title: Strategies to Prevent MRSA Transmission in Community-Based Nursing Homes: A Cost Analysis.
abstract: OBJECTIVE To estimate the costs of 3 MRSA transmission prevention scenarios compared with standard precautions in community-based nursing homes. DESIGN Cost analysis of data collected from a prospective, observational study. SETTING AND PARTICIPANTS Care activity data from 401 residents from 13 nursing homes in 2 states. METHODS Cost components included the quantities of gowns and gloves, time to don and doff gown and gloves, and unit costs. Unit costs were combined with information regarding the type and frequency of care provided over a 28-day observation period. For each scenario, the estimated costs associated with each type of care were summed across all residents to calculate an average cost and standard deviation for the full sample and for subgroups. RESULTS The average cost for standard precautions was $100 (standard deviation [SD], $77) per resident over a 28-day period. If gown and glove use for high-risk care was restricted to those with MRSA colonization or chronic skin breakdown, average costs increased to $137 (SD, $120) and $125 (SD, $109), respectively. If gowns and gloves were used for high-risk care for all residents in addition to standard precautions, the average cost per resident increased substantially to $223 (SD, $127). CONCLUSIONS The use of gowns and gloves for high-risk activities with all residents increased the estimated cost by 123% compared with standard precautions. This increase was ameliorated if specific subsets (eg, those with MRSA colonization or chronic skin breakdown) were targeted for gown and glove use for high-risk activities. Infect Control Hosp Epidemiol 2016;37:962-966.
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Geriatrics Research Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland.
authors.forename: Mary-Claire
authors.initials: MC
authors.lastname: Roghmann
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Geriatrics Research Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland.
authors.forename: Alison
authors.initials: A
authors.lastname: Lydecker
authors.affiliation: Division of Geriatric and Palliative Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Geriatrics Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Lona
authors.initials: L
authors.lastname: Mody
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland.
authors.forename: C Daniel
authors.initials: CD
authors.lastname: Mullins
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland.
authors.forename: Eberechukwu
authors.initials: E
authors.lastname: Onukwugha
mesh_terms: D003365:Costs and Cost Analysis; D003428:Cross Infection / Q000517:prevention & control*; D017575:Gloves, Protective; D006801:Humans; D017053:Infection Control / Q000191:economics* / Q000379:methods*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D009735:Nursing Homes; D011446:Prospective Studies; D011481:Protective Clothing; D013203:Staphylococcal Infections / Q000517:prevention & control* / Q000635:transmission