Hostname: page-component-76fb5796d-vvkck Total loading time: 0 Render date: 2024-04-27T05:42:08.355Z Has data issue: false hasContentIssue false
  • English
  • Français

Selected Aspects of the Socioeconomic Impact of Nosocomial Infections: Morbidity, Mortality, Cost, and Prevention

Published online by Cambridge University Press:  02 January 2015

William R. Jarvis
William R. Jarvis*
Affiliation:
Investigation and Prevention Branch, Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Hospital Infections Program, MS E-69, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333
Get access Rights & Permissions [Opens in a new window]

Abstract

Approximately 2 million nosocomial infections occur annually in the United States. These infections result in substantial morbidity, mortality, and cost. The excess duration of hospitalization secondary to nosocomial infections has been estimated to be 1 to 4 days for urinary tract infections, 7 to 8.2 days for surgical site infections, 7 to 21 days for bloodstream infections, and 6.8 to 30 days for pneumonia. The estimated mortalities associated with nosocomial bloodstream infections and pneumonia are 23.8% to 50% and 14.8% to 71% (overall), or 16.3% to 35% and 6.8% to 30% (attributable), respectively. The estimated average costs of these infections are $558 to $593 for each urinary tract infection, $2,734 for each surgical site infection, $3,061 to $40,000 for each bloodstream infection, and $4,947 for each pneumonia. Even minimally effective infection control programs are cost-effective. In countries with prospective payment systems based on diagnosis-related groups, hospitals lose from $583 to $4,886 for each nosocomial infection. As administrators focus on cost containment, increased support should be given to infection control programs so that preventable nosocomial infections and their associated expenditures can be averted.

Type
From the Fourth International Conference on the Prevention of Infection
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 8 , August 1996 , pp. 552 - 557
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG. The nationwide nosocomial infection rate. A new need for vital statistics. Am J Epidemiol 1985;121:159–167.Google Scholar
2.Haley, RW, Culver, DH, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182–205.Google Scholar
3.Haley, RW, White, JW, Culver, DH, Hughes, JM. The financial incentive for hospitals to prevent nosocomial infections under the prospective payment system: an empirical determination from a nationally representative sample. JAMA 1987;257:1611–1614.Google Scholar
4.Fridkin, SK, Pear, SM, Williamson, TH, Galgiani, JN, Jarvis, WR. The role of understaffing in central venous catheter-associated bloodstream infection. Infect Control Hosp Epidemiol 1996;17:150–158.Google Scholar
5.Robert, J, Fridkin, S, Blumberg, HM, Anderson, B, Chan, J, Jarvis, WR. Does the nurse-to-patient ratio influence surgical intensive care unit patient bloodstream infection rates? Sixth annual meeting of the Society Healthcare Epidemiology of America; April 21-23, 1996; Washington, DC. Abstract S49.Google Scholar
6.Archibald, LK, Manning, ML, Bell, LM, Banerjee, S, Jarvis, WR. Evaluation of the role of the nurse-to-patient ratio on the nosocomial infection rate in a pediatric cardiac intensive care unit (CICU). In: 45th Annual meeting of the Epidemic Intelligence Service (EIS) Conference; April 22-26, 1996; Atlanta, GA.Google Scholar
7.Stamm, WE. Guidelines for the prevention of catheter-associated urinary tract infections. Ann Intern Med 1975;82:386–390.Google Scholar
8.Jarvis, WR, Edwards, JE, Culver, DH, et al. Nosocomial infection rates in adult and pediatric intensive care units in the United States. Am J Med 1991;91:185S–191S.Google Scholar
9.Givens, CD, Wenzel, RP. Catheter-associated urinary tract infections in surgical patients: a controlled study on the excess morbidity and costs. J Urol 1980;124:646–648.Google Scholar
10.Coello, R, Glenister, H, Fereres, J, et al. The cost of infection in surgical patients: a cas-control study. J Hosp Infect 1993;25:239–250.Google Scholar
11.Haley, RW, Culver, DH, Morgan, WM, et al. Identifying patients at high risk of surgical wound infection: a simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol 1985;121:206–215.Google Scholar
12.Culver, DH, Horan, TC, Gaynes, RP, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. Am J Med 1991;91:152S–157S.Google Scholar
13.Pittet, D, Tara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:1598–1601.Google Scholar
14.Fagon, JY, Novara, A, Stephan, F, Girou, E, Safar, M. Mortality attributable to nosocomial infections in the ICU. Infect Control Hosp Epidemiol 1994;15:428–434.Google Scholar
15.Fagon, JY, Chastre, J, Vuagnat, A, Trouillet, JL, Novara, A, Gilbert, C. Nosocomial pneumonia and mortality among patients in intensive care units. JAMA 1996;275:866–869.Google Scholar
16.Townsend, TR, Wenzel, RP. Nosocomial bloodstream infections in newborn intensive care unit: a case-matched control study of morbidity, mortality, and risk. Am J Epidemiol 1981;114:73–80.Google Scholar
17.Craven, DE, Kunches, LM, Lichtenberg, DA, et al. Nosocomial infection and fatality in medical and surgical intensive care unit patients. Arch Intern Med 1988;148:1161–1168.Google Scholar
18.Bueno-Cavanillas, A, Gelgado-Rodriguez, M, Lopex-Luque, A, Schaffino-Cano, S, Galvaz-Vargas, R. Influence of nosocomial infection on mortality in an intensive care unit. Crit Care Med 1994;22:55–60.Google Scholar
19.Driks, MR, Craven, DE, Celli, BR, et al. Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. N Engl J Med 1987;317:1376–1382.Google Scholar
20.Kollef, MH. Ventilator-associated pneumonia. A multivariate analysis. JAMA 1993;270:1965–1970.Google Scholar
21.Craig, CP, Connelly, S. Effect of intensive care unit nosocomial pneumonia on duration of stay and mortality. Am J Infect Control 1984;12:233–238.Google Scholar
22.Leu, HS, Kaiser, DL, Mori, M, Woolson, RF, Wenzel, RP. Hospital-acquired pneumonia: attributable mortality and morbidity. Am J Epidemiol 1989;129:1258–1267.Google Scholar
23.Torres, A, Aznar, R, Gatell, JM, et al. Incidence, risk and prognostic factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 1989;139:877–884.Google Scholar
24.Fagon, JY, Chastre, J, Hence, AJ, Montravers, P, Novara, A, Gilbert, C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 1993;94:281–288.Google Scholar
25.Fagon, JY, Chastre, J, Domart, Y, et al. Incidence, risk and prognostic factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 1989;139:877–884.Google Scholar
26.Diaz-Molina, C, Garcia, MM, Bueno, CA, Lopez, LA, Delgado, RM, Galvez, VR. The estimation of the cost of nosocomial infection in an intensive care unit. Medicina Clinica 1993;100:329–332.Google Scholar
27.French, GL, Cheng, AF. Measurement of the costs of hospital infection by prevalence surveys. J Hosp Infect 1991;18:65–72.Google Scholar