Hospital Infections Cost Billions, Study Shows

Yael Waknine

September 03, 2013

Despite widespread implementation of quality improvement initiatives, an estimated $9.8 billion is spent each year treating hospital-acquired infections (HAIs), according to a study published online September 2 in JAMA Internal Medicine.

Of the top 5 HAIs, surgical site infections contributed the most to overall costs (33.7%), followed by ventilator-associated pneumonia (31.6%), central line–associated bloodstream infections (CLABSIs; 18.9%), Clostridium difficile infections (15.4%), and catheter-associated urinary tract infections (CAUTIs; <1%).

To estimate costs associated with the most significant and targetable HAIs, Eyal Zimlichman, MD, MSc, from Brigham and Women's Hospital and the Harvard Medical School, Boston, Massachusetts, and colleagues performed a meta-analysis of 26 studies published between 1998 and April 2013, adjusting costs to 2012 US dollars. HAI incidence estimates were obtained from the National Healthcare Safety Network of the Centers for Disease Control and Prevention (CDC).

On a per-case basis, CLABSIs were found to be the most costly HAIs, adding an average of $45,814 to a patient's medical bill (95% confidence interval [CI], $30,919 - $65,245).

Ventilator-associated pneumonia ran a close second at $40,144 per case (95% CI, $36,286 - $44,220), followed by surgical site infections ($20,785; 95% CI, $18,902 - $22,667), C difficile infection ($11,285; 95% CI, $9118 - $13,574), and CAUTIs ($896; 95% CI, $603 - $1189).

"As one of the most common sources of preventable harm, health care-associated infections represent a major threat to patient safety," the authors write.

They note that evaluating associated costs could help providers and payers justify investing in prevention strategies, particularly if insurance companies refuse to pick up the tab.

Medicare's nonpayment policy for treating CLABSI, CAUTI, and certain surgical-site infections is a positive step in this direction, the authors point out.

"Not paying for hospital-acquired infections or errors is an important part of the movement toward paying for quality, not quantity, of care," Mitchell H. Katz, MD, director, Los Angeles County Department of Health Services in California, concurs in an accompanying editorial.

The study was sponsored by the Texas Medical Institute of Technology, Austin, as part of a donation promoting research on patient safety. The authors and editorialist have disclosed no relevant financial relationships.

JAMA Intern Med. Published online September 2, 2013. Abstract Editorial

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