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Evaluation of screening risk and nonrisk patients for methicillin-resistant Staphylococcus aureus on admission in an acute care hospital

Evaluation of screening risk and nonrisk patients for methicillin-resistant Staphylococcus aureus on admission in an acute care hospital
Evaluation of screening risk and nonrisk patients for methicillin-resistant Staphylococcus aureus on admission in an acute care hospital
Background: screening for methicillin-resistant Staphylocccus aureus (MRSA) is advocated as part of control measures, but screening all patients on admission to hospital may not be cost-effective.

Objective: our objective was to evaluate the additional yield of screening all patients on admission compared with only patients with risk factors and to assess cost aspects.

Methods: a prospective, nonrandomized observational study of screening nonrisk patients ?72 hours of admission compared with only screening patients with risk factors over 3 years in a tertiary referral hospital was conducted. We also assessed the costs of screening both groups.

Results: a total of 48 of 892 (5%) patients was MRSA positive; 28 of 314 (9%) during year 1, 12 of 257 (5%) during year 2, and 8 of 321 (2%) during year 3. There were significantly fewer MRSA-positive patients among nonrisk compared with MRSA-risk patients: 4 of 340 (1%) versus 44 of 552 (8%), P ? .0001, respectively. However, screening nonrisk patients increased the number of screening samples by 62% with a proportionate increase in the costs of screening. A backward stepwise logistic regression model identified age > 70 years, diagnosis of chronic pulmonary disease, previous MRSA infection, and admission to hospital during the previous 18 months as the most important independent predictors to discriminate between MRSA-positive and MRSA-negative patients on admission (94.3% accuracy, P < .001).

Conclusion: screening patients without risk factors increased the number of screenings and costs but resulted in few additional cases being detected. In a hospital where MRSA is endemic, targeted screening of at-risk patients on admission remains the most efficient strategy for the early identification of MRSA-positive patients
0196-6553
411-415
Creamer, Eilish
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Galvin, Sandra
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Dolan, Anthony
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Sherlock, Orla
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Dimitrov, Borislav D
366d715f-ffd9-45a1-8415-65de5488472f
Fitzgerald-Hughes, Deirdre
ca3b87b5-b37e-40cb-a151-68f6ca501154
Thomas, Toney
8ccd22ca-e6c2-41af-8880-fbd238ef38c8
Walsh, John
e1af825d-b316-462f-904d-a2bad241e3da
Moore, Joan
d88b0dee-bb50-4131-a4f6-6bc0d0000334
Smyth, Edmond G
e540599b-6e8e-4cbf-ad6b-9e1bb595d7ae
Shore, Anna C
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Sullivan, Derek
95a0f7d2-c86e-4847-be21-e6e432b4df71
Kinnevey, Peter
12accab7-ac12-4e85-ba28-95925fc1d738
O'Lorcain, Piaras
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Cunney, Robert
98577b3b-bd9d-401c-8f14-a3eebb8e44dc
Coleman, David C
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Humphreys, Hilary
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Creamer, Eilish
c3405a02-64a1-4dda-833c-31242103525d
Galvin, Sandra
12bab9ac-3893-40e0-87e3-7b736cc00987
Dolan, Anthony
e4352412-0518-4661-9cb4-c3a853d58135
Sherlock, Orla
d09ed07b-5557-4d05-846d-67d24479da77
Dimitrov, Borislav D
366d715f-ffd9-45a1-8415-65de5488472f
Fitzgerald-Hughes, Deirdre
ca3b87b5-b37e-40cb-a151-68f6ca501154
Thomas, Toney
8ccd22ca-e6c2-41af-8880-fbd238ef38c8
Walsh, John
e1af825d-b316-462f-904d-a2bad241e3da
Moore, Joan
d88b0dee-bb50-4131-a4f6-6bc0d0000334
Smyth, Edmond G
e540599b-6e8e-4cbf-ad6b-9e1bb595d7ae
Shore, Anna C
925055c6-706c-467f-b5b5-18b458b1923b
Sullivan, Derek
95a0f7d2-c86e-4847-be21-e6e432b4df71
Kinnevey, Peter
12accab7-ac12-4e85-ba28-95925fc1d738
O'Lorcain, Piaras
490ca484-a088-488c-983e-f6cd22ae631f
Cunney, Robert
98577b3b-bd9d-401c-8f14-a3eebb8e44dc
Coleman, David C
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Humphreys, Hilary
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Creamer, Eilish, Galvin, Sandra, Dolan, Anthony, Sherlock, Orla, Dimitrov, Borislav D, Fitzgerald-Hughes, Deirdre, Thomas, Toney, Walsh, John, Moore, Joan, Smyth, Edmond G, Shore, Anna C, Sullivan, Derek, Kinnevey, Peter, O'Lorcain, Piaras, Cunney, Robert, Coleman, David C and Humphreys, Hilary (2012) Evaluation of screening risk and nonrisk patients for methicillin-resistant Staphylococcus aureus on admission in an acute care hospital. American Journal of Infection Control, 40 (5), 411-415. (doi:10.1016/j.ajic.2011.07.008). (PMID:21962934)

Record type: Article

Abstract

Background: screening for methicillin-resistant Staphylocccus aureus (MRSA) is advocated as part of control measures, but screening all patients on admission to hospital may not be cost-effective.

Objective: our objective was to evaluate the additional yield of screening all patients on admission compared with only patients with risk factors and to assess cost aspects.

Methods: a prospective, nonrandomized observational study of screening nonrisk patients ?72 hours of admission compared with only screening patients with risk factors over 3 years in a tertiary referral hospital was conducted. We also assessed the costs of screening both groups.

Results: a total of 48 of 892 (5%) patients was MRSA positive; 28 of 314 (9%) during year 1, 12 of 257 (5%) during year 2, and 8 of 321 (2%) during year 3. There were significantly fewer MRSA-positive patients among nonrisk compared with MRSA-risk patients: 4 of 340 (1%) versus 44 of 552 (8%), P ? .0001, respectively. However, screening nonrisk patients increased the number of screening samples by 62% with a proportionate increase in the costs of screening. A backward stepwise logistic regression model identified age > 70 years, diagnosis of chronic pulmonary disease, previous MRSA infection, and admission to hospital during the previous 18 months as the most important independent predictors to discriminate between MRSA-positive and MRSA-negative patients on admission (94.3% accuracy, P < .001).

Conclusion: screening patients without risk factors increased the number of screenings and costs but resulted in few additional cases being detected. In a hospital where MRSA is endemic, targeted screening of at-risk patients on admission remains the most efficient strategy for the early identification of MRSA-positive patients

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More information

e-pub ahead of print date: September 2011
Published date: 2012
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 337418
URI: http://eprints.soton.ac.uk/id/eprint/337418
ISSN: 0196-6553
PURE UUID: aeff22fe-83fe-4a52-9335-fc68efd2a7b0

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Date deposited: 26 Apr 2012 07:35
Last modified: 08 Nov 2021 22:40

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Contributors

Author: Eilish Creamer
Author: Sandra Galvin
Author: Anthony Dolan
Author: Orla Sherlock
Author: Borislav D Dimitrov
Author: Deirdre Fitzgerald-Hughes
Author: Toney Thomas
Author: John Walsh
Author: Joan Moore
Author: Edmond G Smyth
Author: Anna C Shore
Author: Derek Sullivan
Author: Peter Kinnevey
Author: Piaras O'Lorcain
Author: Robert Cunney
Author: David C Coleman
Author: Hilary Humphreys

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