Pennsylvania Data Show High Cost of Hospital Infections

By Alicia Ault 

Pennsylvania issued hospital-specific data on infections among 1.6 million patients treated at 168 facilities statewide in 2005. The report, released by the Pennsylvania Health Care Cost Containment Council, is the first time a state issued data on individual hospitals. It is expected to establish a baseline for performance and quality improvement. It also overturns some conventional wisdom about how infections occur.

"It's a breakdown in processes that creates infections," said Marc P. Volavka, executive director of the council, in an interview.

The detailed report, available at the council's Web site (www.phc4.org), shows just how costly infections can be for patients, payers, and hospitals.

Of 1.6 million patients treated at the 168 facilities, 19,154 had a hospital-acquired infection, for a rate of 12 per 1,000 cases. The infections accounted for 394,129 hospital days and $3.5 billion in charges. The average length of stay was 20.6 days for those with an infection and 4.5 days for those without. Charges were higher for those with infections than for those without, averaging $185,260 and $31,389, respectively. Similarly, mortality was 13% and 2%, respectively.

Most cases were covered by Medicare or Medicaid. Only 276,523 of the patients had commercial insurance; among them, 1,522 acquired an infection in the hospital. Private payers covered only about $53,000 of an infection-related stay, but the total payout was $82 million.

The data collection began in 2004, when hospitals were required to report on surgical site infections for circulatory, neurologic, and orthopedic procedures; indwelling catheter-associated urinary tract infections; ventilator-associated pneumonia; and central line-associated bloodstream infections. In the third and fourth quarters of 2005, hospitals had to expand reporting to include all surgical site infections.

Urinary tract infections (UTIs) were the most common, with an infection rate of 7.2 per 1,000. Surgical site infections had the second-highest incident rate, at 5.2 per 1,000. Surgery involving the small and large intestines accounted for the highest percentage of surgical site infections (9%), closely followed by angioplasty and surgery for osteoarthritis and leg fractures.

These surgical infections accounted for most of the infections in each age group, except for patients older than 60 years. In that group, UTIs were most common. Aside from UTIs, the number of infections actually declines as patients age, a fact that runs counter to theories about older patients' being more vulnerable.He said that more UTIs occur in the over-60 group because it comprises a preponderance of people who age in state hospitals, who are catheterized instead of helped to the bathroom.

He said that the Pennsylvania report would likely spur more hospitals to take a closer look at infection control.