Comparative and Cost Effectiveness of Strategies to Limit MRSA in Long Term Care

 描述（由申请人提供）：在过去20年中，耐甲氧西林金黄色葡萄球菌（MRSA）引起的感染显著增加，并与显著的超额发病率、死亡率和成本相关。人与人之间的传播在医疗机构中MRSA的出现中起着核心作用。因此，被MRSA定殖或感染的住院患者通常被置于接触预防措施，以帮助防止MRSA的传播。历史上，住院患者被鉴定为MRSA定殖的主要方式是通过获得用于临床适应症的培养物。最近，积极的监测战略（即，擦拭无症状患者的鼻孔）来鉴定更大比例的MRSA定殖患者。然而，不同的MRSA筛查策略的比较有效性和成本效益定义不清。此外，在长期护理环境中没有严格的数据。 2009年，国家退伍军人健康管理局（VHA）系统制定了一项统一的主动监测计划， 对长期护理中心（LTCC）收治的患者进行MRSA筛查。作为在多个LTCC中实施的具有标准化方法的综合筛查方法，该倡议提供了一个独特的、真实的世界的机会来评估特别是在长期护理环境中不同MRSA筛查策略的比较有效性和成本效益。具体目标将评估LTCC环境中两种MRSA筛查策略的比较有效性和成本效益（即，临床培养筛选和主动监测筛选）。主动监测筛查策略涉及无症状患者的鼻孔拭子，而不是临床培养筛查策略，仅针对临床适应症获得培养物。 目标1：评估两种策略在预防MRSA感染方面的比较有效性目的2：评估两种策略在预防MRSA感染方面的比较有效性目的3：评估两种策略在预防MRSA感染方面的成本效益目的1和2的主要假设是，主动监测筛查将与MRSA感染和感染的显著减少相关。目标3的主要假设是，主动监测筛查策略将具有成本效益。 拟议项目的临床和公共卫生意义重大，因为确定为最有利的方法将被更广泛地推广，以有效地遏制MRSA在长期护理人群中的传播。阐明影响这些筛查策略的影响的个人和机构水平的变量将是至关重要的，为未来的MRSA筛查干预提供信息。确定MRSA主动筛查策略的相对有效性和成本效益对于支持现实世界的采用决策至关重要。

 DESCRIPTION (provided by applicant): Infections due to methicillin-resistant Staphylococcus aureus (MRSA) have increased markedly over the past 20 years and are associated with significant excess morbidity, mortality, and cost. Person to person spread plays a central role in the emergence of MRSA in healthcare settings. As such, hospitalized patients colonized or infected with MRSA are typically placed on contact precautions to help prevent spread of MRSA. Historically, the primary way in which a hospitalized patient was identified as being MRSA colonized was via cultures obtained for clinical indications. More recently, active surveillance strategies (i.e., swabbing the nares in asymptomatic patients) have been proposed to identify a larger proportion of patients colonized with MRSA. However, the comparative effectiveness and cost effectiveness of different MRSA screening strategies are poorly defined. Moreover, no rigorous data exist in the long term care setting. In 2009, the national Veterans Health Administration (VHA) system instituted a uniform active surveillance initiative in which all patients admitted to long term care centers (LTCCs) are screened for MRSA. As a comprehensive screening approach with standardized methods implemented across multiple LTCCs, this initiative provides a unique, real world, opportunity to assess the comparative effectiveness and cost effectiveness of different MRSA screening strategies specifically in the long-term care setting The specific aims will assess the comparative effectiveness and cost effectiveness of two MRSA screening strategies in the LTCC setting (i.e., clinical culture screening and active surveillance screening) in LTCCs. The active surveillance screening strategy involves swabbing the nares in asymptomatic patients, as opposed to a clinical culture screening strategy, whereby cultures are obtained only for clinical indications. Aim 1: To assess the comparative effectiveness of the two strategies in preventing MRSA acquisition Aim 2: To assess the comparative effectiveness of the two strategies in preventing MRSA infection Aim 3: To assess the cost effectiveness of the two strategies in preventing MRSA infection The primary hypothesis for Aims 1 and 2 is that active surveillance screening will be associated with significant decreases in MRSA acquisition and infection. The primary hypothesis for Aim 3 is that the active surveillance screening strategy will be cost-effective. The clinical and public health significance of the proposed project is great in that the approach identified as most favorable will then be advocated more broadly to effectively curb MRSA transmission in the long-term care population. Elucidating the individual and institution level variables which affect the impact of these screening strategies will be critical in informing future MRSA screening interventions. Determination of the comparative effectiveness and cost effectiveness of an active screening strategy for MRSA is vital to support real-world adoption decisions.