The estimated direct medical cost of healthcare-associated infections is around $10 billion annually, not including cost-shifting to private payers, indirect costs or nonmedical social costs. Many hospital and health system CFOs rightly recognize infection prevention as an area of opportunity to improve care quality and cut costs.
The more CFOs know about the infections that afflict their hospital patients, the more they will be able to support the implementation of infection-reducing, cost-cutting interventions. To help, Becker's Hospital Review has created an HAI guide for CFOs.
Here are 25 things CFOs should know about five of the most common HAIs.
Methicillin-resistant Staphylococcus aureus infections
1. MRSA is a type of staph bacteria that is resistant to many antibiotics. In medical facilities, MRSA can cause severe problems, such as life-threatening bloodstream infections, pneumonia and surgical site infections.1
2. On average, the chance being readmitted within a year of a hospital stay for patients with a MRSA-positive culture is 40 percent higher than patients with a MRSA-negative culture. The average readmission time from hospital discharge is 27 days for a culture-positive patient.2
3. In 2015, CMS added MRSA to its list of HAIs for which it would no longer reimburse, meaning the excess costs of this infection will no longer be covered by Medicare and Medicaid services.2
4. The mortality rate for patients with MRSA infections is roughly double the mortality rate for those with methicillin-sensitive Staphylococcus aureus infections, increasing hospital costs. Unlike MRSA, MSSA can be killed by methicillin.2
5. When evaluating the cost-benefit ratio of screening for MRSA and its impact on the utilization of healthcare resources, there are two meaningful measures providers should consider: the cost of the MRSA tests and the specificity of the test's results.
Check out the full CFO guide to MRSA here.
Catheter-associated urinary tract infections
6. Urinary tract infections are the most common type of HAI reported to the CDC's National Healthcare Safety Network, and about 75 percent of UTIs are associated with a catheter.3
7. The excess cost per patient associated with a CAUTI is approximately $1,000, and CAUTIs make up 2 percent of excess costs in U.S. hospitals associated with all HAIs.2
8. Nationally, CAUTIs are associated with an increased cost of $400 million to $500 million annually.4
9. CAUTI rates are examined as part of CMS' Hospital-Acquired Condition Reduction Program. This means if a hospital has a high rate of CAUTIs, as well as other HAIs, it can face a 1 percent reduction in Medicare payments as part of the program.
10. CAUTIs are one of the only HAIs that have not seen improved rates in recent years. The "National and State Healthcare-associated Infection Progress Report" released by the CDC this year showed a 6 percent increase in CAUTIs since 2009, based on data submitted to the NHSN.
Check out the full CFO guide to CAUTIs here.
Central line-associated bloodstream infections
11. A CLABSI is defined as "a laboratory-confirmed bloodstream infection where a central line or umbilical catheter was in place for more than two calendar days on the date of event, with the day the device was placed being day one, or the day before."5
12. CLABSIs make up 36 percent of excess costs in U.S. hospitals associated with all HAIs.2
13. Per infection, CLABSIs cost a hospital an average of $45,800 due to the expenses associated with increased length of stay, antibiotics, supportive care, aftercare and rehabilitation. When combined with a MRSA infection, a CLABSI can cost closer to $58,500.2
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14. On average, CLABSIs add roughly 10.4 days to a patient's length of stay, or 15.7 days if the patient has both a bloodstream infection and a MRSA infection.2
15. On a national level, CLABSIs decreased by 46 percent between 2008 and 2013.
Check out the full CFO guide to CLABSIs here.
Surgical site infections
16. An SSI is an infection that happens after surgery affecting the part of the body where the surgery was performed. Some SSIs are superficial skin infections, while others are more serious and involve tissue under the skin or organs, according to the CDC.
17. SSIs account for 31 percent of all HAIs in hospitalized patients. An estimated 157,000 surgical site infections were associated with inpatient surgeries in 2011.6
18. The excess cost of an SSI per patient is $20,800. An SSI will also be even more costly financially if MRSA is present — the excess cost of one such infection is $42,000.2
19. Part of that excess cost comes from the increased length of stay for a patient with an SSI. When an SSI occurs, it adds 11.2 days to the average length of stay for a patient.2
20. SSIs can also raise costs through readmissions. The most common reason for unplanned hospital readmissions is an SSI, according to a recent study in JAMA.
Check out the full CFO guide to SSIs here.
Clostridium difficile
21. C. diff is a spore-forming, Gram-positive anaerobic bacillus that can lead to antibiotic-associated diarrhea and sepsis, among other conditions.7
22. According to a recent CDC report, C. diff caused nearly half a million infections in U.S. hospitalized patients in 2011. That year, about 29,000 patients died within 30 days of the C. diff diagnosis, with 15,000 of those deaths directly attributable to the infection.
23. C. diff infections, or CDIs, account for 10 percent of all HAIs in hospitalized patients. The excess cost of a CDI per patient is estimated at around $11,000.2
24. Between 2011 and 2013, the nation saw a 10 percent decrease in CDIs, according to the CDC's National and State Healthcare-associated Infection Progress Report.
25. CDIs can be prevented in healthcare settings by using antibiotics judiciously, implementing an environmental cleaning and disinfection strategy, having healthcare workers use contact precautions when working with patients who are (or may be) infected with C. diff and practicing hand hygiene.8
Check out the full CFO guide to C. diff here.
Footnotes:
1 Centers for Disease Control and Prevention. April 3, 2014. Methicillin-resistant Staphylococcus aureus (MRSA) Infections. General Information About MRSA in Healthcare Settings. http://www.cdc.gov/mrsa/healthcare/index.html
2 Becker's Hospital Review. Patient Shield Concepts. May 12, 2015. The True Cost of HAIs. https://www.youtube.com/watch?v=7QyKhmeFeL8
3 Centers for Disease Control and Prevention. January 20, 2015. Catheter-associated Urinary Tract Infections. http://www.cdc.gov/HAI/ca_uti/uti.html
4 Centers for Disease Control and Prevention. Catheter-associated Urinary Tract Infection (CAUTI) Toolkit. http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf
5 Centers for Disease Control and Prevention. April 2015. Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and Non-central line-associated Bloodstream Infection). http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf
6 CDC. "Surgical Site Infection (SSI) Event. April 2015. http://www.cdc.gov/nhsn/PDFs/pscManual/9pscSSIcurrent.pdf
7 Centers for Disease Control and Prevention. February 25, 2015. Healthcare-associated Infections (HAIs). Clostridium difficile Infection. http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_infect.html
8 Centers for Disease Control and Prevention. March 6, 2012. Healthcare-associated Infections (HAIs). Frequently Asked Questions about Clostridium difficile for Healthcare Providers. http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_faqs_HCP.html