Although the technology has been around since the 1980s, on-demand polymerase chain reaction (PCR) – a method for amplifying specific sequences of DNA to aid in the diagnoses of diseases and the identification of bacteria and viruses with results obtainable at the point of care within hours – is relatively new. In a recent paper by Spencer, et al.1 in the American Journal of Infection Control (AJIC), the authors report that a survey of infection preventionists (IPs) found that 41% of respondents lacked understanding of how the technology works and that 57% of their facilities that did not have access to PCR technology had no plans to obtain it.
The responses are surprising in light of the high sensitivity and specificity of this testing method and the need for expedient and accurate diagnosis and treatment of infection. These authors have provided infection prevention professionals with a primer on this technology and answered the question, “How does on-demand PCR testing impact health care delivery?”
On-demand PCR technology differs from the early days of this testing method when patient specimens of blood, urine, sputum or stool samples were collected and batched to be run by highly skilled staff. The technology now allows healthcare personnel in any setting to run specimens in automated PCR testing units and have results in two hours or less. The testing is available for Staphylococcus aureus (MRSA and MSSA), Clostridium difficile (CDI), Mycobacterium tuberculosis, Chlamydia trachomatis, Neisseria gonorrhoeae, group B Streptococcus, norovirus, vancomycin-resistant Enterococus, and enteroviral meningitis. The access to this technology has significant implications for patient management:
- Rapid and reliable identification of pathogens responsible for healthcare-associated infections (HAIs). The authors cite several papers that describe dramatic declines in the MRSA infection rates when on-demand MRSA testing was implemented to identify colonized patients, who were subsequently isolated and decolonized.
- Antimicrobial stewardship: More expedient bacterial identification has a significant impact on physicians’ ordering and subsequent administration of antibiotics. One of the authors states, “on-demand PCR testing allows for a switch from empiric to directed therapy, which might be a game changer in the emergency department.”
- Isolation management: On-demand PCR technology has the potential to substantially reduce the number of patients isolated and the number of days on isolation. The authors cite a study that demonstrated a significant decrease in isolation days, tests ordered, and treatment of patients screened for CDI with PCR compared to less sensitive testing as well as a decline in the incidence of HA-CDI from 4.4/10,000 patient-days to 0.9/10,000 patient-days with PCR testing.
In addition to these patient management advantages, on-demand PCR technology can result in dramatic cost savings for a healthcare organization. The rapid identification and management of patients with multidrug-resistant organisms, such as MRSA or CDI, and the subsequent decline in HAI rates due to these organisms can have a profound financial impact.
Zimlichman and colleagues2 reported an average cost of $20,785 for a non-MRSA surgical site infection (SSI) vs. $45,814 for a MRSA SSI. Spencer, et al cite a study from the Netherlands which described a significant reduction in S. aureus SSIs in patients screened with on-demand PCR and then decolonized and an associated reduction on the mean hospital length of stay (LOS) of almost 2 days. The LOS reduction is important to consider in the cost-benefit analysis of on-demand PCR technology, as the availability of beds is critical for generating hospital revenue and emergency department throughput.
Education regarding the advantages of on-demand PCR technology for infection prevention professionals is needed and should be included in the curriculum of the professional organizations, APIC and SHEA. Collaboration with laboratory personnel to define the value of this technology to administrators making budgetary decisions is also necessary.
1 Spencer M, Barnes S, Parada J, Brown S, Perri L, et al. A primer on on-demand polymerase chain reaction technology. Am J Infect Control 2015; (43): 1102-8.
2 Zimlichman E, Henderson D, Tamir O, Franz C, Song P, et al. Healthcare-associated infections: a meta-analysis of costs and financial impact on the US healthcare system. JAMA Intern Med 2013; 173:2039-46.