The Fiscal Case for Fighting Hospital Acquired Infections - Part 1

In 2014, an outbreak of carbapenemase-producing Enterobacteriaceae (CPE), a bacteria dubbed the “nightmare superbug,” struck 40 patients in five West London hospitals.

The outbreak put the hospitals under immense strain.

Eight bays and four wards were closed, forcing elective procedures to be cancelled by the dozens and new patients to be turned away. Waste storage rooms were created and en-suite facilities built. CPE patients were isolated and treated with expensive medications. Nearly 10,000 other patients were screened via rectal swab.

Curtains were changed, mattresses disposed of, extra gloves and aprons purchased. Ward cleaning increased from daily to three times a day. Specialists were brought in — epidemiologists, data analysts, microbiologists, hand-hygiene monitors, experts in equipment disinfection.

In the end, the outbreak took 10 months to contain, and the financial cost was enormous: 1,206 bed-days lost and 1.1 million spent.

This was just one outbreak triggered by one pathogen in one part of one city in one year — a speck in the expanding universe of healthcare-acquired infections, many caused by antibiotic-resistant bacteria.

As the human cost of healthcare-associated infections has risen — with hundreds of millions of patients infected each year, many with debilitating or fatal consequences — the economic burden has skyrocketed as well, straining hospital budgets globally.

“With rising levels of antimicrobial resistance worldwide, investment in infection prevention and control is an increasing priority,” concluded the UK scientists who tallied the cost of every extra glove purchased and specialist hired during the West London CPE outbreak.

Of course, superbugs aren’t the only pathogens wreaking havoc on hospital budgets. Ordinary bacterial infections, as well as highly contagious viral infections such as norovirus, influenza, and measles, also contribute to what the World Health Organization (WHO) deems “massive additional costs for health systems.”

“All outbreaks cost considerable amounts of efforts and money,” confirm Dutch scientists who analyzed the costs of seven infection outbreaks, bacterial and viral, in a single academic hospital.

In recent years, researchers have scrutinized which pathogens and infection sites cost hospitals most and where the money is spent. Though the particulars differ by country, the findings are universal: the infection crisis and its financial fallout demand an “urgent focus” on prevention.

Hospital Acquired Infections: Following the Money

As the West London CPE case demonstrates, an infection outbreak can force spending on a range of products, procedures, and services: medication, blood transfusions, operations, sanitary supplies, patient isolation, ward renovations, expert consultations, disinfection, and more.

Yet these direct costs are surpassed by a major opportunity cost: the reduced capacity to accept new patients, particularly for elective surgical procedures.

Healthcare-acquired infections “lead to the prolongation of average hospital stay, which will reduce the number of patients admitted and reduce the hospital’s medical income,” concluded a study of healthcare-associated infections in 68 Chinese hospitals.

In the Chinese hospitals surveyed, nearly 50,000 healthcare-acquired infections occurred in one year. On average, infected patients were hospitalized twice as long as uninfected patients and remained hospitalized for an extra 10.4 days.

In the Dutch study of seven outbreaks, researchers found bed closures represented 50% of the outbreak costs.

“One of the biggest cost drivers is the closure of wards and the subsequent drop in revenue, especially when this closure has consequences for scheduled procedures,” the authors reported.

How Infection Location Affects Cost

Healthcare-acquired infections most commonly invade the bloodstream, urinary tract, lungs, and surgical wounds. Which of these cost hospitals the most?

On a per-case basis, probably bloodstream infections. A single central line-associated bloodstream infection costs hospitals about $46,000, according to a review article published in JAMA Internal Medicine. When a patient in the ICU develops a catheter-related bloodstream infection, the cost can reach $80,000.

But surgical-site infections, costing American hospitals about $20,000 per infection, contribute more to expenses overall. Cesarean section, hip replacements, coronary artery bypasses, and spinal fusions are among the surgical procedures that commonly leave patients infected.

A review of six European countries — France, Germany, the Netherlands, Italy, Spain, and the United Kingdom — deemed surgical-site infections “extremely costly,” as many patients require further operations.

In a UK study, 9 out of 20 infected neurosurgery patients required reoperation. American researchers found that surgery patients who developed infections were readmitted to the hospital at a rate of nearly 52 readmissions per 100 procedures, compared to just 8 readmissions for uninfected patients.

“Patients who develop a surgical site infection constitute a financial burden approximately double that of patients who do not,” concluded the European researchers.

This burden will only increase, the authors note, due to a growing global demand for surgical procedures.

Read part 2 of this blog post here.