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Two hospital-acquired infections estimated to have killed 48,000, cost $8.1 billion in 2006

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hospital-acquired infection, pneumonia, sepsis, death, costWhen patients get infections in the hospital, the ramifications can be expensive—and sometimes deadly.

Hospital-acquired infections (HAIs), including staph, pneumonia, sepsis and others, account for 44,000 to 98,000 deaths and $17 billion to $29 billion in additional costs each year, the Institute of Medicine (the health arm of the National Academy of Sciences) estimated about a decade ago.

"Infections that are acquired during the course of a hospital stay cost the United States a staggering amount in terms of lives lost and health care," Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics and Policy at the nonprofit research group Resources for the Future, said in a prepared statement.

He and a group of fellow researchers wanted to create a more detailed picture of how these infections are affecting patients and health care costs. "Previous estimates of the health consequences and economic costs attributable to HAIs remain contentious," Laxminarayan and his colleagues noted in a study published online February 22 in the Archives of Internal Medicine. Faulting small sample sizes and lack of statistical controls of other reports on the issue, the team used the Nationwide Inpatient Sample database to search 69 million hospital discharges between 1998 and 2006 in 40 different states. They focused on pneumonia and sepsis infections—both frequent results of improper care in hospital settings—to reduce overlap with community-acquired infections and pre-existing conditions; they also controlled for patient diagnosis, demographics, co-morbidities, hospital treatment and possible exposure before admission.

From this analysis, the team estimated that these two HAIs alone caused some 48,000 deaths, an additional $8.1 billion in care costs and about 2.3 million extra days in the hospital in 2006 (the last year for which data was available). And these figures are likely to be conservative, the researchers argued, because the data "focus on infections that were acquired and diagnosed during the same hospitalization, although many HAIs…are not diagnosed until hospital discharge."

How can these numbers be reduced? "In many cases, these conditions could have been avoided with better infection control in hospitals," Laxminarayan said. But as superbug infections such as MRSA (methicillin-resistant Staphylococcus aureus) spread, they "are increasingly difficult to treat," Anup Malani, a law professor at the University of Chicago and co-author of the study, said in a prepared statement.

Not all of the infections occurred in patients who were already sick in the hospital. Infections from elective surgery can result in infection as well and can often end up incurring even greater costs than cases in which a person was already hospitalized, the researchers found. "In some cases, relatively healthy people check into the hospital for routine surgery," Malani said. "They develop sepsis because of a lapse in infection control—and they can die."

Commenting on the study in a published response in Archives, David Murphy and Peter Pronovost, both of Johns Hopkins University in Baltimore, asserted that the persistence of widespread harm from HAIs is "unconscionable" but given "our shortcomings in providing care are entirely understandable and predictable." They note that these rates are likely to remain high until more research goes into "the science of health care quality and safety."

The study authors concluded that time is of the essence, though. "Hospitals and other health care providers must act now to protect patients from this growing menace," Laxminarayan said. And as a financial bonus, Malani added, "improving infection control is a clear way to both improve patient outcomes and lower health care costs."

Image courtesy of iStockphoto/SilviaJansen

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  1. 1. JamesDavis 4:34 pm 02/22/2010

    We no longer need "Dr. Death", the hospitals are taking over his job. Are these hospitals filthy dirty or are these doctors just poorly educated in sanitation and disease control?

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  2. 2. Vidiot 5:27 pm 02/22/2010

    Scandinavian healthcare systems virtually eliminated HAI’s with a rigorous, mandatory program of testing upon hospital admittance. New, rapid-turnaround assays capable of achieving the same effect in the US are widely available, but hospitals claim that costs… several dollars per test… prevent them from testing every patient. Aren’t wrongful death lawsuits even more expensive?

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  3. 3. dskan 6:28 pm 02/22/2010

    Only if they can be proved, which requires rigorous arguments and many years of battles. Most cannot sustain the monetary or emotional strain of lawsuits, particularly since the suit doesn’t reverse the death.

    I’m sure US hospitals also treat a much larger volume of patients than most other hospitals in the world. It’s easy to compare costs in retrospect, but extra days in bed, etc., are soft expenditures that are impossible to quantify in real-time. Accountants need dollar values, so soft costs will never be factored.

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  4. 4. Jean 7:59 pm 02/22/2010

    They pass every other cost onto us, why not this? This would be one test I would be happy to underwrite.

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  5. 5. 8:24 pm 02/22/2010

    When my mother was in the hospital I sat in the visitor’s chair in her room. My white shirt was black from the dirt on this plastic covered chair. Bleach would help and the walls need to be scrubbed down with it as well as the floors. I never saw anyone truly clean her room.

