Economic burden of healthcare-associated infections: an American perspective

Annually, approximately 2 million patients suffer with healthcare-associated infections (HAIs) in the USA, and nearly 90,000 are estimated to die. The overall direct cost of HAIs to hospitals ranges from US$28 billion to 45 billion. While the range is wide, HAIs are clearly expensive. In addition, most HAIs are thought to be preventable; however, published guidelines are not congruent. Important policy changes include mandating hospitals to publically report HAI rates and a federal pay-for-performance measure that will no longer allow Medicare to pay more for patients with HAIs. Further rigorous economic evaluations of specific interventions, as well as on evaluations of the policies, are required.

[1]  Larry J. Anderson,et al.  Guidelines for preventing health-care-associated pneumonia, 2003 recommendations of the CDC and the Healthcare Infection Control Practices Advisory Committee. , 2004, Respiratory care.

[2]  R. Chaitow.  Guideline for prevention of catheter-associated urinary tract infections. , 1981, Infection control : IC.

[3]  M. Rosenthal,et al.  Early experience with pay-for-performance: from concept to practice. , 2005, JAMA.

[4]  Didier Pittet,et al.  Guideline for Hand Hygiene in Health-Care Settings Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC / SHEA / APIC / IDSA Hand Hygiene Task Force , 2002 .

[5]  Elaine Larson,et al.  A systematic audit of economic evidence linking nosocomial infections and infection control interventions: 1990-2000. , 2002, American journal of infection control.

[6]  Kelly D Peterson,et al.  National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. , 2008, American journal of infection control.

[7]  D. Cardo,et al.  Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002 , 2007, Public health reports.

[8]  M. Jackson,et al.  Management of multidrug-resistant organisms in health care settings, 2006. , 2007, American journal of infection control.

[9]  R. Scott,et al.  The Direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention , 2009 .

[10]  C. Bridges,et al.  Guidelines for preventing health-care--associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. , 2004, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[11]  Donald M Berwick,et al.  Public performance reports and the will for change. , 2002, JAMA.

[12]  Joshua A. Doherty,et al.  Gram-negative bacteraemia in non-ICU patients: factors associated with inadequate antibiotic therapy and impact on outcomes. , 2008, The Journal of antimicrobial chemotherapy.

[13]  Deborah Braccia,et al.  Systematic review of economic analyses of health care-associated infections. , 2005, American journal of infection control.

[14]  Public health focus: surveillance, prevention, and control of nosocomial infections. , 1992, MMWR. Morbidity and mortality weekly report.

[15]  R. D. McCormick,et al.  Guidelines for the Prevention of Intravascular Catheter–Related Infections , 2002, Infection Control & Hospital Epidemiology.

[16]  P. Romano,et al.  Do Well-Publicized Risk-Adjusted Outcomes Reports Affect Hospital Volume? , 2004, Medical care.

[17]  J. Edwards,et al.  National Healthcare Safety Network (NHSN) Report, data summary for 2006 through 2007, issued November 2008. , 2008, American Journal of Infection Control.

[18]  S. Saint,et al.  The Clinical and Economic Consequences of Nosocomial Central Venous Catheter-Related Infection: Are Antimicrobial Catheters Useful? , 2000, Infection Control & Hospital Epidemiology.

[19]  E. Larson,et al.  Comparisons of health care-associated infections identification using two mechanisms for public reporting. , 2007, American journal of infection control.

[20]  Richard Platt,et al.  Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[21]  C. Clancy,et al.  Comparative-effectiveness research--implications of the Federal Coordinating Council's report. , 2009, The New England journal of medicine.

[22]  David Jarjoura,et al.  Administrative coding data, compared with CDC/NHSN criteria, are poor indicators of health care-associated infections. , 2008, American journal of infection control.

[23]  Acip.  Prevention and control of influenza : recommendations of the Advisory Committee on Immunization Practices (ACIP) , 2004 .

[24]  A. Elixhauser,et al.  Clostridium Difficile-Associated Disease in U.S. Hospitals, 1993–2005 , 2008 .

[25]  K. Sepkowitz,et al.  Adverse outcomes associated with Contact Precautions: a review of the literature. , 2009, American journal of infection control.

[26]  S. Cosgrove,et al.  The Impact of Methicillin Resistance in Staphylococcus aureus Bacteremia on Patient Outcomes: Mortality, Length of Stay, and Hospital Charges , 2005, Infection Control & Hospital Epidemiology.

[27]  S. Cosgrove.  The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[28]  Eli N. Perencevich,et al.  Health and Economic Impact of Surgical Site Infections Diagnosed after Hospital Discharge , 2003, Emerging infectious diseases.

[29]  Ateev Mehrotra,et al.  Pay for Performance in the Hospital Setting: What Is the State of the Evidence? , 2009, American journal of medical quality : the official journal of the American College of Medical Quality.

