An estimated 440,000 adult inpatients acquire one of the top five nosocomial infections in the United States every year, according to a report published online Sept. 2 in JAMA Internal Medicine.
The annual cost of these hospital-acquired infections is an estimated $9.8 billion. One-third of these costs are attributable to surgical site infections. One-fourth are due to ventilator-associated pneumonia, and another fourth are due to catheter-associated urinary tract infections, said Dr. Eyal Zimlichman of the Center for Patient Safety Research and Practice, Brigham and Women’s Hospital and Harvard Medical School, Boston.
CDC/D. Holdeman
Clostridium difficile is one of the five most common, most costly, most preventable, and most well-monitored infections among adult inpatients.
Other studies have estimated that 55%-75% of hospital-acquired infections are preventable with currently available evidence-based interventions. If hospitals nationwide were to implement these existing interventions, an estimated $5.0-$5.5 billion would be saved annually, and the hospitals themselves would be able to tap into those savings.
"Thus, implementation of readily available strategies has the potential to produce significant bottom-line savings to hospitals," the investigators noted.
Dr. Zimlichman and his colleagues analyzed data from the Centers for Disease Control and Prevention’s National Healthcare Safety Network and from a systematic review of the medical literature to estimate the impact of hospital-acquired infections on the U.S. health care system. They focused on a single year (2009) and the five most common, most costly, most preventable, and most well-monitored infections among adult inpatients: surgical site infection, central line–associated bloodstream infection, catheter-associated urinary tract infection, ventilator-associated pneumonia, and Clostridium difficile infection.
These infections occurred against a background of approximately 34.7 million adults receiving inpatient care in U.S. hospitals, for a total of 165.1 million patient-days. These patients underwent approximately 8 million surgical procedures and were treated with invasive medical devices for approximately 96.2 million days of care, which placed them at risk for hospital-acquired infections.
"On an annual basis, surgical site infections (158,639) and Clostridium difficile infections (133,657) were estimated to be the most frequent hospital-acquired infections nationwide," accounting for 36% and 30% of the total number. Catheter-associated UTIs accounted for another 17%, central line–associated bloodstream infection accounted for 9%, and ventilator-associated pneumonia accounted for 7%, Dr. Zimlichman and his associates wrote (JAMA Intern. Med. 2013 Sept. 2 [doi:10.1001/jamainternmed.2013.9763]).
Surgical site infections contributed the greatest portion (34%) to the $9.8 billion estimated total. Catheter-associated UTIs, while frequent, contributed less than 1% to the total expenditure. Ventilator-associated pneumonia contributed 32%, central line–associated bloodstream infection contributed 19%, and C. difficile contributed 15%.
"Since surgical site infections constitute the largest portion of hospital-acquired infection–related costs nationally, and since less progress has been made in preventing these infections than in other areas of care, research and quality improvement efforts are clearly needed in this area," noted Dr. Zimlichman and his associates.
Even though central line–associated bloodstream infections were relatively infrequent, accounting for less than 10% of the total number, these were the most costly infections on a case-by-case basis. Each case of this infection was estimated to cost $45,814. The subgroup of central line–associated bloodstream infections caused by methicillin-resistant Staphylococcus aureus was even more expensive, at $58,614 per case.
The study findings indicate that although much progress has been made in preventing hospital-acquired infections, "much more remains to be done."
"Our study provides updated, robust, and applicable estimates for resources attributable to the major hospital-acquired infections that continue to plague modern health care systems and create considerable harm to patients," they noted.
The investigators added that their findings underestimate the true health care costs of hospital-acquired infection because this study excluded "not only neonatal and pediatric patients but also patients in non–acute care facilities such as long-term care and dialysis centers."
This study was sponsored by the Texas Medical Institute of Technology in Austin. No financial conflicts of interest were reported.