Aggressive methicillin-resistant Staphylococcus aureus screening of patients upon admission to the intensive care unit is cost-effective for American hospitals, study shows.
"What we've shown is that the use of widely-published screening processes will likely to save a hospital money by reducing patient stay, and that's good for the hospital's bottom line," says Gregory Filice, Professor of Medicine and Chief of the Infectious Disease Section at the University of Minnesota in Minneapolis.
A study, led by John Nyman of the 279-bed Veterans Affairs Medical Center in Minneapolis, is based on calculating all conceivable costs of screening patients who might be colonized with MRSA, including gowns, gloves, masks, and the time to don them, and the cost of equipment dedicated to each infected patient.
The study, published a recent issue of the American Journal of Infection Control was performed with patients who were admitted to the intensive care unit between 2004 and 2006. The tally compared costs of imposing isolation precautions on those who had colonized MRSA (since infected patients were already isolated), compared with no intervention.
The bottom line is that the total cost of screening and isolating those patients with colonization, on a per patient basis, was either $22.22, $23.33 and $30.20 depending on which of three screening tests (culture, chromogenic agar or PCR) were used. But that was very cost-effective, compared to the cost of caring for a patient who became infected.
The cost of taking care of a MRSA-infected patient "averaged $1,620.69 per diem during the period 2004-2006," with an average 39-day length of stay. That compares with the average per diem cost of a patient with colonized MRSA who is not infected, of $2,553, but whose average length of stay was 33 days less, only 5.9 days, the researchers wrote, based on data from 2005.
"For every admission, about .0321 MRSA infections were avoided with the intervention, resulting in a net savings of $484 per admission," the researchers wrote. For more expensive screening tests, the savings were similar but slightly less, $483 and $476, per admission.
"The results suggest that each patient admitted is expected to cost $18,051 without the intervention, but $17,567 with the intervention," they wrote.
In an interview, Filice says that some hospitals might balk at the suggestion they should expend this amount in resources for universal ICU screening because they don't perceive they have that much of a MRSA problem in their community.
To that extent, the issue is controversial, and solutions should be individualized.
"Here's the other side of the debate," he says. "Some people say we shouldn't have organism specific programs, because they have lots of different types of infections, such as C. diff or multiple resistant gram negative rod infections. Well, our study helps people decide what's best for their hospital. They may wish to put their resources into something else."
The VA setting may be unique, because its population is older, and tends to be sicker with co-morbidities and perhaps higher risk of infections, Filice adds. However, Filice says that it does represent hospital experience because non-VA hospitals may have higher costs. "The cost-savings generated by the screening intervention may have been even greater if the resources used had been evaluated at non-VA unit prices."
At the VA, protocol is to screen for MRSA on admission and discharge from each ward in hospital. So, that would include most discharges from hospital.
That may be the next major care and cost focus for hospitals hoping to avoid penalties from expected new regulations stemming from the Patient Protection and Affordable Care Act which reduce per discharge reimbursements for hospitals with higher rates of infections acquired within their walls.