title: Clinical, patient experience and cost impacts of performing active surveillance on known methicillin-resistant Staphylococcus aureus positive patients admitted to medical-surgical units.
abstract: BACKGROUND
  There is a large and growing body of evidence that methicillin-resistant Staphylococcus aureus (MRSA) screening programs are cost effective, but such screening represents a significant cost burden for hospitals. This study investigates the clinical, patient experience and cost impacts of performing active surveillance on known methicillin-resistant S aureus positive (MRSA+) patients admitted to 7 medical-surgical units of a large regional hospital, specifically to allow discontinuation of contact isolation.
  
  
  METHODS
  We conducted mixed-methods retrospective evaluation of a process improvement project that screened admitted patients with known MRSA+ status for continued MRSA colonization.
  
  
  RESULTS
  Of those eligible patients on our institution's MRSA+ list who did complete testing, 80.2% (130/162) were found to be no longer colonized, and only 19.8% (32/162) were still colonized. Forty-one percent (13/32) of interviewed patients in contact isolation for MRSA reported that isolation had affected their hospital stay, and 28% (9/32) of patients reported emotional distress resulting from their isolation. Total cost savings of the program are estimated at $101,230 per year across the 7 study units.
  
  
  CONCLUSIONS
  Our findings provide supporting evidence that a screening program targeting patients with a history of MRSA who would otherwise be placed in isolation has the potential to improve outcomes and patient experience and reduce costs.
authors.affiliation: Value Institute, Christiana Care Health System, Newark, DE. Electronic address: jgoldsack@christianacare.org.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Goldsack
authors.affiliation: Nursing, Christiana Care Health System, Newark, DE.
authors.forename: Christine
authors.initials: C
authors.lastname: DeRitter
authors.affiliation: Infection Prevention Department, Christiana Care Health System, Newark, DE.
authors.forename: Michelle
authors.initials: M
authors.lastname: Power
authors.affiliation: Nursing, Christiana Care Health System, Newark, DE.
authors.forename: Amy
authors.initials: A
authors.lastname: Spencer
authors.affiliation: Infection Prevention Department, Christiana Care Health System, Newark, DE.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Taylor
authors.affiliation: Department of Medicine, Christiana Care Health System, Newark, DE.
authors.forename: Sofia F
authors.initials: SF
authors.lastname: Kim
authors.affiliation: Value Institute, Christiana Care Health System, Newark, DE.
authors.forename: Ryan
authors.initials: R
authors.lastname: Kirk
authors.affiliation: Department of Medicine, Christiana Care Health System, Newark, DE.
authors.forename: Marci
authors.initials: M
authors.lastname: Drees
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002353:Carrier State / Q000175:diagnosis* / Q000382:microbiology; D003365:Costs and Cost Analysis; D003428:Cross Infection / Q000517:prevention & control*; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D017053:Infection Control / Q000191:economics* / Q000379:methods*; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology; D013503:Surgery Department, Hospital
keywords: Cost; Isolation; Methicillin-resistant Staphylococcus aureus; Patient experience; Surveillance