Hospital Acquired Infections Costly, Preventable
By Emily P. Walker, Washington Correspondent, MedPage Today
Published: August 24, 2011
A program to reduce hospital-acquired infections can save an average of $1.1 million a year, according to results of a new study.
In 2002, one in every 20 hospitalized patients developed a healthcare-associated infection (HAI), making HAIs one of the leading causes of death and illness in the U.S., and costing up to $33 billion dollars, according to the Department of Health and Human Services (HHS).
The 1.7 million reported HAIs resulted in an estimated 99,000 deaths in that year, wrote Hugh Waters, MS, PhD, of Johns Hopkins Bloomberg School of Public Health, and colleagues in the September/October issue of the American Journal of Medical Quality.
There's been "substantial uncertainty" among hospitals on how reducing infections would impact their financial performance, according to the study authors.
"Without a strong business case, hospitals may be reluctant to embark on meaningful efforts to improve safety," they wrote.
The current study examined an HAI-reduction protocol called the Michigan Keystone ICU Patient Safety Program that was created by Peter Pronovost, MD, PhD, also of Johns Hopkins, and a co-author on the current study.
The two most common HAIs are central line-associated bloodstream infections and ventilator-associated pneumonia.
Other HAIs include surgical site infections, catheter-related urinary tract infections, and infections stemming from chest tube placement.
The Keystone program has two main components:
•Interventions to improve the culture of safety and to strengthen teamwork and communication in ICUs
•Interventions to improve compliance with proven infection-prevention methods, such as handwashing before inserting a catheter
Data from 103 hospitals in Michigan participating in the program for 18 months showed that the mean rate of central line-associated bloodstream infections dropped to 1.3 per 1,000 catheter days from 7.7 at 16 to 18 months of follow-up.
The mean rate for ventilator-associated pneumonia was 3.4 per 1,000 ventilator days, down from 6.9, at 16 to 18 months follow-up.
The authors examined the prevalence of the two most common HAIs at a six-hospital subset and determined that nearly 30 catheter-related bloodstream infections and 18 cases of ventilator-associated pneumonia were averted per hospital each year.
They determined the average cost per catheter-related bloodstream infection was $36,500 and the average cost per ventilator-associated pneumonia was $10,000.
The difference between the financial benefits and the costs of the intervention for the average hospital in Michigan was $1.1 million per year per hospital the authors concluded. That is not necessarily profit for the hospital, but it is savings for the healthcare system at large.
The study authors factored in the costs of starting an infection-prevention program based on their experience.
It costs a hospital about $161,000 to run the Keystone ICU program each year, from training costs, to buying sterile central line dressing kits, to time spent implementing and overseeing the interventions. But the savings in averted infections are well worth the investment, the study authors said.
"The results of our study show that there is a strong connection between hospital quality and economic outcome," the study authors wrote.
Preventing infections also prevents people from potentially having to stay in a rehabilitation facility, use home healthcare services, and take extended absences from work, the authors pointed out. The study didn't examine longer term savings.
The authors pointed out that the current healthcare reimbursement system doesn't reward hospitals for preventing infections. In fact, if a hospital prevents infections, they may also be preventing readmissions to the hospital, which would mean a loss in reimbursement.
However, in 2008, Medicare stopped reimbursing hospitals for treating some conditions, infections, or illnesses that were acquired in the hospital, and CMS recently announced that Medicaid would follow suit.
Private insurers also have stopped reimbursing for HAIs.
In general, HAIs appear to be decreasing nationwide. A 2010 report from the Agency for Healthcare Quality and Research however found that while HAIs remain a huge problem, rates have declined in recent years.
The Centers for Disease Control and Prevention reported an 18% reduction in central line-associated bloodstream infections in the first half of 2009 compared with the previous three years, based on data from 17 states.
The research was funded by Blue Cross Blue Shield of Michigan through the Michigan Health and Hospital Association.
Several of the authors reported receiving grants from AHRQ, the Robert Wood Johnson Foundation, the National Patient Safety Agency, and the World Health Organization, and receiving lecture fees (including from a number of drug companies) to speak on quality and patient safety.
© 2011 Everyday Health, Inc. All rights reserved.
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