Costs associated with a strict policy to eradicate methicillin-resistant Staphylococcus aureus in a Dutch university medical center:: A 10-year survey

Although the Dutch policy to eradicate methicillin-resistant Staphylococcus aureus (MRSA) is very strict compared to policies employed in other countries, it has proven to be successful epidemiologically (incidence of MRSA in the Netherlands, <0.5%). The present study was performed to investigate both the financial and the logistical consequences of this strict, so-called "search and destroy" policy in the Netherlands. The data were based on a 10-year survey (1991-2000) of screening, surveillance, and outbreaks at the University Medical Center Utrecht. The consequences of the policy were determined by a panel comprising physicians from the Department of Surgery, the Department of Medical Microbiology, Subdivision Hospital Hygiene and Infection Prevention, the Department of Pharmacy, and Household Services. The costs associated with the policy were also calculated, including those for additional (disposable) material, cultures, specific medication, decontamination, and closing of the wards. Over the course of the 10 years, implementation of the MRSA policy resulted in more than 2,265 lost hospitalization days. In addition, the wards had to be closed 48 times, 29 healthcare workers had to temporarily discontinue working, and 78,000 additional cultures had to be performed. The total cost reached 6 million Dutch guilders (euro 2,800,000). The financial and logistical consequences were then compared to those in a hypothetical situation without the "search and destroy" policy. In such a situation, the hospital would be faced with an increased incidence of MRSA, vancomycin intermediate-susceptible Staphylococcus aureus, and vancomycin-resistant enterococci. The costs associated with the use of alternative antibiotics, required in a scenario of high endemic-level MRSA, would be at least twice as high as the costs expended in the actual situation, thus demonstrating that a strict MRSA policy is financially worthwhile.