Page 18 - Insurance Times January 2018 Sample

HCAI can also present as postoperative infection within 30 treatment. 90,000 of these patients succumb to nosocomial
days from surgery or within 1 year if implantation surgery, infections every year. [11]
device related infections due to central venous catheters,
urinary tract catheters, ventilator treatment, or One year mortality was 15.2% in patients without HAI as
endotracheal tubes or indwelling cerebral ventricular compared to 24.5% in patients with HAI. The extra
drainage, drug-related infections defined as C difficile mortality due to HCAI was 9.3%. [10, 12, 13]. Klevens et al
enteritis, infections related to chemotherapy for cancer, or estimated a US case fatality rate of HAI in hospitalized
infections due to other immune modulating drugs or patients to 5.7% during 1999-2002, with the highest
corticosteroids; and other infections occurring after mortality rate in ventilator associated pneumonia (14.4%)
48?hours of admission. The HAI was categorized according and catheter associated bloodstream infections (12.3%).
to the suspected anatomic site of the infection origin.[6] [13]. In Europe the 30 day mortality rate for Clostridium
difficile infection (CDI) is estimated to be from 3%-30% in
Incidence different countries. [14]

HAIs are known to comprise the largest part of adverse Kaye et al showed that the 90 day mortality rate in
events in health care and cause prolonged hospital length hospitalized older adults rises from 33.2%-49.4% in patients
of stay (LOS) and deaths. [2, 3, 4, 5] with a health care associated bloodstream infection. [15]

Different studies on HCAI have reported different incidences LOS & Morbidity:
varying between 3.9% and 34%. All studies point to the fact
that the problem is significant and poses the payer system The additional length of stay due to HCAI varies with the
site of organ or the body system affected as well as the
enormous financial burden. [7]. WHO has reported an
incidence of between 5.7 and 19.1% in middle and low specialty of admission, ranging from 9.3 days to 23 days in
income countries.[8] different studies.
Plowman et al found that HAIs in general extended the LOS
In high income countries approximately 30% of the patients by 14 days, which was almost 3 times longer than the
in ICU are affected by at least one HCAI during the stay in average LOS for patients without an HAI. There was a large
the ICU. HCAIs adversely affect the LOS, morbidity, mortality variation in extended stay depending on the site of single
and cost of treatments posing a high financial burden on the infection (2-13 days) and admission specialty (1-23 days).
payer system.[8, 9]
[16, 17]. Sheng et al found an additional LOS was around
20 days for patients affected by an HCAI. [18]
The prevalence rate of HCAI varied significantly between
clinical units, ranging from 3.9% to 34.0%, being the highest
in ICU and Burns wards and lowest in Gynecology & Bed Days:
Obstetrics wards. Patients with HCAI accounted for 20.2% of the total bed
days while 79.8 % bed days were accounted for patients
In a study reported in American Journal of Infection without HCAI.Of all days, 9.3% were considered to be excess
Control,Mikael Rahmqvist et all have reported an average days for the group with an HAI.The average of excess days
prevalence rate of HCAI to be 10.8% with higher prevalence were 10.5 per patient with an HAI. The cost for the excess
in males than females and lower in children (4.3%). [10] days was, after adjustment, 11.4% of the total costs [10].

Mortality: Re-admission rates:
HCAI are known to increase the preventable mortality rates Mikael Rahmqvistet al reported a 30 days re-admission rate
tremendously, thus reducing the earning life span in patients to be 29 % in cases with HCAI as against 16.5% in cases
suffering from HCAI.The study reported an in hospital without HCAI. Half of the readmissions (49.6%) were within
mortality due to HCAI to be 17.4% with 30 day mortality on 10 days of discharge from the hospital. [10]
follow up patients reported to be 15.8%. Both the reported
figures were significantly higher as compared to mortality Readmission rates add to treatment costs increasing the
rates in patients without HCAI.[10] financial burden on payer systems.

In US 20, 00,000 patients are hospitalized every year for Chopra et al found that it was about twice as common in

18 The Insurance Times, January 2018

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