title: Impact of rapid screening for discontinuation of methicillin-resistant Staphylococcus aureus contact precautions.
abstract: BACKGROUND
  A history of methicillin-resistant Staphylococcus aureus (MRSA) is a determinant of inpatient bed assignment.
  
  
  METHODS
  We assessed outcomes associated with rapid testing and discontinuation of MRSA contact precautions (CP) in a prospective cohort study of polymerase chain reaction (PCR)-based screening in the Emergency Department (ED) of Massachusetts General Hospital. Eligible patients had a history of MRSA and were assessed and enrolled if documented off antibiotics with activity against MRSA and screened for nasal colonization (subject visit). PCR-negative subjects had CP discontinued; the primary outcome was CP discontinuation. We identified semiprivate rooms in which a bed was vacant owing to the CP status of the study subject, calculated the hours of vacancy, and compared idle bed-hours by PCR results. Program costs were compared with predicted revenue.
  
  
  RESULTS
  There were 2864 eligible patients, and 648 (22.6%) subject visits were enrolled. Of these, 65.1% (422/648) were PCR-negative and had CP discontinued. PCR-negative subjects had fewer idle bed-hours compared with PCR-positive subjects (28.6 ± 25.2 vs 75.3 ± 70.5; P < .001). The expected revenues from occupied idle beds and averted CP costs ranged from $214,160 to $268,340, and exceeded the program costs.
  
  
  CONCLUSIONS
  A program of targeted PCR-based screening for clearance of MRSA colonization resulted in expected revenues and decreased CP costs that outweighed programmatic costs.
authors.affiliation: Harvard Medical School, Boston, MA; Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA; Infection Control Unit, Massachusetts General Hospital, Boston, MA; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA. Electronic address: eshenoy@partners.org.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Shenoy
authors.affiliation: Department of Biostatistics, Massachusetts General Hospital, Boston, MA.
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.affiliation: Infection Control Unit, Massachusetts General Hospital, Boston, MA.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Cotter
authors.affiliation: Clinical Care Management Unit, Massachusetts General Hospital, Boston, MA.
authors.forename: Winston
authors.initials: W
authors.lastname: Ware
authors.affiliation: Partners Information Systems, Massachusetts General Hospital and Massachusetts General Physicians Organization, Boston, MA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Kelbaugh
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA; Massachusetts General Physicians Organization.
authors.forename: Eric
authors.initials: E
authors.lastname: Weil
authors.affiliation: Harvard Medical School, Boston, MA; Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Rochelle P
authors.initials: RP
authors.lastname: Walensky
authors.affiliation: Harvard Medical School, Boston, MA; Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA; Infection Control Unit, Massachusetts General Hospital, Boston, MA. Electronic address: dhooper@mgh.harvard.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Hooper
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D006801:Humans; D017053:Infection Control; D008297:Male; D008404:Massachusetts; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification*; D008875:Middle Aged; D009666:Nose / Q000382:microbiology; D010865:Pilot Projects; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000191:economics / Q000382:microbiology* / Q000517:prevention & control; D016635:Universal Precautions
keywords: Contact precautions; Costs; Implementation; MRSA