MRSA screening program saving lives and dollars
MRSA screening program saving lives and dollars
'The worst enemy of good is perfect.'
A universal screening program for methicillin-resistant Staphylococcus aureus (MRSA) at Loyola University Medical Center in Chicago is reducing infections by approximately 70% annually, says Jorge Parada, MD, MPH, infectious disease chief at the teaching hospital.
Based on the Loyola experience, hospitals that undertake similar aggressive screening programs to detect MRSA in admitted patients will probably at least break even on the financial investment while meeting the higher moral imperative to protect patients from infections. That's based on a "back of the envelope" calculation of a program that has now been underway three years at the hospital, Parada says.
"It has cost us somewhere around $3.5 million and we think we have saved from $4 to $5 million," Parada says. "We have no doubt that it has paid for itself and probably has made the hospital money in terms of getting people discharged sooner because they didn't get MRSA infections. That allows more patients to be admitted, so the 'through-put' is greater and that in of itself pays for the program. Never mind the right reason for doing it, which is that there are some 150 patients by our estimate that didn't have an MRSA infection [over the three-year period]."
When Illinois passed an MRSA screening law in 2007, Parada and colleagues decided to go beyond the limited scope of the statute and develop a state-of-the-art program.
"We are doing more than what is required by the law," he explains. "The law stipulates that everyone admitted to an intensive care unit needs to be screened for MRSA. In addition, anyone admitted to a hospital that is going to a non-ICU bed but is deemed to be at high risk of being an MRSA carrier should also be screened."
However, the patient risk definitions may vary by facility and the law is poorly enforced in any case, he adds. "The truth is with community-associated MRSA essentially everybody is at risk for MRSA," Parada says. "You no longer have these well defined patient groups that are easy to identify."
As a result, Loyola went to a universal screening policy for MRSA.
"We screen every single person who is admitted to the hospital independent of whether they are going to the ICU or not," he says. "We can't predict who might be a carrier, but only if we know someone's status are we going to put them in contact isolation. Then we are less likely to pick up the MRSA from that patient and hand it off to another patient."
Upfront expenses for such programs include molecular PCR testing, which provide results in a matter of hours instead of days. "You get your answer back in time to make sure that the patient is put on isolation precautions," he says. "If you rely on culture which is much cheaper by the time you get your results back you have already contaminated a bunch of other patients. I think the more people that adopt screening the less [the testing] is going to cost."
The devil you know or don't
What about the "unintended consequences" often cited as arguments against MRSA screening, including such issues as room shortages, patient admission backups and diminished care to patients under contact isolation precautions?
"A lot of those comments have some degree of truth I won't deny that," he says. "But the worst enemy of good is perfect. What they are doing with that argument is focusing on the devil you know versus the devil you don't. Look, anytime that we know somebody has an MDRO whether its MRSA or this New Delhi gram negative strain there is nobody in infection control that would dare to say, `We are not going to put this person in isolation.'"
The cost effective argument also pales somewhat when you realize many public health interventions and screenings would have never been established if they had to pass such a test.
"Keep in mind, there are a lot of interventions that we do that nobody would think of not doing," he says. "There are a lot of screenings that we do that never come close to being cost effective, but the question is can we save a few lives? With MRSA, the screening is proving to be more than cost effective in addition to saving lives."
That said, Parada cautions against any patient perception that hospital MRSA screening is going to end the infections or the tragic stories told in their aftermath.
"Some of those stories might have been exactly the same whether there was screening or not," he says. "We know that there are a substantial number of these MRSA infections that are preventable by using screening, but it won't touch all the ones that are going on out in the community. This is a hospital-based intervention that can improve care in the hospital, but it will not reduce in any way the bulk of MRSA infections in the community."
A universal screening program for methicillin-resistant Staphylococcus aureus (MRSA) at Loyola University Medical Center in Chicago is reducing infections by approximately 70% annually, says Jorge Parada, MD, MPH, infectious disease chief at the teaching hospital.Subscribe Now for Access
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