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Hospital infections cost U.S. $10 billion a year

By Anne Harding

NEW YORK (Reuters Health) - Infections acquired in the hospital cost the U.S. health care system $10 billion a year, new findings show.

Past studies have pegged the annual cost of treating those infections at $20 billion to $40 billion, so the new numbers show progress is being made, Dr. Eyal Zimlichman of The Center for Patient Safety Research and Practice at Brigham and Women's Hospital in Boston, one of the new study's authors, told Reuters Health.

Nevertheless, he said, much more can be done.

According to the U.S. Centers for Disease Control and Prevention (CDC), about one in every 20 hospitalized patients contracts a hospital-acquired infection.

Zimlichman and his team reviewed 26 studies to identify the costs associated with treating the five most common, expensive and preventable infections among hospitalized patients.

Bloodstream infections from central lines, which are long tubes inserted in a large vein such as in the chest or arm to deliver medication, fluids, nutrients or blood products, were the most expensive, at a cost of $45,814 per case. Ventilator-associated pneumonia, or a lung infection that develops while a person is on a respirator, came in second, at $40,144 per case.

Post-surgery infections occurring at the site of the operation cost $20,785 per patient. Infection with Clostridium difficile, a tough-to-treat bacterium that causes severe diarrhea and can spread within hospital units, cost $11,285 per case. Catheter-associated urinary tract infections (UTIs) were the least costly, at $896 per case.

About 441,000 of these infections occur among hospitalized adults in the U.S. every year, for a total cost of $9.8 billion, Zimlichman and his colleagues reported in JAMA Internal Medicine.

Surgical site infections and ventilator-associated pneumonia each accounted for about one third of the total costs. That was followed by central line bloodstream infections (about 19 percent), C. difficile infections (15 percent) and catheter-associated UTIs, which accounted for less than 1 percent of all costs.

"This study really adds further evidence that not only are these infections too common and often lethal, they're extremely expensive," Dr. Peter Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine in Baltimore, told Reuters Health.

"We really need to accelerate our efforts to reduce these infections."

Up to 70 percent of central line infections and ventilator-associated pneumonias can be prevented if the healthcare team treating the patient follows a checklist of best practices, added Pronovost, who did not take part in the new study.

Patients can protect themselves by asking hospitals about their infection rates and what they are doing to reduce them, he said.

Many states also require hospitals to report data on hospital-acquired infections to the CDC, which provides this information on its website (http://1.usa.gov/1aYZ1r2).

When patients are in the hospital, there are a few simple steps they can take to protect themselves, Pronovost added. "If someone walks into your room and you don't see them washing their hands, ask them if they did," he said.

Although there's ample evidence on how to prevent central line infections and ventilator-associated pneumonia, Zimlichman noted, less research has been done on the best strategies for heading off surgical site infections.

"There's not one magic bullet for them, but a series of small little things of being meticulous," Pronovost said - for example making sure a patient's skin is cleaned properly and that he or she is being prescribed the right dose of antibiotics.

Nevertheless, he added, if nurses and doctors follow these strategies they can reduce the rate of surgical site infections by 40 percent to 50 percent.

In the past, hospitals had little financial incentive to prevent these types of infections, since insurers would reimburse them for any additional costs associated with treating them, Dr. Mitchell H. Katz wrote in a note accompanying the study.

"Under this perverse payment scheme, a hospital that invested money to decrease infections would pay 'twice': once for the intervention and once through not getting the additional money for treating the patient for the additional complication," Katz, a deputy editor at the journal, wrote.

But that has begun to change, he added, since Medicare - the government-funded insurance program for the elderly and disabled - is no longer paying hospitals to treat these infections. "Not paying for hospital-acquired infections or errors is an important part of the movement toward paying for quality, not quantity, of care," Katz wrote.

SOURCE: http://bit.ly/1eb1COz JAMA Internal Medicine, online September 2, 2013.

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