Prevalence, Cost, and Per-Patient Economic Burden of Hospital-Onset Bacteremia and Fungemia

OBJECTIVES: Healthcare-associated infections (HAIs) are those infections that occur during the process of caring for a patient in a healthcare facility and were not present or incubating at the time of admission. In the United States, a government pay-for-performance program called the Hospital-Acquired Condition (HAC) Reduction Program penalizes hospitals deemed to have excessive rates of five HAIs – the most expensive of which are central-line-associated bloodstream infections (CLABSIs). Currently an initiative is being considered to replace the chart-abstracted measure for CLABSI with a much broader digital quality measure that includes all cases of hospital-onset bacteremia and fungemia (HOB). As organizations prepare to expand their prevention focus beyond those bloodstream infections caused by central lines, to all-cause HOB, they may be assisted by understanding the per-patient burden of both CLABSI and non-CLABSI HOB.

METHODS: The prevalence and cost data from a 41-hospital (645,315-patient) retrospective real-world data analysis were employed to calculate the per-patient economic burden of both CLABSI and non-CLABSI HOB.

RESULTS: The rates of CLABSI and non-CLABSI HOB per 1,000 adult hospital patients with a length of stay ≥ 2 days and ≤ 365 days, were found to be 0.62 and 2.44, respectively. The per-patient burden of CLABSI was $20 in patients with no ICU stay and $34 in patients with an ICU stay. The per-patient burden of non-CLABSI HOB was $61 in patients with no ICU stay and $103 in patients with an ICU stay.

CONCLUSIONS: The per-patient economic burden of non-CLABSI HOB is three times the burden of CLABSI HOB – the subset of infections that receive scrutiny today. Organizations may find that the cost of infection prevention processes may be offset by the economic benefit of infection avoidance while they also work to avoid a potential HAC penalty that may be based on reducing all forms of HOB.