Methicillin-Resistant : What Is the Best Prevention Strategy?*Staphylococcus aureus: What Is the Best Prevention Strategy?* Infection in ICU: What Is the Best Prevention Strategy?*
In 2014, the Society for Healthcare Epidemiology of America in collaboration with the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission published an updated document on the strategies to prevent MRSA transmission and infection in acute care hospitals (5). These strategies include MRSA risk assessment, education, infection control measures, monitoring program, reporting, and accountability. If MRSA is not controlled with these strategies, special approaches may include active surveillance, decolonization (universal or targeted), universal gown and glove use, or additional special approaches. The data on the best approach to MRSA reduction have been mixed. Active screening for MRSA and decolonization in ICU settings has been associated with a decrease in MRSA infections, mortality, and medical costs (6). In a prospective, interventional study, using a case-control design, compared with targeted screening, universal screening increased the rate of detection of MRSA upon hospital admission but did not significantly reduce the rate of hospital-acquired MRSA infection and was associated with higher costs of care (7). In a pragmatic, cluster-randomized trial, universal decolonization was more effective than targeted decolonization or screening and isolation in reducing rates of MRSA clinical isolates and bloodstream infection (8). In a subsequent cost-effectiveness, decision-analysis model, the same authors demonstrated that, compared with screening and isolation, universal decolonization was estimated to save $171,000 and prevent nine additional bloodstream infections for every 1,000 ICU admissions (9). Individualized bundling infection control measures have also shown to improve quality of care and reduce cost (10).
In this issue of Critical Care Medicine, Whittington et al (11) performed another cost analysis of three prevention strategies for MRSA. Using a Markov model in a hypothetical cohort of adults admitted to the ICU followed up for 1 year, they found that universal and targeted decolonization were less costly and more effective than screening and isolation. When compared with targeted decolonization, universal decolonization was cost saving to cost effective, with maximum cost savings occurring when a hospital uses more expensive screening tests like polymerase chain reaction.