News and Info -MedicInvent

Centers for Disease Control and Prevention; The Impact of Hospital-Acquired Bloodstream Infections

'Nosocomial bloodstream infections are a leading cause of death in the United States. Bloodstream infections .. represent the eighth leading cause of death in the United States. Because most risk factors for dying .. may not be changeable, prevention efforts must focus on new infection-control technology and techniques.'

Guidelines for the Management of Intravascular Catheter Related Infections

'Each year in the United States, hospitals and clinics purchase 150+ million intravascular devices for the administration of iv fluids, medications, blood products, and parenteral nutrition fluids; to monitor hemodynamic status; and to provide hemodialysis. The majority of these devices are peripheral venous catheters, but 5+ million CVCs are inserted each year.

More than 200,000 nosocomial bloodstream infections occur each year in the United States; most of these infections are related to different types of intravascular devices—in particular, the nontunneled CVC.

The pathogenesis of nontunneled CVC infection is often related to extraluminal colonization of the catheter, which originates from the skin and, less commonly, from hematogenous seeding of the catheter tip. Infection related to iv devices results in significant increases in hospital costs, duration of hospitalization, and patient morbidity. In a recent meta-analysis of 2573 catheter-related bloodstream infections, the case-fatality rate was 14%.'

Centers for Disease Control and Prevention; Guidelines for the Prevention of Intravascular Catheter-Related Infections

'Health-care institutions purchase millions of intravascular catheters each year. The incidence of CRBSI varies considerably by type of catheter, frequency of catheter manipulation, and patient-related factors (e.g., underlying disease and acuity of illness). Peripheral venous catheters are the devices most frequently used for vascular access. Although the incidence of local or bloodstream infections (BSIs) associated with peripheral venous catheters is usually low, serious infectious complications produce considerable annual morbidity because of the frequency with which such catheters are used. However, the majority of serious catheter-related infections are associated with central venous catheters (CVCs), especially those that are placed in patients in ICUs.

Certain catheters (e.g., pulmonary artery catheters and peripheral arterial catheters) can be accessed multiple times per day for hemodynamic measurements or to obtain samples for laboratory analysis, augmenting the potential for contamination and subsequent clinical infection. The magnitude of the potential for CVCs to cause morbidity and mortality resulting from infectious complications has been estimated in several studies. In the United States, 15 million CVC days (i.e., the total number of days of exposure to CVCs by all patients in the selected population during the selected time period) occur in ICUs each year. If the average rate of CVC-associated BSIs is 5.3 per 1,000 catheter days in the ICU, approximately 80,000 CVC-associated BSIs occur in ICUs each year in the United States. The attributable cost per infection is an estimated $34,508--$56,000, and the annual cost of caring for patients with CVC-associated BSIs ranges from $296 million to $2.3 billion.

A total of 250,000 cases of CVC-associated BSIs have been estimated to occur annually if entire hospitals are assessed rather than ICUs exclusively. In this case, attributable mortality is an estimated 12%--25% for each infection, and the marginal cost to the health-care system is $25,000 per episode.'

Consumers Union: Stop Hospital Infections.org

Committee to Reduce Infection Deaths

Centers for Disease Control and Prevention; Estimates of Healthcare-Associated Infections

Centers for Disease Control and Prevention; Questions and Answers about Healthcare-Associated Infections

Department of Health and Human Services Centers for Medicare & Medicaid Services Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems

'Complications, such as infections, acquired in the hospital can lead to higher Medicare payments in two ways. First, the treatment of complications can increase the cost of hospital stays enough to generate outlier payments. Second, under the MS-DRGs we are adopting in this final rule with comment period, there are 258 sets of DRGs that are split into 2 or 3 subgroups based on the presence or absence of a major CC (MCC) or CC. If a condition acquired during the beneficiary’s hospital stay is one of the conditions on the MCC or CC list, the result may be a higher payment to the hospital under the MS-DRGs.

Section 5001(c) of Pub. L. 109-171 requires the Secretary to select, by October 1, 2007, at least two conditions that are (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence-based guidelines. For discharges occurring on or after October 1, 2008, hospitals will not receive additional payment for cases in which one of the selected conditions was not present on admission. Section 5001(c) also requires hospitals to submit the secondary diagnoses that are present at admission when reporting payment information for discharges on or after October 1, 2007.

The hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication. With respect to the concern about a hospital avoiding patients that are at high risk of complications, we note that the policy is selecting only those conditions that are "reasonably preventable." Thus, we are only selecting those conditions where, if hospital personnel are engaging in good medical practice, the additional costs of the hospital-acquired condition will, in most cases, be avoided and the risk of selectively avoiding patients at high risk of complications will be minimized.

In the FY 2007 IPPS proposed rule (71 FR 24100), we sought input from the public regarding conditions with evidence-based guidelines that should be selected in order to implement section 5001(c) of Pub. L. 109-171. In summary, the majority of the comments that we received in response on the FY 2007 IPPS proposed rule addressed conceptual issues concerning the selection, measurement, and prevention of hospital-acquired infections.

The summary presents the conditions that best meet the statutory criteria and which conditions we are selecting to be subject to the payment adjustment for hospital-acquired conditions beginning in FY 2009.

Vascular Catheter-Associated Infections

CDC reports that there are 248,678 central line associated bloodstream infections per year. It appears to be both high cost and high volume. Some patients require long-term indwelling catheters, which are more prone to infections. Ideally catheters should be changed at certain time intervals. However, circumstances might prevent such practice (for example, the patient has a bleeding diathesis). In addition, a patient may acquire an infection from another source which can colonize the catheter.

Since the publication of the FY 2008 IPPS proposed rule, CDC has created a new code (ed. specifically) for vascular catheter-associated infection. The new code 999.31, (Infection due to central venous catheter) will become effective on October 1, 2007.

Staphylococcus Aureus Bloodstream Infection/Septicemia

CDC reports that there are 290,000 cases of staphylococcus aureus infection annually in hospitalized patients of which approximately 25 percent are bloodstream infections or sepsis. For FY 2006, there were 29,500 cases of Medicare patients who had staphylococcus aureus infection reported as a secondary diagnosis. The average charges for the hospital stay were $82,678. Inpatient staphylococcus aureus result in an estimated 2.7 million days in excess length of stay, $9.5 billion in excess charges, and approximately 12,000 inpatient deaths per year.

Preventive health care associated bloodstream infections/septicemia that are preventable are primarily those that are related to a central venous/vascular catheter, a surgical procedure (postoperative sepsis) or those that are secondary to another preventable infection (for example, sepsis due to catheter-associated urinary tract infection). We continue to believe that hospital-acquired staphylococcus aureus septicemia remains a significant public health issue.

Catheter-Associated Urinary Tract Infections

CDC reports that there are 561,667 catheter-associated urinary tract infections per year. For FY 2006, there were 11,780 reported cases of Medicare patients who had a catheter associated urinary tract infection as a secondary diagnosis. The cases had average charges of $40,347 for the entire hospital stay. According to a study in the American Journal of Medicine, catheter associated urinary tract infection is the most common nosocomial infection, accounting for more than 1 million cases in hospitals and nursing homes nationwide. Approximately 40 percent of Medicare beneficiaries have a urinary catheter during hospitalization based on Medicare Patient Safety Monitoring System (MPSMS) data.'


Copyright ©2008 MedicInvent, LLC