus; SICU: surgical intensive care unit.
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Fig1: Study design: period one (baseline), period two (intervention period), period three (interruption period) and period four (re-introduction of intervention period). MRSA: methicillin-resistant Staphylococcus aureus; SICU: surgical intensive care unit.

Mentions: The study period was divided into four stages. In period one (baseline, between January and September 2007), contact precautions, eradication and environmental disinfection at discharge were performed only for those patients with positive clinical cultures for MRSA. In period two (intervention period), routine active screening and decolonization (supported by a research grant from the hospital) was initiated and lasted between October 2007 and April 2008. The intervention was halted in period three (interruption period, between May 2008 and August 2009) owing to a lack of research grants. After a resurgence in the SICU MRSA infection rates during period three prompted the hospital leadership to provide financial support for the active screening and decolonization program, the intervention was resumed in period four (reintroduction period, between September 2009 and September 2010) (Figure 1).Figure 1


Impact of active screening for methicillin-resistant Staphylococcus aureus (MRSA) and decolonization on MRSA infections, mortality and medical cost: a quasi-experimental study in surgical intensive care unit.

Lee YJ, Chen JZ, Lin HC, Liu HY, Lin SY, Lin HH, Fang CT, Hsueh PR - Crit Care (2015)

Study design: period one (baseline), period two (intervention period), period three (interruption period) and period four (re-introduction of intervention period). MRSA: methicillin-resistant Staphylococcus aureus; SICU: surgical intensive care unit.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4403941&req=5

Fig1: Study design: period one (baseline), period two (intervention period), period three (interruption period) and period four (re-introduction of intervention period). MRSA: methicillin-resistant Staphylococcus aureus; SICU: surgical intensive care unit.
Mentions: The study period was divided into four stages. In period one (baseline, between January and September 2007), contact precautions, eradication and environmental disinfection at discharge were performed only for those patients with positive clinical cultures for MRSA. In period two (intervention period), routine active screening and decolonization (supported by a research grant from the hospital) was initiated and lasted between October 2007 and April 2008. The intervention was halted in period three (interruption period, between May 2008 and August 2009) owing to a lack of research grants. After a resurgence in the SICU MRSA infection rates during period three prompted the hospital leadership to provide financial support for the active screening and decolonization program, the intervention was resumed in period four (reintroduction period, between September 2009 and September 2010) (Figure 1).Figure 1

Bottom Line: However, there is currently a lack of data on its effect on mortality and medical cost.Regression models were used to adjust for effects of confounding variables.After adjusting for effects of confounding variables, the active screening and decolonization program was independently associated with a decrease in in-hospital MRSA infections (adjusted odds ratio: 0.3; 95% CI: 0.1 to 0.8) and 90-day mortality (adjusted hazard ratio: 0.8; 95% CI: 0.7 to 0.99).

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases, Department of Internal Medicine, Taipei Medical University Hospital, 252 Wusing Street, Taipei, 11031, Taiwan. yuarn438@yahoo.com.tw.

ABSTRACT

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is a leading pathogen of healthcare-associated infections in intensive care units (ICUs). Prior studies have shown that decolonization of MRSA carriers is an effective method to reduce MRSA infections in ICU patients. However, there is currently a lack of data on its effect on mortality and medical cost.

Methods: Using a quasi-experimental, interrupted time-series design with re-introduction of intervention, we evaluated the impact of active screening and decolonization on MRSA infections, mortality and medical costs in the surgical ICU of a university hospital in Taiwan. Regression models were used to adjust for effects of confounding variables.

Results: MRSA infection rate decreased from 3.58 (baseline) to 0.42‰ (intervention period) (P <0.05), re-surged to 2.21‰ (interruption period) and decreased to 0.18‰ (re-introduction of intervention period) (P <0.05). Patients admitted to the surgical ICU during the intervention periods had a lower in-hospital mortality (13.5% (155 out of 1,147) versus 16.6% (203 out of 1,226), P = 0.038). After adjusting for effects of confounding variables, the active screening and decolonization program was independently associated with a decrease in in-hospital MRSA infections (adjusted odds ratio: 0.3; 95% CI: 0.1 to 0.8) and 90-day mortality (adjusted hazard ratio: 0.8; 95% CI: 0.7 to 0.99). Cost analysis showed that $22 medical costs can be saved for every $1 spent on the intervention.

Conclusions: Active screening for MRSA and decolonization in ICU settings is associated with a decrease in MRSA infections, mortality and medical cost.

No MeSH data available.


Related in: MedlinePlus