Evidence map›Paper›PMID 30231943›Full record

ArticleInfection control and hospital epidemiology2018

Cost-effectiveness of pre-operative Staphylococcus aureus screening and decolonization.

Susan E Kline, Erinn C Sanstead, James R Johnson, Shalini L Kulasingam

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Infection control and hospital epidemiology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Implementation ofJTCVS techniques · 2025
    Article
  2. Association ofOpen forum infectious diseases · 2024
    Article
  3. Review
  4. Article
  5. A cost-effectiveness analysis of mupirocin and chlorhexidine gluconate forAntimicrobial resistance and infection control · 2019
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Susan E Kline1Division of Infectious Diseases,Department of Medicine, University of Minnesota Medical School,Minneapolis,Minnesota.
Erinn C Sanstead2Division of Epidemiology, University of Minnesota School of Public Health,Minneapolis,Minnesota.
James R Johnson1Division of Infectious Diseases,Department of Medicine, University of Minnesota Medical School,Minneapolis,Minnesota.
Shalini L Kulasingam2Division of Epidemiology, University of Minnesota School of Public Health,Minneapolis,Minnesota.

Funding

University of Minnesota Clinical and Translational Science Institute (UMN CTSI)UL1TR000114 · NCATS · UNIVERSITY OF MINNESOTA · PI BLAZAR, BRUCE R · 2012 to 2015
$35.0M
University of Minnesota Clinical and Translational Science Institute (UMN CTSI)UL1TR002494 · NCATS · UNIVERSITY OF MINNESOTA · PI BLAZAR, BRUCE R, WEISDORF, DANIEL J · 2018 to 2022
$34.9M
Effectiveness of Screening and Decolonization of S. aureus in Surgery OutpatientsR03HS022912 · AHRQ · UNIVERSITY OF MINNESOTA · PI KLINE, SUSAN ELIZABETH · 2014 to 2015
$100k
AHRQ HHS R03 HS022912NCATS NIH HHS UL1 TR000114NCATS NIH HHS UL1 TR002494
6 · The paper itself

Abstract

objectiveWe developed a decision analytic model to evaluate the impact of a preoperative Staphylococcus aureus decolonization bundle on surgical site infections (SSIs), health-care-associated costs (HCACs), and deaths due to SSI.

methodsOur model population comprised US adults undergoing elective surgery. We evaluated 3 self-administered preoperative strategies: (1) the standard of care (SOC) consisting of 2 disinfectant soap showers; (2) the "test-and-treat" strategy consisting of the decolonization bundle including chlorhexidine gluconate (CHG) soap, CHG mouth rinse, and mupirocin nasal ointment for 5 days) if S. aureus was found at any of 4 screened sites (nasal, throat, axillary, perianal area), otherwise the SOC; and (3) the "treat-all" strategy consisting of the decolonization bundle for all patients, without S. aureus screening. Model parameters were derived primarily from a randomized controlled trial that measured the efficacy of the decolonization bundle for eradicating S. aureus.

resultsUnder base-case assumptions, the treat-all strategy yielded the fewest SSIs and the lowest HCACs, followed by the test-and-treat strategy. In contrast, the SOC yielded the most SSIs and the highest HCACs. Consequently, relative to the SOC, the average savings per operation was $217 for the treat-all strategy and $123 for the test-and-treat strategy, and the average savings per per SSI prevented was $21,929 for the treat-all strategy and $15,166 for the test-and-treat strategy. All strategies were sensitive to the probability of acquiring an SSI and the increased risk if SSI if the patient was colonized with SA.

conclusionWe predict that the treat-all strategy would be the most effective and cost-saving strategy for preventing SSIs. However, because this strategy might select more extensively for mupirocin-resistant S. aureus and cause more medication adverse effects than the test-and-treat approach or the SOC, additional studies are needed to define its comparative benefits and harms.

Indexed as

Models, EconomicAdministration, IntranasalAnti-Bacterial AgentsChlorhexidineCost-Benefit AnalysisDisinfectionHumansMupirocinStaphylococcal InfectionsStaphylococcus aureusSurgical Wound InfectionUnited StatesAnti-Bacterial AgentsChlorhexidinechlorhexidine gluconateMupirocin

Identifiers

PMID30231943
PMCPMC8559732

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.