Search and destroy policy for methicillin-resistant Staphylococcus aureus: cost-benefit analysis

This paper is a report of a cost-benefit analysis of a 'search and destroy' policy as compared with the absence of such a policy for methicillin-resistant Staphylococcus aureus from a hospital perspective, including the impact of nurses on the costs and benefits of this policy.

The 'search and destroy' policy involved screening, isolation, decontamination and antimicrobial treatment of methicillin-resistant Staphylococcus aureus.

A prospective analysis was carried out in one intensive care unit and one gerontology unit of a university hospital in 2007. A benefit-cost ratio was calculated by dividing the benefits of the 'search and destroy' policy by its costs related to screening and quarantine. Benefits consisted of hospital savings through avoidance of isolation, decontamination, antimicrobial therapy and extended hospital stay of affected patients. Resource utilization data were gathered from a time-and-motion study of nurses, patient medical records, hospital databases and the literature. Unit costs pertained to 2005.

The benefit-cost ratio of the 'search and destroy' policy as compared with the absence of such a policy was 1.17 in the intensive care unit and 1.16 in the gerontology unit. Nurses accounted for 23% of costs and 16% of benefits of the policy as compared with the absence of such a policy in the intensive care unit, and 19% of costs and 28% of benefits in the gerontology unit.

Hospital managers should consider implementing a 'search and destroy' policy for methicillin-resistant Staphylococcus aureus and to support the contribution of nurses and other healthcare workers to such a policy.