Cost-savings achieved by eradication of epidemic methicillin-resistant Staphylococcus aureus (EMRSA)-16 from a large teaching hospital
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Methicillin-resistant Staphylococcus aureus continues to be an increasing problem worldwide, although its prevalence in the Nordic countries still is low. In 1997 an unusually readily transmissible strain of epidemic methicillin-resistant S. aureus, EMRSA-16, was introduced by a single patient into a 2,600 bed teaching hospital in Sweden. Despite the standard “search and destroy” policy (Standard MRSA Control Programme), the outbreak took on epidemic proportions. Therefore, the hospital management chose to implement vigorous and costly actions (Intensive MRSA Control Programme). These measures were successful, and the strain was completely eradicated. Whether the actions taken were cost-effective was analysed using an analytical framework in which different scenarios were simulated (decision analytic modelling). Thus, the relative costs and consequences of the Standard MRSA Control Programme and the Intensive MRSA Control Programme could be compared in a simple manner. Coefficients were developed from the observations of the transmission of the bacteria during the period preceding the study period. These were then used to simulate the outcome of the alternative programmes. The uncertainty of the results was explored in sensitivity analyses. The Intensive MRSA Control Programme was shown to be cost saving after slightly more than 24 months of implementation. In conclusion, due to vigorous control efforts, a large EMRSA-16 outbreak in a university hospital was stopped. The initial costs of the control programme were high, but future healthcare resources were saved.
KeywordsHand Hygiene Reference Period Hospital Infection Control Communicable Disease Control Cohort Care
We wish to express our gratitude to Prof. Bengt Jönsson, Stockholm School of Economics, Sweden, for his support regarding the health economic aspects of this study. We are also grateful for the assistance of the following persons from Sahlgrenska University Hospital in Gothenburg: Leif Larsson, Department of Hospital Infection Control, for information about the transmission of EMRSA-16 within the hospital; Torsten Sandberg, MD, PhD, Department of Infectious Diseases, for supplying information on the care of the EMRSA-16 patients, and Leif Sundberg, Department of Economics, for help in identifying the costs of the outbreak. The study was performed in accordance with the current laws of Sweden.
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