Modeling relaxed policies for discontinuation of methicillin-resistant Staphylococcus aureus contact precautions

Area of Science:

• Infectious Disease Epidemiology
• Health Economics
• Hospital Infection Control

Background:

• The University of Virginia Hospital currently employs a "3-negative" policy for discontinuing methicillin-resistant Staphylococcus aureus (MRSA) contact precautions.
• This policy requires three consecutive negative test results before contact precautions are lifted.
• Evaluating alternative policies with fewer negative tests is crucial for optimizing patient care and resource allocation.

Purpose of the Study:

• To assess the economic costs associated with reducing the MRSA "3-negative" policy to either a "2-negative" or "1-negative" policy.
• To compare the cost-effectiveness of different MRSA clearance strategies at the University of Virginia Hospital.

Main Methods:

• A cost-effectiveness analysis was conducted using data from 41,216 patients between 2015 and 2019.
• A mathematical model simulating MRSA transmission, incorporating environmental and patient-provider interactions, was developed using electronic health record data.
• Counterfactual simulations compared the existing 3-negative policy with hypothetical 2-negative and 1-negative policies.

Main Results:

• The 2-negative and 1-negative policies were projected to result in 6 and 17 additional MRSA cases, respectively, compared to the 3-negative policy.
• The 1-negative policy demonstrated statistically significant annual cost savings of $628,452 compared to the 2-negative policy ($687,946) and the 3-negative policy ($702,823).
• These cost savings are inflation-adjusted for 2023.

Conclusions:

• A single negative MRSA nares PCR test may be sufficient to discontinue contact precautions.
• The 1-negative policy appears to be the most cost-effective strategy for managing MRSA in this hospital setting.
• Implementing a 1-negative policy could lead to substantial cost reductions while managing MRSA transmission.