title: Clinical effectiveness and cost benefit of universal versus targeted methicillin-resistant Staphylococcus aureus screening upon admission in hospitals.
abstract: OBJECTIVE
  To conduct an exploratory study to evaluate the clinical effectiveness and cost benefit of universal versus targeted screening for methicillin-resistant Staphylococcus aureus (MRSA) to prevent hospital-acquired MRSA infections.
  
  
  METHODS
  Prospective, interventional study, using a case-control design, difference-in-differences, and cost-benefit analyses.
  
  
  METHODS
  Two community hospitals in Wisconsin.
  
  
  METHODS
  Consecutive sample of 15,049 adult admissions from April 2009 to July 2010.
  
  
  METHODS
  MRSA surveillance performed by polymerase chain reaction (PCR) on samples collected from all adult patients (aged over 18 years) within 30 days before or upon an admission to the hospital. During a 9-month baseline period, targeted screening was conducted at both hospitals. During the 5-month intervention period, all patients admitted to the intervention hospital were screened for MRSA. Infection control measures were consistent at both hospitals.
  
  
  RESULTS
  Universal screening was associated with an increase in admission screening of 43.58 percentage points (P< .01), an increase in MRSA detection of 2.95 percentage points (P< .01), and a small, nonsignificant decline in hospital-acquired MRSA infections of 0.12 percentage points (P< .01). The benefit-to-cost ratio was 0.50, indicating that for every dollar spent on universal versus targeted screening, only $0.50 is recovered in avoided costs of hospital-acquired MRSA infection.
  
  
  CONCLUSIONS
  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. Universal screening was associated with higher costs of care and was not cost beneficial.
authors.affiliation: Aurora Health Care, Milwaukee, Wisconsin 53122, USA. Kathy.Leonhardt@aurora.org
authors.forename: Kathryn K
authors.initials: KK
authors.lastname: Leonhardt
authors.forename: Olga
authors.initials: O
authors.lastname: Yakusheva
authors.forename: David
authors.initials: D
authors.lastname: Phelan
authors.forename: Anne
authors.initials: A
authors.lastname: Reeths
authors.forename: Teresa
authors.initials: T
authors.lastname: Hosterman
authors.forename: Deborah
authors.initials: D
authors.lastname: Bonin
authors.forename: Mike
authors.initials: M
authors.lastname: Costello
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D017053:Infection Control / Q000191:economics / Q000379:methods*; D008297:Male; D008403:Mass Screening / Q000191:economics*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D010343:Patient Admission; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D014922:Wisconsin