Hospital-acquired sepsis, pneumonia kill 48,000 each year

The nosocomial illnesses accounted for 2.3 million extra days in the hospital and cost $8.1 billion to treat, according to a new study.

By — Posted March 8, 2010

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

A new study is the latest to document the high costs and deadly consequences of preventable nosocomial infections.

Researchers examined 69 million hospital discharges in 40 states from 1998 to 2006, looking at two conditions, sepsis and pneumonia, often caused by drug-resistant infections. Nosocomial sepsis and pneumonia kill 48,000 patients annually and cost $8.1 billion to treat, said the study, published in the Feb. 22 Archives of Internal Medicine.

"The first thing is to show causation -- that the hospital caused the infection and the infection caused the death," said study co-author Anup Malani, PhD, professor of law and Aaron Director Research Scholar at the University of Chicago Law School. "The reason why causation is important is because if there's no causation, you can't make the opposite claim, which is that these deaths can be prevented."

Researchers examined claims information from the Nationwide Inpatient Sample, a database run by the Agency for Healthcare Research and Quality. While lacking definitive clinical data, they used two techniques to isolate sepsis and pneumonia caused by infections acquired in the hospital and to show that the infections were deadly.

First, researchers looked at sepsis and pneumonia that developed in the hospital after elective surgery, assuming that surgery in nearly all cases would have been delayed if the illnesses were present before the procedures. Second, they matched patients who died after developing sepsis or pneumonia and compared them with similar patients who had the same procedures to differentiate the mortality rate from what otherwise would have been expected.

David J. Murphy, MD, said death and cost estimates are debatable, but that the toll exacted by hospital-acquired infections demands action.

"When you're dealing with 69 million discharges, you've got to make some systematic assumptions," said Dr. Murphy, who co-authored a commentary on the study in the same Archives issue. "These decisions can affect your specific effects. Whether it's $8.1 billion in costs or $7 billion or $10 billion, we're still talking about a whole lot of money. ... What the study tells us is that health care-associated infections continue to be a big problem, and it provides more evidence that we have to continue to work as a system to eliminate this harm."

Timely information needed

To make better progress in protecting patients, doctors and nurses need actionable clinical data at the local level, said Dr. Murphy, a member of the national team for On the CUSP: Stop BSI, a quality initiative aimed at preventing bloodstream infections that kill as many as 62,000 patients annually. Hospitals in 27 states are participating in the program, based on a project in Michigan that has cut the average catheter-related bloodstream infection rate 83% by implementing a checklist of infection-control procedures.

"This study provides yet another picture of the harm that's going on, but it's limited in that it's administrative data and it is difficult to translate that into actions," said Dr. Murphy, a pulmonology and critical care fellow at the Johns Hopkins University School of Medicine. "In our project, we have real-time data about things like the time since the last infection. The frontline staff can see the fruits of their labor or, conversely, the problems they still have to deal with."

While quality initiatives can yield benefits, Malani argued that hospitals lack the financial impetus to implement them, despite the Centers for Medicare & Medicaid Services' "no pay" policy for certain hospital-associated conditions, such as catheter-associated urinary tract infections.

"The Medicare solution doesn't go far enough," Malani said. "Because hospitals get paid for caring for the infections, they don't have a strong incentive to eliminate them. ... We want to break that connection."

The American Medical Association, the American Hospital Assn. and others have argued that it is unfair to deny payment for care associated with conditions that cannot always be prevented, even when evidence-based guidelines are followed.

Back to top


Infections take deadly, costly toll

Nosocomial infections can lead to sepsis, pneumonia and 48,000 deaths annually, according to a new study. Outcomes for health care-associated sepsis and pneumonia after invasive surgical procedures:

Mortality rate19.5%11.4%
Average length of stay10.9 days14.0 days
Average hospital cost$32,900$46,400

Source: "Clinical and economic outcomes attributable to health care-associated sepsis and pneumonia," Archives of Internal Medicine, Feb. 22 (link)

Back to top

External links

"Reducing Preventable Harm: Comment on 'Clinical and Economic Outcomes Attributable to Health Care-Associated Sepsis and Pneumonia' " extract, Archives of Internal Medicine, Feb. 22 (link)

"Clinical and Economic Outcomes Attributable to Health Care-Associated Sepsis and Pneumonia," Archives of Internal Medicine, Feb. 22 (link)

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story