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Study Will Evaluate the Cost-Effectiveness of Methods to Curb the Spread of Antibiotic-Resistant Bacteria in Health Care

February 12, 2007

Researchers from the University of Maryland School of Medicine have received an $800,000 grant from the Centers for Disease Control and Prevention to evaluate measures by hospitals and long-term care facilities to prevent the spread of antibiotic-resistant bacteria. The researchers will study the cost-effectiveness of new infection control interventions designed to rapidly identify patients colonized with a particular strain of Staph infection, known as methicillin-resistant Staphlococcus aureus (MRSA), an antibiotic-resistant organism that is increasing in community settings. They will also look at ways that these pathogens are most commonly transmitted.

"Healthcare-associated infections like MRSA account for about 90,000 deaths in the United States and $4.5 billion in excess health care costs each year," says Anthony Harris, M.D., M.P.H., an associate professor of epidemiology and preventive medicine at the University of Maryland School of Medicine and a co-principal investigator on the study. "The prevalence of antimicrobial resistance is increasing in the community, and hospitals have been seeing a rise in patients admitted to their facilities with these bugs. It’s a concern, especially because some of these organisms have developed resistance to the standard antibiotics used to fight them."

The researchers will study a comprehensive infection control program at the University of Maryland Medical Center in Baltimore to identify, isolate and effectively treat any patients who come to the hospital with MRSA. The medical center recently expanded its active MRSA surveillance program, which had already been in place for years.

Today, patients admitted to the hospital’s nine intensive care units are screened for MRSA using a nasal swab test that gives rapid results within a few hours. Those ICU patients are also screened weekly after admission and at discharge. The screening program also applies to patients admitted to any non-ICU bed in the medical center if they have been in another health care facility within the last year or have a skin or soft tissue infection, two risk factors for the presence of MRSA. If MRSA is identified in a patient, the hospital uses contact precautions such as gowns and gloves to prevent the possible transmission of the organism to other patients. The rapid screening test also enables doctors to prescribe the appropriate targeted antibiotics.

According to Harold Standiford, M.D., medical director of infection control at the University of Maryland Medical Center and a professor of medicine at the University of Maryland School of Medicine, "These measures are necessary because of a significant growth of MRSA in the community, which means that more people are coming to hospitals with MRSA. This nasal swab test identifies individuals so that proper precautions can be taken immediately to prevent transmission to others. Also, it enables us to treat patients with the right medications much sooner. The older culture-based tests took as long as 48 hours for results."

Dr. Harris and the research team, including Mary-Claire Roghmann, M.D., M.S., and Eli Perencevich, M.D., M.S., both associate professors of epidemiology and preventive medicine at the University of Maryland School of Medicine, and Jon Furuno, Ph.D., an assistant professor of epidemiology and preventive medicine at the medical school, will be evaluating the cost-effectiveness of the hospital-wide screening program. The University of Maryland School of Medicine is one of three sites to receive a Centers for Disease Control grant to study the issue.

"Even with aggressive infection-control interventions in intensive care unit populations, MRSA can spread among patients in other locations in a hospital," says Dr. Harris. "No published studies have assessed the cost-effectiveness of active surveillance outside of the high-risk ICU population, so most hospitals have not implemented such a broad MRSA screening program for fear that it would be too expensive."

The study team will also be assessing the cost-effectiveness of universal glove and gown use by healthcare workers during all patient contact in the medical center’s Medical and Surgical Intensive Care Units. The researchers also will identify factors that are associated with the transmission of MRSA among residents in numerous Baltimore-area long-term care facilities.
 
"There are substantial costs associated with antimicrobial resistance, but those costs are difficult to estimate," says Dr. Harris. "These increased costs are the result of using more expensive antibiotics, increased labor and laboratory costs, increased length of hospital stay and costs associated with patient isolation. Making optimal medical decisions around infection control interventions requires the availability of proper cost-effectiveness analyses. But few studies have been published that assess the benefit to patients and the economic impact of these interventions."

"Our comprehensive MRSA identification and eradication program is part of our continuing focus on patient safety," says Timothy Babineau, M.D., Chief Medical Officer of the University of Maryland Medical Center. "We are pleased to partner with leading scientists such as Dr. Harris and his colleagues to help protect our patients from MRSA infections."

The University of Maryland Medical Center is listed among the nation’s top 50 acute care hospitals for patient safety and quality care by the Leapfrog Group, which uses objective criteria to rate hospitals. The Leapfrog Group was founded by the Business Roundtable to represent the nation’s largest corporations and public agencies that provide health benefits to employees.

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