17 HAI Clinical and Financial Implications and Policy Future Peter B. Angood, MD, FRCS(C), FACS, FCCM Senior Advisor, Patient Safety, National Quality Forum Member of Safe Practices Steering Committee Former Chief Patient Safety Officer and Vice President for The Joint Commission Safe Practices Webinar February 18, 2010

18 1 Stone PW, et al. AJIC 2005; 33:501-5 Background: Impact of HAIs 5%-10% of hospitalized patients develop an HAI 99,000 deaths per year $20 billion per year 1 Risk of serious HAI complications is highest for patients requiring intensive care Increasing number of HAIs Sicker patient population More complex procedures and equipment Increasing antimicrobial resistance

19 Klevens, Edwards, Richards, et al. Pub Health Rep 2007;122:160-6 Estimated Number of Healthcare-Associated Infections in U.S. Hospitals by Subpopulation and Major Site of Infection, United States, 2002

20 HRN = high-risk newborns; WBN = well-baby nurseries; ICU = intensive care unit; SSI = surgical-site infections; BSI = bloodstream infections; UTI = urinary infections; PNEU = pneumonia SSI 20% BSI 11% UTI 36% PNEU 11% Other 22% 133, , , , , , ,385 TOTAL HRN WBN Non-newborn ICU = SSI Klevens, Edwards, Richards, et al. Pub Health Rep 2007;122:160-6 Calculation of Estimates of Healthcare-Associated Infections in U.S. Hospitals Among Adults and Children Outside of Intensive Care Units, 2002

21 What Are the Costs of Healthcare- Associated Infections? U.S. Total excess costs $32 million to $825 million annually Most costs not reimbursed when DRGs are used or if costs are capitated Preventing 6% of nosocomial infections offsets cost of $60,000 I.C. program UK = cost £111 million/year and 950,000 lost bed days (1987) Decrease NI rate by 20%, saves $15 million - $16 million

NQF Safe Practices – 2010: Healthcare-Associated Infections 19. Hand Hygiene 20. Influenza Prevention 21. CLABSI Prevention 22. Surgical-Site Infection Prevention 23. Care of the Ventilated Patient 24. MDRO Prevention 25. Catheter-Associated UTI Prevention 22