THE CLINICAL, PSYCHO-SOCIAL AND COST IMPACTS OF PERFORMING ACTIVE SURVEILLANCE ON KNOWN MRSA+ PATIENTS ADMITTED TO MEDICAL-SURGICAL UNITS

Purpose: There is a large and growing body of evidence that MRSA screening programs are cost effective, but such screening represents a significant cost burden for hospitals. This study investigates the clinical, psycho-social and cost impacts of performing active surveillance on known MRSA+ patients specifically to allow discontinuation of contact isolation.

Methods: We conducted a mixed-methods, retrospective evaluation of implementing screening for admitted patients with known MRSA+ status for continued MRSA colonization.

Results: Over the nine month project period, seven study units admitted 211 previously MRSA+ patients without a positive MRSA in the prior 12 months. These patients represented 2% of inpatient admissions (211/10,771) to these units. Twenty three percent of patients (49/211) did not complete the screening due to discharge (73.5%, 36/49) or receiving antibiotics (14.3%, 7/49). Of those MRSA+ list patients who did complete testing, 80% (130/162) were found to be no longer colonized.

Forty-one percent (13/32) of patients isolated for MRSA reported that isolation affected their hospital stay. One patient shared that they were “concerned about transmitting infection to visitors”, others that they have “fewer visitors” or that family had “avoided visiting” due to isolation measures. One patient reported “feeling contaminated” and another that they were “pissed off”. One patient perceived that “nurses take longer to respond” and another that they were “treated differently by staff”.

Twenty eight percent (9/32) of patients reported emotional distress resulting from their isolation. Specifically patients stated that it “feels like certain rights and privileges have been limited”, that they “feel stigmatized for infection and limited in personal freedoms”. Three patients reported being very worried about their MRSA+ status, one that they felt “often uncomfortable”, another that they “feel neglected” and a final patient reported feeling like they were “treated like a plague victim”.

For the seven study units, the annual projected costs of screening were $7,700 and the costs of unnecessary isolation $108,940 resulting in savings of $101,230.21 attributable to program implementation.

Conclusion: Our findings provide evidence that a screening program targeting patients with a history of MRSA who otherwise would be placed in isolation has the potential to improve both patient outcomes and patient experience while reducing hospital costs.