The U.S. Agency for Healthcare Research and Quality (AHRQ) supports “projects to advance the science of hospital-acquired infection (HAI) prevention, develop more effective approaches for reducing HAIs, and help clinicians apply proven methods to prevent HAIs on the front lines of care.” They have now reported preliminary estimates of the change in incidence of hospital-acquired conditions (HACs), including selected hospital-acquired infections from 2010-2014.
There was a cumulative reduction of HAC episodes of approximately 2.1 million relative to the expected number over this time, although there was no significant change from 2013-2014. (See Figure 1.) AHRQ also estimates that nearly 87,000 fewer patients died during hospitalization as a result of this reduction, and that approximately $19.8 billion in healthcare costs were saved from 2010 to 2014.
While the majority of this reduction in HACs was due to decreased incidences of adverse drug events (-39.8%) and pressure ulcers (-28.0%), there were also significant decreases in selected reported HAIs. (See Figure 2.) These included a 16.1% decreased incidence of catheter-associated urinary tract infection (CAUTI), a 2.9% decrease in surgical site infections (SSI), a 1.1% decrease in central line-associated bloodstream infection (CLABSI), and a 0.4% decrease in ventilator-associated pneumonia (VAP). These reductions were associated with cumulative estimated decrements in deaths of 7922, 1748, 4402, and 1150, respectively.
A number of factors likely contributed to these overall reductions, including the dissemination of evidence regarding improved patient safety developed by AHRQ, as well as their investment in tools and training for improvement and in data and measures facilitating the tracking of change. There has been, in addition, the implementation of financial incentives and required public reporting of selected conditions.
However, while the overall improvement is significant, there are some worrisome findings, not the least of which is the lack of a reduction in HAC in the last year. Furthermore, while the reduction in CAUTI was large, that of SSI, CLABSI, and VAP were de minimis. Clearly, more work is needed in the prevention of HAI.
Figure 1. HAC Rates, 2010 to Interim 2014
SOURCE: Saving Lives and Saving Money: Hospital-Acquired Conditions Update . December 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/pfp/interimhacrate2014.html.
Figure 2. Change in HACs, 2011-2014 (Total = 2,107,800)
SOURCE: Saving Lives and Saving Money: Hospital-Acquired Conditions Update. December 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/pfp/interimhacrate2014.html.
There was a large decrease in the number of total hospital-acquired conditions from 2010-2014, but with no improvement from 2013-2014. While there were decreases in hospital-acquired infections, much further improvement is needed.
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