Vriens M, Blok H, Fluit A, Troelstra A, Van Der Werken C, Verhoef J
Department of Surgery, University Medical Center Utrecht, HP G 04.228, Heidelberglaan 100, The Netherlands.
Eur J Clin Microbiol Infect Dis. 2002 Nov;21(11):782-6. doi: 10.1007/s10096-002-0811-4. Epub 2002 Nov 8.
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.
尽管与其他国家实施的政策相比，荷兰根除耐甲氧西林金黄色葡萄球菌（MRSA）的政策非常严格，但事实证明，该政策在流行病学上是成功的（荷兰MRSA的发病率<0.5%）。本研究旨在调查荷兰这种严格的所谓“搜索并消灭”政策在财务和后勤方面的后果。数据基于乌得勒支大学医学中心1991年至2000年的10年筛查、监测和疫情调查。该政策的后果由一个专家小组确定，小组成员包括外科、医学微生物学、医院卫生与感染预防分部、药学和家政服务部门的医生。还计算了与该政策相关的成本，包括额外（一次性）材料、培养、特定药物、去污和病房关闭的成本。在这10年中，MRSA政策的实施导致超过2265个住院日的损失。此外，病房不得不关闭48次，29名医护人员不得不暂时停止工作，还不得不额外进行78000次培养。总成本达到600万荷兰盾（280万欧元）。然后将财务和后勤方面的后果与没有“搜索并消灭”政策的假设情况进行比较。在这种情况下，医院将面临MRSA、万古霉素中度敏感金黄色葡萄球菌和万古霉素耐药肠球菌发病率上升的问题。在MRSA高流行水平的情况下，使用替代抗生素的相关成本将至少是实际情况中支出成本的两倍，从而表明严格的MRSA政策在财务上是值得的。
