Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-20T22:30:24.791Z Has data issue: false hasContentIssue false
  • English
  • Français

Estimating the Proportion of Healthcare-Associated Infections That Are Reasonably Preventable and the Related Mortality and Costs

Published online by Cambridge University Press:  02 January 2015

Craig A. Umscheid ,
Matthew D. Mitchell ,
Jalpa A. Doshi ,
Rajender Agarwal ,
Kendal Williams  and
Patrick J. Brennan
Craig A. Umscheid*
Affiliation:
Center for Evidence-Based Practice, University of Pennsylvania, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Matthew D. Mitchell
Affiliation:
Center for Evidence-Based Practice, University of Pennsylvania, Philadelphia, Pennsylvania
Jalpa A. Doshi
Affiliation:
Center for Evidence-Based Practice, University of Pennsylvania, Philadelphia, Pennsylvania Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Rajender Agarwal
Affiliation:
Center for Evidence-Based Practice, University of Pennsylvania, Philadelphia, Pennsylvania
Kendal Williams
Affiliation:
Center for Evidence-Based Practice, University of Pennsylvania, Philadelphia, Pennsylvania Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Patrick J. Brennan
Affiliation:
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Office of the Chief Medical Officer, University of Pennsylvania, Philadelphia, Pennsylvania
*
Assistant Professor of Medicine and Epidemiology, Director, Center for Evidence-Based Practice, University of Pennsylvania, 3535 Market Street, Mezzanine, Suite 50, Philadelphia, PA 19104 (craig.umscheid@uphs.upenn.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To estimate the proportion of healthcare-associated infections (HAIs) in US hospitals that are “reasonably preventable,” along with their related mortality and costs.

Methods.

To estimate preventability of catheter-associated bloodstream infections (CABSIs), catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs), and ventilator-associated pneumonia (VAP), we used a federally sponsored systematic review of interventions to reduce HAIs. Ranges of preventability included the lowest and highest risk reductions reported by US studies of “moderate” to “good” quality published in the last 10 years. We used the most recently published national data to determine the annual incidence of HAIs and associated mortality. To estimate incremental cost of HAIs, we performed a systematic review, which included costs from studies in general US patient populations. To calculate ranges for the annual number of preventable infections and deaths and annual costs, we multiplied our infection, mortality, and cost figures with our ranges of preventability for each HAI.

Results.

AS many as 65%–70% of cases of CABSI and CAUTI and 55% of cases of VAP and SSI may be preventable with current evidence-based strategies. CAUTI may be the most preventable HAI. CABSI has the highest number of preventable deaths, followed by VAP. CABSI also has the highest cost impact; costs due to preventable cases of VAP, CAUTI, and SSI are likely less.

Conclusions.

