Hospital-acquired conditions (HACs), or nosocomial infections, affect millions of patients and add billions to global healthcare costs each year.

5 Most Common & Costly HACs1,3

1. Catheter-Associated Urinary Tract Infections (CAUTIs)

CAUTI facts:

  • More than 30% of HACs are urinary tract infections—almost all of these are CAUTIs4
  • Number 1 cause of secondary nosocomial bloodstream infections4
  • Associated with increased morbidity and mortality, prolonged length of stay, and higher hospital costs4
  • $390M – $450M: estimated annual cost to U.S. healthcare system5
  • Responsible pathogens: Escherichia coli (21.4%), Candida spp (21.0%), Enterococcus spp (14.9%), Pseudomonas aeruginosa (10.0%), Klebsiella pneumoniae (7.7%), and Enterobacter spp (4.1%).4

2. Central Line–Associated Bloodstream Infections (CLABSIs)

CLABSI facts:

  • HAC with one of the highest mortality and morbidity rates2
  • Responsible for 1/3 of all HAC deaths6
  • Associated with prolonged length of stay and higher hospital costs7
  • $590M – $2.68B: estimated annual cost to U.S. healthcare system5
  • Responsible pathogens: gram-positive organisms (coagulase-negative staphylococci 34.1%, enterococci 16%, Staphylococcus aureus 9.9%); gram-negatives (Klebsiella 5.8%, Enterobacter 3.9%, Pseudomonas 3.1%, Escherichia coli 2.7%, Acinetobacter 2.2%); Candida species (11.8%); and others (10.5%)7

3. Ventilator-Associated Pneumonia (VAP)

VAP facts:

  • HAC with the highest mortality rate in critically ill patients8
  • Associated with longer mechanical ventilation and prolonged stay in ICU9
  • $780M – 1.5B: estimated annual cost to U.S. healthcare system5
  • Responsible pathogens: aerobic Enterobacteriaceae (25%), Staphylococcus aureus (20%), Pseudomonas aeruginosa (20%), Haemophilus influenza (10%), and streptococci8

4. Surgical Site Infections (SSIs)

SSI facts:

  • Leading cause of hospital readmission following surgery10
  • Associated with increased morbidity and mortality, prolonged length of stay, and higher hospital costs11
  • Most costly to U.S. healthcare system, estimated at $3.5B – 10B annually12
  • Responsible pathogens: Staphylococcus, Streptococcus, Pseudomonas13

5. Clostridium difficile (C. diff)

C. diff facts:

  • Most common microbial cause of HACs14
  • Leading cause of gastroenteritis-associated death in the U.S.15
  • Patients taking antibiotics are at highest risk14
  • $1.0B – $1.62B: estimated annual cost to U.S. healthcare system5

The Role of Biofilms in HACs

Biofilms are colonies of microorganisms that grow on living surfaces as well as non-living surfaces like medical devices.16 Responsible for an estimated 50% of all nosocomial infections,17 biofilms are particularly dangerous because they’ve demonstrated both immune system resistance and antimicrobial resistance.17,18

References:

  1. CDC website. CDC at Work: preventing healthcare-associated infections. https://www.cdc.gov/washington/~cdcatWork/pdf/infections.pdf Accessed December 6, 2018.
  2. Infection Control Today website. Device-associated infections: evidence-based practice remains the best way to decrease HAIs. https://www.infectioncontroltoday.com/infections/device-associated-infections-evidence-based-practice-remains-best-way-decrease-hais. Accessed December 6, 2018.
  3. Zimlichman E, Henderson D, Tamir O, et al. Health care–associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med. 2013;173(22):2039–2046.
  4. CDC website. Guideline for prevention of catheter-associated urinary tract infections 2009. https://www.cdc.gov/infectioncontrol/pdf/guidelines/cauti-guidelines.pdf. Accessed December 6, 2018.
  5. CDC website. The direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention. https://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf. Accessed December 6, 2018.
  6. Joint Commission website. Do no harm: prevent central line-associated bloodstream infections. https://www.jointcommission.org/assets/1/6/CLABSI_infographic_final.pdf. Accessed December 6, 2018.
  7. Haddadin Y, Regunath H. Central line associated blood stream infections (CLABSI) [Updated 2018 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan. https://www.ncbi.nlm.nih.gov/books/NBK430891/. Accessed December 6, 2018.
  8. Timsit JF, Esaied W, Neuville M, et al. Update on ventilator-associated pneumonia. F1000Res. 2017;6:2061. Published 2017 Nov 29. doi:10.12688/f1000research.12222.1.
  9. CDC website. Ventilator-associated event. https://www.cdc.gov/nhsn/PDFs/pscManual/10-VAE_FINAL.pdf. Accessed December 6, 2018.
  10. Patient Safety Network website. U.S. Department of Health and Human Services. Surgical site infections. https://psnet.ahrq.gov/primers/primer/45/Surgical-Site-Infections. Accessed December 6, 2018.
  11. CDC website. Surgical site infection (SS) event. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Accessed December 6, 2018.
  12. ScienceDaily website. Surgical site infections are the most common and costly of hospital infections. https://www.sciencedaily.com/releases/2017/01/170119161551.htm. Accessed December 6, 2018.
  13. John Hopkins Medicine website. Surgical site infections. https://www.hopkinsmedicine.org/health/conditions-and-diseases/surgical-site-infections. Accessed December 6, 2018.
  14. CDC website. Nearly half a million Americans suffered from Clostridium difficile infections in a single year. https://www.cdc.gov/media/releases/2015/p0225-clostridium-difficile.html. Accessed December 6, 2018.
  15. Infectious Disease Advisor website. Clostridium difficile in the hospital: infection prevention considerations. https://www.infectiousdiseaseadvisor.com/hospital-infection-control/clostridium-difficile-in-the-hospital-infection-prevention-considerations/article/658507/. Accessed December 6, 2018.
  16. Jamal M, Ahmad W, Andleeb S, et al. Bacterial biofilm and associated infections. J Chin Med Assoc. 2018;81(1):7-11.
  17. Philippe HB, Yves FD. Force matters in hospital-acquired infections. Science. 2018;359(6383):1464-1465.
  18. Infection Control Today website: Biofilms & catheters: the mechanisms of infection. https://www.infectioncontroltoday.com/clabsi/biofilms-catheters-mechanisms-infection. Accessed December 6, 2018.