Screening high-risk patients for methicillin-resistant Staphylococcus aureus on admission to the hospital: Is it cost effective?

OBJECTIVES: To determine the cost-effectiveness of a policy of screening hi gh-risk patients for methicillin-resistant Staphylococcus aureus (MRSA) col onization on admission to hospital. SETTING: 980-bed university-affiliated tertiary-care hospital. PATIENTS: Between June 1996 and May 1997, patients directly transferred fro m another hospital or nursing home, or who had been hospitalized in the pre vious 3 months, were screened for MRSA within 72 hours of hospital admissio n. DESIGN: Nasal, perineal, and wound swabs were obtained for MRSA screening u sing standard laboratory methods. Laboratory and nursing costs associated w ith screening patients for MRSA on admission to hospital were calculated. T he costs associated with the implementation of recommended infection contro l measures for patients with MRSA also were determined. RESULTS: 3,673 specimens were obtained from 1,743 patients. MRSA was found on admission in 23 patients (1.3%), rep resenting 36% of the 64 patients wi th MRSA identified in the hospital during the year. MRSA-colonized patients were more likely to have been transferred from a nursing home (odds ratio [OR], 6.4; P=.04) or to have had a previous history of MRSA colonization (O R, 13.1; P=.05). Laboratory and nursing costs were found to be $8.34 per sp ecimen, for a total cost of $30,632 during the year. The average cost of im plementing recommended infection control measures for patients colonized wi th MRSA was approximately $5,235 per patient. CONCLUSION: If early identification of MRSA. in colonized patients prevents nosocomial transmission of the organism to as few as six new patients, the screening program would save money.