Our findings suggest that 100% prevention of HAIs may not be attainable with current evidence-based prevention strategies; however, comprehensive implementation of such strategies could prevent hundreds of thousands of HAIs and save tens of thousands of lives and billions of dollars.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 2 , February 2011 , pp. 101 - 114
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Kohn, LT, Corrigan, JM, Donaldson, MS, eds. To err is human: building a safer health system. National Academy of Sciences, 2000.Google Scholar
2. Klevens, RM, Edwards, JR, Richards, CL Jr, et al. Estimating health care-associated infections and deaths in US hospitals, 2002. Public Health Rep 2007;122(2):160–166.CrossRefGoogle ScholarPubMed
3. Ranji, SR, Shetty, K, Posley, KA, et al. Volume 6: prevention of healthcare-associated infections. Rockville, MD: Agency for Healthcare Research and Quality; 2007 January 2007. AHRQ publication 04(07)-0051-6.Google Scholar
4. Yokoe, DS, Mermel, LA, Anderson, DJ, et al. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(suppl 1): S12–S21.CrossRefGoogle ScholarPubMed
5. Wald, HL, Kramer, AM. Nonpayment for harms resulting from medical care: catheter-associated urinary tract infections. JAMA 2007;298(23):2782–2784.CrossRefGoogle ScholarPubMed
6. Pronovost, PJ, Goeschel, CA, Wachter, RM. The wisdom and justice of not paying for “preventable complications.” JAMA 2008;299(18):2197–2199.CrossRefGoogle Scholar
7. Brown, A, Wells, P, Jaffey, J, et al. Point-of-care monitoring devices for long-term oral anticoagulation therapy: clinical and cost effectiveness. Ottawa: Canadian Agency for Drugs and Technologies in Health, 2007. Technology report 72.Google Scholar
8. DiGiovine, B, Chenoweth, C, Watts, C, Higgins, M. The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med 1999;160(3):976–981.CrossRefGoogle ScholarPubMed
9. Harbarth, S, Sax, H, Gastmeier, P. The preventable proportion of nosocomial infections: An overview of published reports. J Hosp Infect 2003;54(4):258–266.CrossRefGoogle ScholarPubMed
10. Shannon, RP, Patel, B, Cummins, D, Shannon, AH, Ganguli, G, Lu, Y. Economics of central line-associated bloodstream infections. Am J Med Qual 2006;21(suppl 6):7S–16S.CrossRefGoogle ScholarPubMed
11. Warren, DK, Quadir, WW, Hollenbeak, CS, Elward, AM, Cox, MJ, Fraser, VJ. Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital. Crit Care Med 2006;34(8):2084–2089.CrossRefGoogle Scholar
12. Dimick, JB, Pelz, RK, Consunji, R, Swoboda, SM, Hendrix, CW, Lipsett, PA. Increased resource use associated with catheter-related bloodstream infection in the surgical intensive care unit. Arch Surg 2001;136(2):229–234.CrossRefGoogle ScholarPubMed
13. Lansford, T, Moncure, M, Carlton, E, et al. Efficacy of a pneumonia prevention protocol in the reduction of ventilator-associated pneumonia in trauma patients. Surg Infect (Larchmt) 2007;8(5):505–510.CrossRefGoogle ScholarPubMed
14. Warren, DK, Shukla, SJ, Olsen, MA, et al. Outcome and attributable cost of ventilator-associated pneumonia among intensive care unit patients in a suburban medical center. Crit Care Med 2003;31(5):1312–1317.CrossRefGoogle Scholar
15. Tambyah, PA, Knasinski, V, Maki, DG. The direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care. Infect Control Hosp Epidemiol 2002;23(1):27–31.CrossRefGoogle ScholarPubMed
16. Saint, S, Veenstra, DL, Sullivan, SD, Chenoweth, C, Fendrick, AM. The potential clinical and economic benefits of silver alloy urinary catheters in preventing urinary tract infection. Arch Intern Med 2000;160(17):2670–2675.CrossRefGoogle ScholarPubMed
17. Bologna, RA, Tu, LM, Polansky, M, Fraimow, HD, Gordon, DA, Whitmore, KE. Hydrogel/silver ion-coated urinary catheter reduces nosocomial urinary tract infection rates in intensive care unit patients: a multicenter study. Urology 1999;54(6):982–987.CrossRefGoogle ScholarPubMed
18. Dimick, JB, Chen, SL, Taheri, PA, Henderson, WG, Khuri, SF, Campbell, DA Jr. Hospital costs associated with surgical complications: a report from the private-sector national surgical quality improvement program. J Am Coll Surg 2004;199(4):531–537.CrossRefGoogle ScholarPubMed
19. Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG. The nationwide nosocomial infection rate: a new need for vital statistics. Am J Epidemiol 1985;121(2):159–167.CrossRefGoogle Scholar
20. Haley, RW, Culver, DH, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121(2):182–205.CrossRefGoogle ScholarPubMed
21. Braun, BI, Kritchevsky, SB, Wong, ES, et al. Preventing central venous catheter-associated primary bloodstream infections: characteristics of practices among hospitals participating in the evaluation of processes and indicators in infection control (EPIC) study. Infect Control Hosp Epidemiol 2003;24(12):926–935.CrossRefGoogle ScholarPubMed
22. Kaye, KS, Engemann, JJ, Fulmer, EM, Clark, CC, Noga, EM, Sexton, DJ. Favorable impact of an infection control network on nosocomial infection rates in community hospitals. Infect Control Hosp Epidemiol 2006;27(3):228–232.CrossRefGoogle ScholarPubMed
