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Updated: Jun 1, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)
Published on: February 9, 2011
Cost and health outcomes associated with mandatory MRSA screening in a special care nursery
Robin Garcia1, Susan Vonderheid, Barbara McFarlin
1Saint Joseph Hospital, USA. rgarcia1@reshealthcare.org
Purpose:
Methicillin-resistant Staphylococcus aureus (MRSA) rates continue to rise and pose a threat to patient health and limited hospital resources. In 2007, Illinois passed a legislative mandate requiring active surveillance cultures to screen for MRSA in all patients in hospital intensive care units. However, professional guidelines do not support mandated universal surveillance cultures, and funding to cover screening costs was not included. The purpose of the study was to examine the costs (personnel, screening test, and supply) associated with the mandated universal MRSA screening and to examine the infant health-related outcomes and costs associated with implementing MRSA screening in a special care nursery.
Subjects:
Personnel-54 observations of staff members in a community-based hospital in a large midwestern city. Infants-445 infants admitted from January 2008 through January 2009.
Methods:
Time and motion (related to screening activities by registered nurses) based on observations of staff during MRSA screenings, and abstraction of health and cost data from the infant log, infant medical records, and financial reports.
Main Outcome Measures:
Costs (laboratory tests, personnel, and supplies) and infant health outcomes.
Design:
A prospective descriptive study.
Results:
Mandatory screening leads to increased costs, problems related to false-positives, and unintended consequences (eg, decision whether to treat non-MRSA organisms identified on screening cultures, possibility of legal implications, adverse family psychosocial affects, and questionable validity of the polymerase chain reaction test). The average total costs of laboratory, supply, and personnel were $15,270.12 ($34.31 per infant or $19.58 per screen).
Conclusions:
A screening test for MRSA with a high positive predictive value, low cost, and quick turnaround (<24 hours) is greatly needed for neonates. Our findings indicate that mandatory universal MRSA screening is not warranted when the incidence of MRSA is low. Just as health care providers require evidence when determining best practices, legislators should require adequate evidence before passing policy.
Insights
Mandatory universal screening for methicillin-resistant Staphylococcus aureus (MRSA) in intensive care units is costly and not supported by evidence when MRSA incidence is low. Legislators should require data before enacting such policies.
Area of Science:
- Healthcare policy
- Infectious disease surveillance
- Health economics
Background:
- Rising rates of methicillin-resistant Staphylococcus aureus (MRSA) infections pose significant risks to patient health and hospital resources.
- Illinois enacted a legislative mandate in 2007 requiring universal active surveillance cultures for MRSA in all intensive care unit (ICU) patients.
- Professional guidelines do not universally support mandated screening, and the mandate lacked dedicated funding for screening costs.
Purpose of the Study:
- To evaluate the costs associated with mandated universal MRSA screening, including personnel, screening tests, and supplies.
- To examine infant health-related outcomes and associated costs following the implementation of MRSA screening in a special care nursery.
Main Methods:
- A prospective descriptive study design was employed.
- Personnel costs were assessed through 54 observations of staff activities during MRSA screenings in a community hospital.
- Health and cost data were abstracted from 445 infants admitted to a special care nursery between January 2008 and January 2009.
Main Results:
- Mandatory MRSA screening resulted in increased costs, with average total expenses for laboratory, supplies, and personnel amounting to $15,270.12 ($34.31 per infant or $19.58 per screen).
- The study identified issues related to false-positive results, including challenges in deciding treatment for non-MRSA organisms and potential legal implications.
- Unintended consequences included adverse family psychosocial effects and questions regarding the validity of the polymerase chain reaction (PCR) test used for screening.
Conclusions:
- A need exists for a cost-effective MRSA screening test for neonates with high positive predictive value and rapid turnaround time (<24 hours).
- Mandatory universal MRSA screening is not justified in settings with low MRSA incidence.
- Evidence-based decision-making is crucial for both healthcare providers and legislators when establishing best practices and policies.
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