Kosten van het huidige infectiepreventiebeleid voor meticillineresistente Staphylococcus aureus (MRSA) beduidend lager dan bij loslaten van dat beleid; een retrospectief onderzoek over 10 jaar in het Universitair Medisch Centrum Utrecht

To determine the financial and logistical consequences of the ‘search and destroy’ policy with respect to methicillin-resistant Staphylococcus aureus (MRSA).

Design

Descriptive.

Method

The data were based on a 10-year survey (1991-2000) of screening, surveillance, and outbreaks at the University Medical Center Utrecht, the Netherlands. The consequences of the policy were determined by a panel comprising physicians from the Department of Surgery, the Department of Medical Microbiology, Subdivision Hospital Hygiene and Infection Prevention, the Department of Pharmacy, and Household Services. The costs associated with the policy were also calculated, including those for additional (disposable) material, cultures, specific medication, decontamination, personnel, and closing of the wards.

Results

Over the course of the 10 years, implementation of the MRSA policy resulted in more than 2,265 lost hospitalization days. In addition, wards had to be closed 33 times, 29 healthcare workers had to discontinue working temporarily, and 78,000 additional cultures were performed. The total cost amounted to € 2,800,000.–. The financial consequences were compared to those in a hypothetical situation without the search-and-destroy policy. In such a situation, the hospital would be faced with an increased incidence of MRSA, vancomycin intermediate-susceptible S. aureus, and vancomycin-resistant enterococci. The costs associated with the use of alternative antibiotics, required in a scenario of high endemic-level MRSA, would be at least twice as high as the costs expended in the actual situation.

Conclusion

The current MRSA policy in the Netherlands is cost effective.