23. Pittet, D, Harbarth, S. What techniques for diagnosis of ventilator-associated pneumonia? [see comment]. Lancet 1998; 352(9122):83–84.CrossRefGoogle ScholarPubMed
24. Meisen, WG, Rovers, MM, Bonten, MJ. Ventilator-associated pneumonia and mortality: a systematic review of observational studies. Crit Care Med 2009;37(10):2709–2718.Google Scholar
25. Perencevich, EN, Stone, PW, Wright, SB, et al. Raising standards while watching the bottom line: making a business case for infection control. Infect Control Hosp Epidemiol 2007;28(10):1121–1133.CrossRefGoogle ScholarPubMed
26. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355(26):2725–2732.CrossRefGoogle ScholarPubMed
27. Berenholtz, SM, Pronovost, PJ, Lipsett, PA, et al. Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004;32(10):2014–2020.CrossRefGoogle ScholarPubMed
28. Coopersmith, CM, Zack, JE, Ward, MR, et al. The impact of bedside behavior on catheter-related bacteremia in the intensive care unit. Arch Surg 2004;139(2):131–136.CrossRefGoogle ScholarPubMed
29. Warren, DK, Zack, JE, Mayfield, JL, et al. The effect of an education program on the incidence of central venous catheter-associated bloodstream infection in a medical ICU. Chest 2004; 126(5):1612–1618.CrossRefGoogle Scholar
30. Warren, DK, Zack, JE, Cox, MJ, Cohen, MM, Fraser, VJ. An educational intervention to prevent catheter-associated bloodstream infections in a nonteaching, community medical center. Crit Care Med 2003;31(7):1959–1963.CrossRefGoogle Scholar
31. Coopersmith, CM, Rebmann, TL, Zack, JE, et al. Effect of an education program on decreasing catheter-related bloodstream infections in the surgical intensive care unit. Crit Care Med 2002; 30(1):59–64.CrossRefGoogle ScholarPubMed
32. Sherertz, RJ, Ely, EW, Westbrook, DM, et al. Education of physicians-in-training can decrease the risk for vascular catheter infection. Ann Intern Med 2000;132(8):641–648.CrossRefGoogle ScholarPubMed
33. Babcock, HM, Zack, JE, Garrison, T, et al. An educational intervention to reduce ventilator-associated pneumonia in an integrated health system: a comparison of effects. Chest 2004;125(6):2224–2231.CrossRefGoogle Scholar
34. Zack, JE, Garrison, T, Trovillion, E, et al. Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia. Crit Care Med 2002;30(11):2407–2412.CrossRefGoogle ScholarPubMed
35. Lai, KK, Baker, SP, Fontecchio, SA. Impact of a program of intensive surveillance and interventions targeting ventilated patients in the reduction of ventilator-associated pneumonia and its cost-effectiveness. Infect Control Hosp Epidemiol 2003;24(11):859–863.CrossRefGoogle ScholarPubMed
36. Topal, J, Conklin, S, Camp, K, Morris, V, Balcezak, T, Herbert, P. Prevention of nosocomial catheter-associated urinary tract infections through computerized feedback to physicians and a nurse-directed protocol. Am J Med Qual 2005;20(3):121–126.CrossRefGoogle Scholar
37. Dumigan, DG, Kohan, CA, Reed, CR, Jekel, JF, Fikrig, MK. Utilizing national nosocomial infection surveillance system data to improve urinary tract infection rates in three intensive-care units. Clin Perform Qual Health Care 1998;6(4):172–178.Google ScholarPubMed
38. Dellinger, EP, Hausmann, SM, Bratzier, DW, et al. Hospitals collaborate to decrease surgical site infections. Am J Surg 2005;190(1):9–15.CrossRefGoogle ScholarPubMed
39. Lutarewych, M, Morgan, SP, Hall, MM. Improving outcomes of coronary artery bypass graft infections with multiple interventions: putting science and data to the test. Infect Control Hosp Epidemiol 2004;25(6):517–519.CrossRefGoogle ScholarPubMed
40. Rao, N, Schilling, D, Rice, J, Ridenour, M, Mook, W, Santa, E. Prevention of postoperative mediastinitis: a clinical process improvement model. J Healthc Qual 2004;26(1):22–27.CrossRefGoogle ScholarPubMed
41. Cocanour, CS, Ostrosky-Zeichner, L, Peninger, M, et al. Cost of a ventilator-associated pneumonia in a shock trauma intensive care unit. Surg Infect (Larchmt) 2005;6(1):65–72.CrossRefGoogle Scholar
42. Relio, J, Ollendorf, DA, Oster, G, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Cliesi 2002;122(6):2115–2121.Google Scholar
43. Herwaldt, LA, Cullen, JJ, Scholz, D, et al. A prospective study of outcomes, healthcare resource utilization, and costs associated with postoperative nosocomial infections. Infect Control Hosp Epidemiol 2006;27(12):1291–1298.CrossRefGoogle ScholarPubMed
44. Kirkland, KB, Briggs, JP, Trivette, SL, Wilkinson, WE, Sexton, DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20(11):725–730.CrossRefGoogle ScholarPubMed
45. Perencevich, EN, Sands, KE, Cosgrove, SE, Guadagnoli, E, Meara, E, Platt, R. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis 2003;9(2):196–203.CrossRefGoogle ScholarPubMed
46. Dimick, JB, Pronovost, PJ, Cowan, JA, Lipsett, PA. Complications and costs after high-risk surgery: where should we focus quality improvement initiatives? J Am Coll Surg 2003;196(5):671–678.CrossRefGoogle ScholarPubMed
47. Herwaldt, LA, Swartzendruber, SK, Edmond, MB, et al. The epidemiology of hemorrhage related to cardiothoracic operations. Infect Control Hosp Epidemiol 1998;19(1):9–16.CrossRefGoogle ScholarPubMed