Top healthcare-associated infections: UTI, VAP, SSI

Urinary tract infections, ventilator associated pneumonia and surgical site infections are three of the top HAIs

Healthcare-associated infections cost the US healthcare system a shocking $35-$45 billion each year1. There are many different types of HAIs that contribute to this disturbingly high number. Let’s focus on three of the top HAIs that are demanding immediate public attention:

  1. Urinary tract infections
  2. Ventilator associated pneumonia
  3. Surgical site infections

Urinary tract infections are the most common type of healthcare-associated infections, accounting for more than 30% of all reported cases in the US2. Part of this problem lies in the sheer number of patients involved.Urinary catheters are inserted in more than five million patients each year, placing them at higher risk of developing an infection in their urinary tract. Urinary catheters are used on patients who are immobile and therefore unable to get to a toilet to void their bladders without great assistance. During catheterization, a thin plastic tube is inserted into a patient’s bladder through their urethra. Although these patients benefit from being able to empty their bladder, bacteria in biofilm format are now able to bypass the natural protective barriers of the body. This procedure results in an easier route for biofilm infection of the urinary tract, an organ system with little natural immunity for such a direct and unnatural invasion. As a result of long term catheterization, UTIs affect 10%-12% of all urinary catheter users, adding billions of dollars in additional costs to the US healthcare system, and killing over 13,000 patients each year2,3.

Ventilator associated pneumonia is another high profile healthcare-associated infection. It occurs when a lung infection develops in a patient ventilated with an endotracheal tube. In a manner similar to how catheter-associated UTIs develop, the presence of a tube inserted into a patient’s body increases their risk of developing a biofilm infection. For patients requiring mechanical ventilation, this risk increases each day they remain inserted with an endotracheal tube. More than one million people in healthcare facilities across the US require mechanical ventilation each year. Clinical studies have suggested that ventilator associated pneumonia will occur in up to 25% of these patients, and that up to 50% of them will die4. The cost per infection is estimated to be an additional $40,0005, making ventilator associated pneumonia one of the most costly HAIs.

Surgical site infections are the third type of top HAI. With more than 25 million surgical procedures occurring each year, surgical site infections have become a major source of postoperative illness in the US, accounting for up to a quarter of all healthcare-associated infections6. A growing trend in surgical site infections is the rise of antibiotic resistant pathogens infecting surgical wounds. A study published in the Clinical Infectious Diseases journal showed that MRSA-related surgical site infections can cost a staggering $118,500 to treat, significantly more than regular surgical site infections7. Antibiotic-resistant infections such as these are known to be extremely difficult to treat, and often result in unscheduled return surgeries and longer hospital stays.  Clearly, more should be done in preventing antibiotic-resistant surgical site infections from having such an adverse affect on patient outcomes.

UTIs, ventilator associated pneumonia, and surgical site infections are three of the top HAIs that contribute to a massive $35-$45 billion public health problem. When a patient develops any of these HAIs, the infections are severe, costly and very difficult to treat. More difficult to grasp, however, is the true socio-economic cost of healthcare-associated infections. These include the cost of lost income,  rehabilitation, funerals, and impact on families and friends etc. These add to a considerably greater estimate and are the reason behind a growing interest by policy makers to better track and prevent HAIs.

  1. Scott RD. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention, 2009.
  2. Klevens RM, Edward JR, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Reports 2007;122:160-166
  3. UCLA Health System http://urology.ucla.edu/body.cfm?id=168
  4. Davis et al. Ventilator-Associated Pneumonia: A Review. Journal of Intensive Care Medicine July 2006. Vol 21 (4): 211-226
  5. Augustyn et al. Ventilator-Associated Pneumonia: Risk Factors and Prevention. Crit Care Nurse. 2007;27-32-39
  6. Nichols et al. Preventing Surgical Site Infections: A Surgeon’s Perspective. Emerging Infectious Diseases 2001, Vol 7 No.2 Mar-Apr
  7. Engermann et al. Adverse Clinical & Economic Outcomes Attributable To Methicillin Resistance Among Patients with S. aureus Surgical Site Infection. Clin Infect Dis 2003;36:592-8
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