title: Impact of active screening for methicillin-resistant Staphylococcus aureus (MRSA) and decolonization on MRSA infections, mortality and medical cost: a quasi-experimental study in surgical intensive care unit.
abstract: BACKGROUND
  Methicillin-resistant Staphylococcus aureus (MRSA) is a leading pathogen of healthcare-associated infections in intensive care units (ICUs). Prior studies have shown that decolonization of MRSA carriers is an effective method to reduce MRSA infections in ICU patients. However, there is currently a lack of data on its effect on mortality and medical cost.
  
  
  METHODS
  Using a quasi-experimental, interrupted time-series design with re-introduction of intervention, we evaluated the impact of active screening and decolonization on MRSA infections, mortality and medical costs in the surgical ICU of a university hospital in Taiwan. Regression models were used to adjust for effects of confounding variables.
  
  
  RESULTS
  MRSA infection rate decreased from 3.58 (baseline) to 0.42‰ (intervention period) (P <0.05), re-surged to 2.21‰ (interruption period) and decreased to 0.18‰ (re-introduction of intervention period) (P <0.05). Patients admitted to the surgical ICU during the intervention periods had a lower in-hospital mortality (13.5% (155 out of 1,147) versus 16.6% (203 out of 1,226), P = 0.038). After adjusting for effects of confounding variables, the active screening and decolonization program was independently associated with a decrease in in-hospital MRSA infections (adjusted odds ratio: 0.3; 95% CI: 0.1 to 0.8) and 90-day mortality (adjusted hazard ratio: 0.8; 95% CI: 0.7 to 0.99). Cost analysis showed that $22 medical costs can be saved for every $1 spent on the intervention.
  
  
  CONCLUSIONS
  Active screening for MRSA and decolonization in ICU settings is associated with a decrease in MRSA infections, mortality and medical cost.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Taipei Medical University Hospital, 252 Wusing Street, Taipei, 11031, Taiwan. yuarn438@yahoo.com.tw.|Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, 250 Wusing Street, Taipei, 11031, Taiwan. yuarn438@yahoo.com.tw.
authors.forename: Yuarn-Jang
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Department of Infection Control, Taipei Medical University Hospital, 252 Wusing Street, Taipei, 11031, Taiwan. icn@h.tmu.edu.tw.
authors.forename: Jen-Zon
authors.initials: JZ
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, 250 Wusing Street, Taipei, 11031, Taiwan. jane217@mail.tmuh.org.tw.|Department of Laboratory Medicine, Taipei Medical University Hospital, 252 Wusing Street, Taipei, 11031, Taiwan. jane217@mail.tmuh.org.tw.
authors.forename: Hsiu-Chen
authors.initials: HC
authors.lastname: Lin
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Taipei Medical University Hospital, 252 Wusing Street, Taipei, 11031, Taiwan. b8601032@tmu.edu.tw.
authors.forename: Hsin-Yi
authors.initials: HY
authors.lastname: Liu
authors.affiliation: Department of General Medicine, School of Medicine, College of Medicine, Taipei Medical University, 250 Wusing Street, Taipei, 11031, Taiwan. sylin@tmu.edu.tw.
authors.forename: Shyr-Yi
authors.initials: SY
authors.lastname: Lin
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei, 10002, Taiwan. hsienho@ntu.edu.tw.
authors.forename: Hsien-Ho
authors.initials: HH
authors.lastname: Lin
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei, 10002, Taiwan. fangct@ntu.edu.tw.|Department of Internal Medicine, National Taiwan University Hospital, 7 Chun-Shan South Road, Taipei, 10002, Taiwan. fangct@ntu.edu.tw.
authors.forename: Chi-Tai
authors.initials: CT
authors.lastname: Fang
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, 7 Chun-Shan South Road, Taipei, 10002, Taiwan. hsporen@ntu.edu.tw.|Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, 1 Jen-Ai Road, Taipei, 10055, Taiwan. hsporen@ntu.edu.tw.
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000191:economics; D002353:Carrier State / Q000175:diagnosis*; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics; D003428:Cross Infection / Q000517:prevention & control; D004203:Disinfection; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D017053:Infection Control / Q000191:economics; D007362:Intensive Care Units / Q000191:economics; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage / Q000191:economics; D009296:Nasal Cavity / Q000382:microbiology; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000191:economics* / Q000401:mortality / Q000635:transmission; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D016712:Mupirocin; C010882:chlorhexidine gluconate; D002710:Chlorhexidine