title: Screening test recommendations for methicillin-resistant Staphylococcus aureus surveillance practices: A cost-minimization analysis.
abstract: BACKGROUND
  To mitigate methicillin-resistant Staphylococcus aureus (MRSA) infections, intensive care units (ICUs) conduct surveillance through screening patients upon admission followed by adhering to isolation precautions. Two surveillance approaches commonly implemented are universal preemptive isolation and targeted isolation of only MRSA-positive patients.
  
  
  METHODS
  Decision analysis was used to calculate the total cost of universal preemptive isolation and targeted isolation. The screening test used as part of the surveillance practice was varied to identify which screening test minimized inappropriate and total costs. A probabilistic sensitivity analysis was conducted to evaluate the range of total costs resulting from variation in inputs.
  
  
  RESULTS
  The total cost of the universal preemptive isolation surveillance practice was minimized when a polymerase chain reaction screening test was used ($82.51 per patient). Costs were $207.60 more per patient when a conventional culture was used due to the longer turnaround time and thus higher isolation costs. The total cost of the targeted isolation surveillance practice was minimized when chromogenic agar 24-hour testing was used ($8.54 per patient). Costs were $22.41 more per patient when polymerase chain reaction was used.
  
  
  CONCLUSIONS
  For ICUs that preemptively isolate all patients, the use of a polymerase chain reaction screening test is recommended because it can minimize total costs by reducing inappropriate isolation costs. For ICUs that only isolate MRSA-positive patients, the use of chromogenic agar 24-hour testing is recommended to minimize total costs.
authors.affiliation: Department of Health Systems, Management, and Policy, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO. Electronic address: Melanie.Whittington@UCDenver.edu.
authors.forename: Melanie D
authors.initials: MD
authors.lastname: Whittington
authors.affiliation: Children's Hospital Colorado, Aurora, CO.
authors.forename: Donna J
authors.initials: DJ
authors.lastname: Curtis
authors.affiliation: Department of Health Systems, Management, and Policy, University of Colorado Anschutz Medical Campus, Aurora, CO.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Atherly
authors.affiliation: Department of Health Systems, Management, and Policy, University of Colorado Anschutz Medical Campus, Aurora, CO; University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO.
authors.forename: Cathy J
authors.initials: CJ
authors.lastname: Bradley
authors.affiliation: Department of Health Systems, Management, and Policy, University of Colorado Anschutz Medical Campus, Aurora, CO.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Lindrooth
authors.affiliation: Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, CO.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Campbell
mesh_terms: D001431:Bacteriological Techniques / Q000191:economics / Q000379:methods; D002353:Carrier State / Q000175:diagnosis* / Q000382:microbiology; D003365:Costs and Cost Analysis; D062665:Epidemiological Monitoring; D006801:Humans; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units; D008403:Mass Screening / Q000191:economics* / Q000379:methods*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D010356:Patient Isolation / Q000379:methods; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology
keywords: Cost-effectiveness; Infection control; Isolation; Surveillance