Investigators Evaluate the Cost of Failure to Actively Screen for VRE

Vancomycin-resistant enterococci (VRE) are still a concern in hospital units tending to seriously ill patients. However, the cost-effectiveness of active surveillance program to identify asymptomatically VRE colonized patients remains debatable. Escaut, et al. (2013) sought to evaluate the cost of a failure in the active surveillance of VRE that had resulted in an outbreak in a French University Hospital.
 
A VRE outbreak was triggered by a failure in the systematic VRE screening in a medico-surgical ward specialised in liver transplantation as a patient was not tested for VRE. This failure was likely caused by the reduction of healthcare resource. The outbreak involved 13 patients. Colonized patients were grouped in a dedicated part of the infectious diseases unit and tended by a dedicated staff. Transmission was halted within two months after discovery of the index case.
 
The direct cost of the outbreak was assessed as the cost of staffing, disposable materials, hygiene procedures, and surveillance cultures.
 
The loss of income from spare isolation beds was computed by difference with the same period in the preceding year. Payments were drawn from the hospital database. The direct cost of the outbreak (2008 Euros) was Euro 60,524 and the loss of income reached Euro 110,915.
  
Despite this failure, the researchers say that rapid eradication of the VRE outbreak was a consequence of the rapid isolation of colonized patient. Yet, eradicating even a limited outbreak requires substantial efforts and resources. This underlines that special attention has to be paid to strictly adhere to active surveillance program. Their research was published in Antimicrobial Resistance and Infection Control. 

Reference: Escaut L, Bouam S, et al. Eradication of an outbreak of vancomycin-resistant Enterococcus (VRE): the cost of a failure in the systematic screening. Antimicrobial Resistance and Infection Control 2013, 2:18 doi:10.1186/2047-2994-2-18.