title: Effectiveness and cost of implementing an active surveillance screening policy for Acinetobacter baumannii: a Monte Carlo simulation model.
abstract: BACKGROUND
  Acinetobacter baumannii infections are common and associated with high mortality and costs. Early identification of asymptomatic carriers can reduce patient-to-patient transmission, but the sensitivity of A baumannii surveillance tools is poor, and thus active surveillance is not routine practice. This study examined whether an active surveillance screening policy can reduce the transmission, mortality, and costs associated with A baumannii.
  
  
  METHODS
  A simulation model was developed to determine the impact of active screening on patient outcomes. Model parameters included A baumannii prevalence, screening sensitivity and specificity, probability of transmission, progression from colonization to infection, mortality, and cost of screening, contact precautions, and infection. A scenario analysis was performed to evaluate the robustness of the results when varying the sensitivity of the screening test and the prevalence rate of A baumannii.
  
  
  RESULTS
  Assuming a screening sensitivity of 55%, active screening reduced A baumannii transmissions, infections, and deaths by 48%. As the screening sensitivity approached 90%, the reduction in transmissions, infections, and deaths reached 78%. For all scenarios tested, active surveillance was cost saving (19%-53% reduction in mean hospital cost per patient) except at a carrier prevalence of ≤2% and screening test sensitivity of ≤55%.
  
  
  CONCLUSIONS
  In institutions where A baumannii is endemic or during epidemics, implementing a surveillance program is cost-saving and can greatly reduce transmissions and deaths. Methodologies to improve the sensitivity of surveillance testing will help optimize the clinical impact of active screening programs on preventing the spread of A baumannii in health care facilities.
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit, MI.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Coyle
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit, MI.
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit, MI.
authors.forename: Thomas
authors.initials: T
authors.lastname: Taylor
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit, MI.
authors.forename: Ryan
authors.initials: R
authors.lastname: Tansek
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit, MI.
authors.forename: Michelle
authors.initials: M
authors.lastname: Campbell
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit, MI.
authors.forename: Kayoko
authors.initials: K
authors.lastname: Hayakawa
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit, MI; Division of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: drormc@hotmail.com.
authors.forename: Dror
authors.initials: D
authors.lastname: Marchaim
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D040981:Acinetobacter baumannii / Q000302:isolation & purification*; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D062665:Epidemiological Monitoring; D006291:Health Policy; D006801:Humans; D017053:Infection Control / Q000191:economics* / Q000379:methods*; D015233:Models, Statistical
keywords: Contact isolation precautions; Isolation; Multidrug resistance; Nosocomial; Transmission