| Methicillin-resistant Staphylococcus aureus (MRSA) is a growing problem in health care, associated with increased morbidity and mortality in patient populations. Several initiatives have deployed to decrease the number of MRSA infections in hospitalized patients. Two major areas are targeted: screening for colonization in patients and infection intervention strategies. These included bundling of screening tests and preventive measures such as decolonization and contact isolation. While infection prevention is vital in all hospital settings, the identification of appropriate screening groups remains unclear. Some authorities recommend a universal screening program to include all hospital admissions while others recommend screening in various settings, notably in high-risk patients (surgical, critically ill).;This study evaluated two aspects of MRSA screening: 1) validation of nucleic acid testing methods for MRSA when compared to the gold standard of microbiological culture, and; 2) a cost effectiveness and benefit analysis of screening for MRSA in a hospital setting. Validation of new test methods in the clinical laboratory compared traditional microbiological cultures using chromogenic MRSA agars versus polymerase chain reaction (PCR) assay using the Cepheid GeneXpert instrument. Based on industry standards, the two methods are equivalent for the identification of MRSA colonization. However a study of the cost effectiveness and cost benefit to the hospital was less clearcut. A pilot screening program of high risk patients revealed that PCR screening of high risk patients did result in a decrease in the number of hospital acquired infection. The cost of this type of screening compared to the cost of chromogenic agar screening was substantially greater. Other less tangible factors include turn-around time, which is considerably shorter for PCR methods. Further, although a difference in length of stay for patients screened for MRSA and who received infection intervention, it is difficult to determine the overall cost benefit of implementation of a screening program. |
