Health Acquired Infections (HAC)

Hospital-acquired conditions (HACs) are an undesirable situation or condition that affects the patient and the care they receive. The condition was not present on admission (POA), it developed while the patient was in the hospital. HACs lead to increase length of stay (LOS), increase in patient care cost, poor patient outcomes, and even death. It is estimated that in 2010 adult patients experienced roughly 4.8 million HACs out of 32.8 million hospital discharges. There are eight initial conditions of HACs. Health Acquired Infections (HAI), are one example of a HAC. HAIs make up the largest percentage of the HAC score hence, the focus on the impact of healthcare quality and safety outcome for two indicator conditions: catheter associated
urinary tract infection (CAUTI), and central-line associated bloodstream infection (CLABSI).
Health care associated infections (HAIs) are some of the most common and serious complications patients’ encountered while in the hospital. HAI are also among the leading threats to patient safety. According to a study by the Centers for Disease Control and Prevention (CDC, 2005), “at any given time, approximately 1 of every 25 hospitalized patients in the United States has an HAI, meaning that nearly 650,000 patients contract one of these infections annually” (p 1013). These infections can lead to significant cost, increased length of stay (LOS), morbidity and mortality. HAIs, which have been identified as a serious public health problem in the United States and globally (Kurtzman & Corrigan, 2007). HAIs account for approximately three quarters of acute care hospital, catheter-associated urinary tract infections (CAUTI), and central line–associated bloodstream infections (CLABSI), are the most common, costliest, and deadliest of all
the HAI’s.

CAUTIs are considered to be the most common and most preventable of all the HAIs. Often, catheters are placed for convenience not for medical reason. Many times catheters are often left in patients for long periods of time unnecessarily. The longer catheters stay in, the risk of acquiring a CAUTI is increased by 3-7%. According to one study, about 40% of patients with a urinary catheter experienced at least 1 inappropriate catheter-day and 31% of the urinary catheter-days were inappropriate (Tiwari MM, et al, 2012). Catheters left in patients for long periods of times also increases the patients chance of acquiring a bloodstream infection. CAUTI’s are the second most common cause of secondary bloodstream infections. These CAUTIs and blood stream infections increase the cost per admission by $676 or $2836 when complicated by bacteremia (Saint, 2000). More than 500,000 patients suffer from CAUTIs annually. CAUTIs have an increase in morbidity and mortality attributing to 40% of all HAI’s and 5% of all HAI deaths (CDC, 2005). CAUTIs are the most preventable of all the HAIs with 60-75% being preventable, therefore, with hand hygiene, proper technique, and management, the CAUTI rate can be significantly reduced (Schmier et al., 2016). CLABSIs are considered the deadliest and costliest of the four HAIs.
It has been estimated that CLABSIs have a 12 to 25 percent mortality rate (CDC, 2011). Patients who are in the Intensive Care Unit (ICU), account for a significant number of CLABSIs. However, the number continues to increase for those patients in non-ICU. It has been estimated that 80,000 thousand CLABSI’s occur in ICU patient, but when you are considering the patients not in the ICU that number increases to over 250,000 CLABSI’s annually. CLABSI are associated with bad outcomes such as increased LOS, cost and even death. The LOS has an average increase of 7 days, estimated with an estimated 30,000 patients dying annually due to CLABSIs (CDC, 2011). There has been a reduction in ICU CLABSI’s from 43,000 in 2001 to 18,000 in 2009, which, is a 58% reduction. The CDC estimates that this reduction represents 3,000 to 6,000 lives saved in ICUs in 2009 alone (2011). HAC and HAI reduction can be attributed to research, reporting, sharing data, and fostering a safety environment with a zero tolerance for preventable events. In addition, implementing evidence-based practices, behavioral, systematic, and structural changes to ensure no patient is harmed while seeking medical
care.
CAUTI and CLABSI’s are preventable HAI’s that have been associated with undesirable patient outcomes such as increased LOS, increased cost, morbidity and mortality. Due to these infections being preventable, there has been an increasing demand for hospitals and healthcare workers to implement processes and initiatives to prevent HAIs. Joint Commission has made the reduction of HAIs a National Patient Safety Goal (NPSG). Medicare and other regulatory agencies have implemented policies and initiatives that will reduce payments to provided hospitals if they do not reduce their CAUTIs and CLABSIs. Medicare will no longer reimburse hospitals for these infections. In October 2008, Medicare declared CAUTIs “preventable” and declared that they would no longer reimburse hospitals for any care associated with these infections. Medicare rule that the cost could not be passed on to patients; therefore, hospitals would absorb the cost.
According to the Federal Registers, Fiscal year 2015 Medicare introduced the Hospital-Acquired Conditions (HACs). Hospitals that are in the top 25% of HAC incidence will receive a 1% deduction in the payment they would otherwise receive for discharges. With these reductions, overall Medicare payments to hospitals would decrease by approximately 0.3% or $330 million for FY 2015 (2013).
Hospitals will not only receive a reduce payment also, their HAC scores will be published on Medicare’s Hospital Compare website. Currently, CMS denies reimbursement under its value-based purchasing guidelines for CLABSI cases that occur in the ICU, but, the proposed 2020 CLABSI goals will expand this rule to all patients on all units (Proctor, 2014). Commercial payers are following Medicare’s lead and have begun denying reimbursement for HAIs. Hospitals are making HAIs a priority because of reduced payments and public reporting. Hospitals that have not implemented successful processes to reduce their CLABSIs and CAUTIs will have poor patient outcomes and potential revenue loss.
In summary, hospitals should incorporate evidence-based practices into their daily practice. As standardized practices and quality and safety processes are implemented to decrease and ultimately eliminate CAUTI and CLABSI’s, patients will be protected from preventable events, unnecessary harm and increased cost. The most recent reports show that from 2010-2015, HAC’s fell by 21 percent, saving 125,000 lives and $28 billion in health care cost (Agency for Healthcare Research and Quality, 2016). Hospitals that are proactive and promote a safety culture will see a decline in HACs and HAIs and an improvement in quality, safety and patient outcomes.