[30]  E. Larson,et al.  Effect of guideline implementation on costs of hand hygiene. , 2007, Nursing economic$.

[31]  B. Sibbald,et al.  Effects of pay for performance on the quality of primary care in England. , 2009, The New England journal of medicine.

[32]  Jeannie P. Cimiotti,et al.  Attributable Costs and Length of Stay of an Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae Outbreak in a Neonatal Intensive Care Unit , 2003, Infection Control & Hospital Epidemiology.

[33]  L. Kohn,et al.  To Err Is Human : Building a Safer Health System , 2007 .

[34]  Sanjay Saint,et al.  Guidelines for the prevention of intravascular catheter-related infections. , 2002, American journal of infection control.

[35]  Didier Pittet,et al.  Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. , 2002, American journal of infection control.

[36]  C. Kelly,et al.  Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[37]  Yehuda Carmeli,et al.  Multidrug-Resistant Pseudomonas aeruginosa: Risk Factors and Clinical Impact , 2006, Antimicrobial Agents and Chemotherapy.

[38]  S. Segal-Maurer,et al.  Increased Mortality Associated With a Clonal Outbreak of Ceftazidime-Resistant Klebsiella pneumoniae: A Case–Control Study , 2005, Infection Control & Hospital Epidemiology.

[39]  S. Cosgrove,et al.  Raising Standards While Watching the Bottom Line Making a Business Case for Infection Control , 2007, Infection Control & Hospital Epidemiology.

[40]  M. Jackson,et al.  Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings 2007. , 2007 .

[41]  D. Fleming,et al.  Guideline for isolation precautions in hospitals. Part I. Evolution of isolation practices, Hospital Infection Control Practices Advisory Committee. , 1996, American journal of infection control.

[42]  R. Sood,et al.  Direct costs of multidrug-resistant Acinetobacter baumannii in the burn unit of a public teaching hospital. , 2004, American journal of infection control.

[43]  T. Horan,et al.  Definitions of key terms used in the NNIS System. , 1997, American journal of infection control.

[44]  T. Horan,et al.  Surveillance: into the next millennium. , 1997, American journal of infection control.

[45]  Carlene A. Muto,et al.  SHEA Guideline for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of Staphylococcus aureus and Enterococcus , 2003, Infection Control & Hospital Epidemiology.

[46]  Peter J Pronovost,et al.  Improving patient safety in intensive care units in Michigan. , 2008, Journal of critical care.

[47]  A. Wall,et al.  Book ReviewTo Err is Human: building a safer health system Kohn L T Corrigan J M Donaldson M S Washington DC USA: Institute of Medicine/National Academy Press ISBN 0 309 06837 1 $34.95 , 2000 .

[48]  J. Edwards,et al.  National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. , 2007, American journal of infection control.

[49]  T. Perl,et al.  Effect of Nosocomial Vancomycin-Resistant Enterococcal Bacteremia on Mortality, Length of Stay, and Costs , 2003, Infection Control & Hospital Epidemiology.

[50]  P. Pronovost,et al.  An intervention to decrease catheter-related bloodstream infections in the ICU. , 2006, The New England journal of medicine.

[51]  Nnis System.  National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2003, issued August 2003. , 2003, American journal of infection control.

[52]  A. Milstein.  Ending extra payment for "never events"--stronger incentives for patients' safety. , 2009, The New England journal of medicine.

[53]  Bruce Landon,et al.  Paying for quality: providers' incentives for quality improvement. , 2004, Health affairs.

[54]  Reduction in central line-associated bloodstream infections among patients in intensive care units--Pennsylvania, April 2001-March 2005. , 2005, MMWR. Morbidity and mortality weekly report.

[55]  Richard Platt,et al.  Administrative Databases Provide Inaccurate Data for Surveillance of Long-Term Central Venous Catheter-Associated Infections , 2003, Infection Control & Hospital Epidemiology.

[56]  S. Cosgrove,et al.  Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[57]  M. Rosenthal,et al.  Nonpayment for performance? Medicare's new reimbursement rule. , 2007, The New England journal of medicine.

[58]  Carlene A. Muto,et al.  Another tale of two guidelines. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[59]  M. Whitby,et al.  Risk of death from methicillin‐resistant Staphylococcus aureus bacteraemia: a meta‐analysis , 2001, The Medical journal of Australia.

[60]  E. Larson,et al.  Effectiveness of barrier precautions and surveillance cultures to control transmission of multidrug-resistant organisms: a systematic review of the literature. , 2006, American journal of infection control.

[61]  S. Saint,et al.  The potential clinical and economic benefits of silver alloy urinary catheters in preventing urinary tract infection. , 2000, Archives of internal medicine.

[62]  M. Jackson,et al.  2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings , 2007, American Journal of Infection Control.

[63]  R H Brook,et al.  The public release of performance data: what do we expect to gain? A review of the evidence. , 2000, JAMA.

[64]  憲 大久保.  Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings 2007 , 2008 .