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  6. 6. peanutbutter 5:35 am 02/23/2010

    firstly, Our (United States) hospitals are a great deal busier than some Scandinavian tourist spot for the wealthy. If you come to an emergency room bleeding out from a deadly wound, do you want the staff to stop and run tests or do you want them to save your life? If your child is burning with fever, do you want them to tell you that they have to test for staph infections before they take care of your precious baby? Think before you speak, dear heart.

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  7. 7. peanutbutter 5:39 am 02/23/2010

    I never see anyone cleaning rooms at all in hospitals. I have seen them clean the halls, but never the rooms. Of course, you don’t want people with mops, and amonia buckets coming in and banging around your loved one and that expensive machinery, either. Most hospital rooms are continuously occupied, so there probably isn’t alot of time to go in and actually clean.

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  8. 8. jbairddo 8:28 am 02/23/2010

    A) doctors spend less time in hospitals than anyone else, nurses, RT’s,PT’s, LPN’s,etc all have far more contact so before busting on doc’s get your head out.
    B) one of the easiest ways to decrease spread of infection is hand washing which doesn’t get done because administrators have cut overhead and the staff to patient ratio has gone through the roof.
    C) likewise, housekeeping staff in on the chopping block to cut costs and they should be scrubbing down walls, beds, etc between patients.
    D) most administrators don’t see how the hospital can make money unless their numbers are up and that means patient days, some was right about the bean counters
    E) we aren’t paying for crap. most of these occur in elderly pt’s with Medicare, it is borrowing along with the rest of our budget items and even our kids won’t be paying for this fiasco.
    F) How is it that Americans can see a story which is so utterly complex at its core that even I couldn’t begin to explain the numbers of causes in the space provided (but I can try-overuse of antibiotics by patients and doctors, overuse of antibiotics by animal producers, lack of nutritional support in our elderly, over reliance on drugs, lack of ambulation of the elderly and other infirm patients in hospitals, lack of UV lights and other infection reducing programs, weird reimbursement by Medicare that doesn’t actually penalize this kind of stuff, inadequate staffing so nurses and other health care workers have time to do infection controlling techniques, bending over backwards to allow visitors who are another vector into rooms, high turnover in surgical suites that don’t allow for proper cleaning and again reduced staff, getting the idea yet? and there is more) and yet we have answers in only a few sentences and of course someone defending this travesty. We have industry driven health care. Until that ends, this situation and our health care crisis won’t. Kill the lobbyists, let the health care workers do their jobs and keep big business out of this, and stuff like this goes away.

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  9. 9. lamorpa 8:46 am 02/23/2010

    I think you have an extra letter in your name at the beginning. HAI’s come from unsanitary conditions within the hospital. What are you talking about?

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  10. 10. James Michael Howard 12:17 pm 02/23/2010

    Archives of Internal Medicine 2010;170(4):347-353 "Clinical and Economic Outcomes Attributable to Health Care-Associated Sepsis and Pneumonia"

    It is my hypothesis that the "secular trend," the increase in size and earlier puberty occurring in children, is caused by an increase in the percentage of individuals of higher testosterone. More specifically, I suggest this is due to an increase in the percentage of mothers of higher testosterone with time within the population. This exposes more fetuses to increased maternal testosterone with time within the population. I suggest this is the cause of the parallel increase in morbidity occurring within the population, such as obesity, cancer and breast cancer, diabetes, etc., including "failing schools," and increasing infections.

    I have explained this connection with increased infections at:,%20Testosterone,%20and%20DHEA.htm .

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  11. 11. Aleja 1:08 pm 02/23/2010

    Dr. Pronovost is doing great work to eliminate these infections. I just read his new book SAFE PATIENTS, SMART HOSPITALS ( and recommend it to all.

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  12. 12. Pizza1 9:39 pm 02/23/2010

    Ozone is the answer to Hospital Acquired Infections. Look at the work of Dr. Shannon and Medizone International Inc. It can save the US econony Billions.

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  13. 13. neofeign 9:31 am 08/14/2012

    It is good to see that proactive measures are being taken towards this epidemic, as in the case of this TED talk regarding Hospital acquired infections

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  14. 14. Derby2016 4:36 pm 01/27/2015

    My wife goes in hospital for 5 days suffering from High blood pressure, severe anemia and very high glucose. Drugs, drugs and then more drugs.

    Two weeks later she almost dies from Sepsis/Septic shock and spends 7 days in ICU at another hospital.
    Me thinks I ought to go after hospital. Any comments will be appreciated.

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