To get a sense of the overall scope of the HAI problem, it may help to look at some of the measurable goals and the progress towards those goals. As we consider the size and impact of healthcare associated infections (HAIs) in the only ways those factors can actually be measured, we want to acknowledge that the medical, financial, and emotional cost of HAIs to individuals and families is incalculable.

A quick look at the metrics explain why the effort to prevent HAIs is so compelling on economic as well as moral grounds:

• 5% (1 in 20) of all hospitalizations in the U.S. result in HAIs ¹
• 1.7 million HAIs result in 100,000 deaths in the U.S. every year¹ 
• Annual U.S. direct medical costs due to HAIs is in excess of $28 billion¹
• 8.7% (~1 in 12) of all hospitalizations worldwide result in HAIs²
• 30% of intensive care (ICU) patients in high-income countries are affected by HAIs. Low- to middle- income countries could easily see double that rate.²

In other words, in the U.S. HAIs cause more deaths than AIDS³, breast cancer⁴, and auto accidents⁵ combined. The extra direct medical costs in the U.S. could pay for about half of the government’s spending for Medicare Part D⁶ (prescriptions).

It’s worth noting that dollar costs are generally stated as direct medical costs including treatment and resource costs of extended hospital stays due to HAIs. Some economists⁷ would argue, though, that including the opportunity costs of those resources—the value of their alternative uses—yields a more accurate assessment. The opportunity cost argument would increase the economic burden from HAIs, and would thus justify higher expenditures to prevent infections.

Progress

HAIs are indeed a huge and complex problem, and many groups and government agencies are working on solutions. The U.S. Department of Health and Human Services is shepherding an effort to prevent and ultimately eliminate HAIs. Created in 2009, The National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination contains five-year targets for reduction of infections or hospitalizations in several areas, and the update reports progress as of October 2011.

A few areas are on track to meet 2013 targets:

• Central-line associated bloodstream infections should be reduced by 50%
• Catheter-associated urinary tract infections should be reduced by 25%
• Surgical site infections should be reduced by 25%
• MRSA bacteremia data is not yet available, but rates have shown progress towards the 25% reduction goal

But one key area has shown less progress toward the reduction goal:

• Clostridium difficile infections have leveled off, but not decreased, so a 30% decrease by 2013 seems unlikely.

A quick look at that plan’s executive summary confirms the HAI problem’s complexity and the resulting need for a multifaceted approach:

• Hand hygiene
• Equipment sterilization
• Isolation
• Environmental service protocols
• Staff and consumer education
• Surface sanitation
• Antimicrobial surfaces

All of the above are important elements of the solution. Hand hygiene is essential, but alone it’s not sufficient to the task of preventing HAIs.

Steady progress towards reduction goals in most of the measures is encouraging. However, such progress is rarely linear or easy to predict: the most easily achieved results come early in the process, and the rest is often slower to realize. Even if and when HAIs are eliminated, constant vigilance and renewed effort will be required to avoid recurrence or new infections from new sources.

 

^{1 U.S. Centers for Disease Control and Prevention}

^{2 World Health Organization}

^{3 Centers for Disease Control and Prevention, (CDC) (2011 Jun 3). “HIV surveillance–United States, 1981-2008.”. MMWR. Morbidity and mortality weekly report 60 (21): 689-93. PMID 21637182}

^{4 American Cancer Society. Cancer Facts & Figures 2012. Atlanta: American Cancer Society; 2012.}

^{5 ^ “FARS 2010″. National Highway Transportation Safety Administration.}

^{6 Health Care Spending and the Medicare Program – A Data Book – June 2012 Medicare Payment Advisory Commission}

^{7 Graves N. Economics of preventing hospital infection. Emerg Infect Dis [serial online] 2004 Apr [date cited]. Available from: http://wwwnc.cdc.gov/eid/article /10/4/02-0754.htm}