title: Cost and health outcomes associated with mandatory MRSA screening in a special care nursery.
abstract: OBJECTIVE
  Methicillin-resistant Staphylococcus aureus (MRSA) rates continue to rise and pose a threat to patient health and limited hospital resources. In 2007, Illinois passed a legislative mandate requiring active surveillance cultures to screen for MRSA in all patients in hospital intensive care units. However, professional guidelines do not support mandated universal surveillance cultures, and funding to cover screening costs was not included. The purpose of the study was to examine the costs (personnel, screening test, and supply) associated with the mandated universal MRSA screening and to examine the infant health-related outcomes and costs associated with implementing MRSA screening in a special care nursery.
  
  
  METHODS
  Personnel-54 observations of staff members in a community-based hospital in a large midwestern city. Infants-445 infants admitted from January 2008 through January 2009.
  
  
  METHODS
  Time and motion (related to screening activities by registered nurses) based on observations of staff during MRSA screenings, and abstraction of health and cost data from the infant log, infant medical records, and financial reports.
  
  
  METHODS
  Costs (laboratory tests, personnel, and supplies) and infant health outcomes.
  
  
  METHODS
  A prospective descriptive study.
  
  
  RESULTS
  Mandatory screening leads to increased costs, problems related to false-positives, and unintended consequences (eg, decision whether to treat non-MRSA organisms identified on screening cultures, possibility of legal implications, adverse family psychosocial affects, and questionable validity of the polymerase chain reaction test). The average total costs of laboratory, supply, and personnel were $15,270.12 ($34.31 per infant or $19.58 per screen).
  
  
  CONCLUSIONS
  A screening test for MRSA with a high positive predictive value, low cost, and quick turnaround (<24 hours) is greatly needed for neonates. Our findings indicate that mandatory universal MRSA screening is not warranted when the incidence of MRSA is low. Just as health care providers require evidence when determining best practices, legislators should require adequate evidence before passing policy.
authors: Saint Joseph Hospital, USA. rgarcia1@reshealthcare.org
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