Infections increase death risk more than fivefold

PA data presented to Congressional panel

Patients are five times more likely to die if they acquire an infection during hospitalization, according to data collected under Pennsylvania's infection rate disclosure law.

Of 13,711 Pennsylvania patients with a hospital acquired infection in first nine months of 2005, 13% died, compared to 2.4% of patients who did not contract an infection.

"What that means is, you are over five times more likely to die during a hospitalization if you get an infection, than if you don't," said Marc Volavka, executive director of the Pennsylvania Health Care Cost Containment Council in Harrisburg, PA. "Those aren't good odds. While I hate to throw out too many numbers because real people and real lives are at the heart of this issue, a comparison of the mortality rates of patients with and without hospital acquired infections is eye-opening."

Volavka presented data from Pennsylvania — the first state to adopt an infection rate reporting law — recently in Washington, DC, at a hearing held by the Committee on Energy and Commerce's subcommittee on Oversight and Investigations. The 13,711 number actually is a subset broken out for comparison from a total of 14,526 hospital-acquired infections (HAIs) identified in Pennsylvania for the period.

"If the reporting trend continues for the fourth quarter, we will approach 20,000 identified HAIs for all of 2005," he said.

Pennsylvania received actual payment data from third-party commercial insurers and matched it to the hospitalizations for 2004, when 11,668 hospital-acquired infections were reported. In 2004, the average payment — that is the actual payment, not charge — for a hospitalization with a hospital-acquired infection was $60,678, he reported. The average payment for a hospitalization without a hospital-acquired infection was $8,078.

"This data show that, on average, there was a $52,600 payment difference between hospital admissions with and without a hospital-acquired infection," Volavka told the committee. As a result, he estimated that additional insurance payments to Pennsylvania hospitals from the private sector, Medicare, and Medicaid at $613.7 million for the 11,668 hospital-acquired infection cases in 2004.

Extrapolating those figures for all of 2005, he estimated that payments made to hospitals for patients who get a hospital-acquired infection will be more than $1.2 billion. "That would be $24 billion in payments nationally," he testified. "And, this is only the hospital portion of the payment. It does not include the additional physician payments, or the ongoing care many of those patients need, if they are the lucky ones who survive the infection."

Too often infections are seen as an unavoidable consequence of care, but the fact is that simple and effective methods such as hand hygiene, using gloves, and properly sterilizing equipment can dramatically reduce their incidence, Volavka said.

"Hospital-acquired infections should not be about placing blame or fault, with either patients or providers," he told the committee. "However, they also should not be about masking their existence behind statistical methodologies like 'infections/1,000 line days' and language like 'nosocomial' that only the experts could understand or explain. When talking about hospitals, if you didn't come in with it and you got it in the hospital, to me, that's a hospital-acquired infection. The new moniker, 'health care-associated infections,' concerns me, because it has the potential to blur and soften the implications of, and the solutions for, infections acquired while hospitalized."