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In what settings do MRSA skin infections occur?
• MRSA skin infections can occur anywhere.
• Some settings have factors that make it easier for MRSA to be transmitted.
• These factors, referred to as the 5 Cs, are as follows: Crowding, frequent skin-to-skin Contact, Compromised skin (i.e., cuts or abrasions), Contaminated items and surfaces, and lack of Cleanliness.
CDC
By Stacey J. Ackerman, MSE, PhD; Steven B. Duff, MS; Penelope H. Dennehy, MD; Michael S. Mafilios; Leonard R. Krilov, MD
Abstract
Objective
To assess the economic impact, from a societal perspective, of a multidimensional infection control education program (ICEP) in a preschool for children with Down syndrome.
Methods
Krilov et al implemented a comprehensive ICEP in a specialized preschool setting and reported a significant decrease in medical resource utilization and days absent from school. Clinical and economic data from Krilov et al and other sources were incorporated into a health-state transition (Markov) decision analysis model that estimated annual expected costs for the baseline and intervention years. Procedure and diagnosis codes were assigned to all physician office visits, emergency department visits, hospitalizations, and laboratory and diagnostic tests. Cost estimates then were derived using 1999 national reimbursement schedules and other sources. Productivity losses for parents were estimated using national wage rates. The costs of the ICEP were compared with the reduction in the costs of illness (direct medical costs plus costs associated with lost parental working time). The outcomes measured were mean annual costs of illness per child, total annual ICEP costs, and net annual costs or savings.
Results
With a comprehensive ICEP, the mean costs of illness in the baseline year was $1235 per child, of which 68% and 14% were for productivity losses and physician visits, respectively. In the intervention year, the mean costs of illness per child was $615, of which 71% and 20% were for productivity losses and physician visits, respectively. The cost of the preexisting infection control (IC) practices in place at the onset of the study (baseline year) was $716. The comprehensive ICEP cost (intervention year) was $75 627, 92% of which was spent to hire a cleaning service to decontaminate toys 3 times per week. When a secondary analysis was performed to reflect a less intensive ICEP in a nonspecialized preschool setting, the mean costs of illness in the baseline and intervention years were $962 and $614 per child, respectively, representing a total annual cost-of-illness savings of $13 224 for the 38 children who participated in the study by Krilov et al. The annual incremental cost of the less intensive ICEP was $2371; therefore, the estimated net annual savings of the less intensive ICEP in a nonspecialized preschool was $10 853.
Conclusions
This study suggests that the reduction in the costs of illness could more than offset the cost of implementing a multidimensional ICEP in a preschool setting.
Authors
Stacey J. Ackerman, MSE, PhD
Covance Health Economics and Outcomes Services Inc, Gaithersburg, Maryland
Steven B. Duff, MS
Covance Health Economics and Outcomes Services Inc, San Diego, California
Penelope H. Dennehy, MD
Division of Pediatric Infectious Diseases, Hasbro Children's Hospital, Brown Medical School, Providence, Rhode Island
Michael S. Mafilios
Covance Health Economics and Outcomes Services Inc, San Diego, California
Leonard R. Krilov, MD
Pediatric Infectious Diseases, Winthrop Pediatric Specialty Center, Winthrop University Hospital, Mineola, New York
Pediatrics Vol. 108 No. 6 December 1, 2001, pp. e102
(doi: 10.1542/peds.108.6.e102)
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