Five of the most common, costly, and preventable healthcare-associated infections (HAIs) cost the United States nearly $10 billion per year, according to a meta-analysis of 27 years' worth of data by a team from Harvard Medical School and affiliated institutions.

The team reviewed data spanning 1986 to 2013 concerning surgical site infections (SSIs), central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated pneumonia (VAP), and Clostridium difficile infections (CDIs), according to their report, released yesterday by JAMA Internal Medicine.

For HAI incidence estimates, the investigators used the National Healthcare Safety Network of the Centers for Disease Control and Prevention (CDC), which includes 1,700 reporting sites. By conducting a systematic literature review, the team found 26 studies that provided "reasonably robust" estimates of attributable costs and/or length of stay for HAIs.

The overall cost of the HAIs was estimated at $9.8 billion annually. On a per-case basis, CLABSIs were found to be the most expensive HAI at $45,814 each, followed by VAP, $40,144; SSIs, $20,785; CDIs, $11,285; and CAUTIs, $896, the report says.

SSIs, however, accounted for the largest share of costs, at 33.7%. The second largest contributor was VAP, at 31.6%, followed by CLABSIs, 18.9%; CDIs, 15.4%; and CAUTIs, less than 1%.

"While quality improvement initiatives have decreased HAI incidence and costs, much more remains to be done," the report says. "As hospitals realize savings from prevention of these complications under payment reforms, they may be more likely to invest in such strategies."

In an accompanying editor's note, Mitchell H. Katz, MD, deputy editor of the journal, wrote that the journal's aim in publishing the findings was to "motivate health care administrators to invest in the necessary systems to decrease these infections." The costs of such systems are "not trivial," he added.

Katz wrote that hospitals in the past have had a disincentive for preventing HAIs, in that insurers paid them for the additional costs resulting from such infections. But that began to change in 2009, when Medicare stopped paying for HAIs.

"Not paying for hospital-acquired infections or errors is an important part of the movement toward paying for quality, not quantity, of care," Katz said. "As physicians, we should embrace the opportunity that these new payment schemes offer for bringing higher-quality care—including fewer infections—to our patients."

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 Sep 2 (Early online release) [Full text]

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Sep 2 JAMA Intern Med editor's note