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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

Monthly incidence of healthcare-associated methicillin-resistantStaphylococcus aureusinfections during non-intervention periods (period one and period three) and intervention periods (period two and period four) in the surgical intensive care unit.
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Fig2: Monthly incidence of healthcare-associated methicillin-resistantStaphylococcus aureusinfections during non-intervention periods (period one and period three) and intervention periods (period two and period four) in the surgical intensive care unit.

Mentions: Twenty-three patients developed MRSA infections (including eleven bloodstream infections, eight respiratory tract infections, two urinary tract infections, one cardiovascular system infection and one eye, ear, nose, throat or mouth infection) during their stay in the SICU in non-intervention periods, compared with two patients (two respiratory tract infections) during the intervention periods (Table 2). After the start of intervention, the monthly MRSA infection rate in the SICU rapidly dropped to zero (Figure 2) (overall MRSA infection rate: 3.58‰ (period 1) versus 0.42‰ (period 2), P <0.05). After the suspension of the program in May 2008, the monthly MRSA infection rates in the SICU rapidly resurged and rose to 12‰ in August 2009 (Figure 2), despite an improved hand hygiene practice from 16.44 to 21.87 liters per 1,000 patient days. After re-introduction of the intervention program in September 2009, the monthly MRSA infection rate rapidly dropped to zero again (Figure 2) (overall MRSA infection rate: 2.21‰ (period 3) versus 0.18‰ (period 4), P <0.05).Table 2


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)

Monthly incidence of healthcare-associated methicillin-resistantStaphylococcus aureusinfections during non-intervention periods (period one and period three) and intervention periods (period two and period four) in the 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

Fig2: Monthly incidence of healthcare-associated methicillin-resistantStaphylococcus aureusinfections during non-intervention periods (period one and period three) and intervention periods (period two and period four) in the surgical intensive care unit.
Mentions: Twenty-three patients developed MRSA infections (including eleven bloodstream infections, eight respiratory tract infections, two urinary tract infections, one cardiovascular system infection and one eye, ear, nose, throat or mouth infection) during their stay in the SICU in non-intervention periods, compared with two patients (two respiratory tract infections) during the intervention periods (Table 2). After the start of intervention, the monthly MRSA infection rate in the SICU rapidly dropped to zero (Figure 2) (overall MRSA infection rate: 3.58‰ (period 1) versus 0.42‰ (period 2), P <0.05). After the suspension of the program in May 2008, the monthly MRSA infection rates in the SICU rapidly resurged and rose to 12‰ in August 2009 (Figure 2), despite an improved hand hygiene practice from 16.44 to 21.87 liters per 1,000 patient days. After re-introduction of the intervention program in September 2009, the monthly MRSA infection rate rapidly dropped to zero again (Figure 2) (overall MRSA infection rate: 2.21‰ (period 3) versus 0.18‰ (period 4), P <0.05).Table 2

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