Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-23T20:34:17.024Z Has data issue: false hasContentIssue false
  • English
  • Français

Strategies to Prevent MRSA Transmission in Community-Based Nursing Homes: A Cost Analysis

Published online by Cambridge University Press:  13 May 2016

Mary-Claire Roghmann ,
Alison Lydecker ,
Lona Mody ,
C. Daniel Mullins  and
Eberechukwu Onukwugha
Mary-Claire Roghmann*
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
Alison Lydecker
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
Lona Mody
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
C. Daniel Mullins
Affiliation:
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
Eberechukwu Onukwugha
Affiliation:
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
*
Address correspondence to Mary-Claire Roghmann, MD, MS, University of Maryland School of Medicine, 10 South Pine Street, MTSF Room 336, Baltimore, MD 21201 (mroghman@epi.umaryland.edu).
Get access Rights & Permissions [Opens in a new window]

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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 8 , August 2016 , pp. 962 - 966
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L, and the Healthcare Infection Control Practices Advisory Committee. Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006. Am J Infect Control 2007;35:S165–193.CrossRefGoogle Scholar
2. Trick, WE, Weinstein, RA, DeMarais, PL, et al. Comparison of routine glove use and contact-isolation precautions to prevent transmission of multidrug-resistant bacteria in a long-term care facility. J Am Geriatr Soc 2004;52:2003–2009.CrossRefGoogle ScholarPubMed
3. Hughes, C, Tunney, M, Bradley, MC. Infection control strategies for preventing the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people. Cochrane Database Syst Rev 2013;11:CD006354.Google Scholar
4. Johannessen, T. Controlled trials in single subjects. 1. Value in clinical medicine. BMJ 1991;303:173–174.CrossRefGoogle ScholarPubMed
5. Roghmann, MC, Johnson, JK, Sorkin, JD, et al. Transmission of methicillin-resistant Staphylococcus aureus (MRSA) to healthcare worker gowns and gloves during care of nursing home residents. Infect Control Hosp Epidemiol 2015:1–8.Google ScholarPubMed
6. Ye, Z, Mukamel, DB, Huang, SS, Li, Y, Temkin-Greener, H. Healthcare-associated pathogens and nursing home policies and practices: results from a national survey. Infect Control Hosp Epidemiol 2015;36:759–766.CrossRefGoogle ScholarPubMed
7. Kang, J, Mandsager, P, Biddle, AK, Weber, DJ. Cost-effectiveness analysis of active surveillance screening for methicillin-resistant Staphylococcus aureus in an academic hospital setting. Infect Control Hosp Epidemiol 2012;33:477–486.CrossRefGoogle Scholar
8. Huang, SS, Septimus, E, Avery, TR, et al. Cost savings of universal decolonization to prevent intensive care unit infection: implications of the REDUCE MRSA trial. Infect Control Hosp Epidemiol 2014;35(Suppl 3):S23–S31.CrossRefGoogle ScholarPubMed
9. May 2014 National Occupational Employment and Wage Estimates. Occupational Employment Statistics. United States Department of Labor Bureau of Labor Statistics website. http://www.bls.gov/oes/current/oes_nat.htm#29-0000. Published March 25, 2015. Updated 2014. Accessed October 28, 2015.Google Scholar
10. Standard Occupational Classification 29-1141, Registered Nurses. United States Department of Labor Bureau of Labor Statistics website. http://www.bls.gov/soc/2010/soc291141.htm. Published March 11, 2010. Updated 2010. Accessed October 28, 2015.Google Scholar
11. Standard Occupational Classification 31-1014, Nursing Assistants. United States Department of Labor Bureau of Labor Statistics website. http://www.bls.gov/soc/2010/soc311014.htm. Published March 11, 2010. Updated 2010. Accessed October 28, 2015.Google Scholar
12. Technical Notes for May 2014 OES Estimates. Occupational Employment Statistics, Technical Notes for May 2014 OES Estimates United States Department of Labor Bureau of Labor Statistics website. http://www.bls.gov/oes/current/oes_tec.htm. Published March 25, 2015. Updated 2015. Accessed December 10, 2015.Google Scholar
13. Lai, KK, Kelley, AL, Melvin, ZS, Belliveau, PP, Fontecchio, SA. Failure to eradicate vancomycin-resistant enterococci in a university hospital and the cost of barrier precautions. Infect Control Hosp Epidemiol 1998;19:647–652.CrossRefGoogle Scholar
14. Macartney, KK, Gorelick, MH, Manning, ML, Hodinka, RL, Bell, LM. Nosocomial respiratory syncytial virus infections: the cost-effectiveness and cost-benefit of infection control. Pediatrics 2000;106:520–526.CrossRefGoogle ScholarPubMed
15. Mody, L, Krein, SL, Saint, S, et al. A targeted infection prevention intervention in nursing home residents with indwelling devices: a randomized clinical trial. JAMA Intern Med 2015;175:714–723.CrossRefGoogle ScholarPubMed
16. Harrington, C, Carrillo, H, Dowdell, M, Tang, P, Blank, B. Nursing, Facilities, Staffing, Residents, and Facility Deficiencies, 2005 Through 2010. San Francisco, CA: Department of Social & Behavioral Sciences, University of California San Francisco; 2011.Google Scholar
17. Hudson, LO, Reynolds, C, Spratt, BG, et al. Diversity of methicillin-resistant Staphylococcus aureus strains isolated from residents of 26 nursing homes in Orange County, California. J Clin Microbiol 2013;51:3788–3795.CrossRefGoogle ScholarPubMed
18. Evans, ME, Kralovic, SM, Simbartl, LA, et al. Nationwide reduction of health care-associated methicillin-resistant Staphylococcus aureus infections in Veterans Affairs long-term care facilities. Am J Infect Control 2014;42:60–62.CrossRefGoogle ScholarPubMed
19. Crnich, CJ, Duster, M, Hess, T, Zimmerman, DR, Drinka, P. Antibiotic resistance in non-major metropolitan skilled nursing facilities: prevalence and interfacility variation. Infect Control Hosp Epidemiol 2012;33:1172–1174.CrossRefGoogle ScholarPubMed
20. Mody, L, Kauffman, CA, Donabedian, S, Zervos, M, Bradley, SF. Epidemiology of Staphylococcus aureus colonization in nursing home residents. Clin Infect Dis 2008;46:1368–1373.CrossRefGoogle ScholarPubMed
21. FastStats—Nursing Home Care. Centers for Disease Control and Prevention website. http://www.cdc.gov/nchs/fastats/nursingh.htm. Updated 2013. Accessed April 10, 2016.Google Scholar
Supplementary material: File

Roghmann supplementary material

Appendix

Download Roghmann supplementary material(File)
File 19.9 KB