Researchers examined hospital discharge records in 40 states between 1998 and 2006 in drawing their conclusions about the potential death toll from pneumonia and sepsis -- two of the most common hospital-acquired infections. They also calculated that these infections cost $8.1 billion to treat and lead to 2.3 million total days of hospitalization.
"It's something that deserves a much stronger response from public health authorities than it has [received] so far," said Ramanan Laxminarayan, a senior fellow at Resources for the Future, a nonprofit and nonpartisan organization that conducts independent research on environmental, energy, natural resource and public health issues, and the study's lead author.
"We've known for a long time that people who go into hospitals for reasons other than an infection pick up an infection during the course of hospitalization and possibly die from that infection," he said.
If the projections are accurate, hospital-acquired infections of pneumonia and sepsis would account for more than 1 percent of all hospital spending in the United States, which was $718.4 billion in 2008, according to the most recent report from the Centers for Medicare & Medicaid Services.
The hospital-acquired infection study appears in the most recent issue of the Archives of Internal Medicine.
"I wish we would have had the paper in January [when we released a paper on bloodstream infections] because the methodology they used is so robust compared to other methodologies used to measure the impact [of hospital-acquired infections]," said Dr. John Santa, director of the Consumer Reports Health Ratings Center. "The impact of hospital associated infections is huge, from both a mortality and a cost point of view."
"These are really more data which speak to the importance of preventing health care associated infections," said Dr. Brian Koll, chief of infection control at Beth Israel Medical Center in New York.
He said in many cases, the conditions are referred to as "health care associated infections" (the study authors referred to them as such in their paper) because these measures are important in clinics and other patient care settings as well.
Patients, Koll said, need to be aware of what is going on whenever they enter a health care setting.
"The reason everybody really focuses on hand-washing is that is really the single best way to prevent transmission of infections," he said. It is also easier to follow, since a patient can see if health staffers wash their hands or change their gloves.
There are a few more questions patients could ask, Koll said.
"They should speak with their provider, to say, 'What do you do to prevent infections,'" he said. "Do you give antibiotics before my procedure to make sure I don't get infected? Should I get screened for MRSA?"
Koll said studies like the current one will aid in reform because they highlight the problem with numbers.
"I think that will be a strong impetus for folks who are not following guidelines set by the CDC [and other health care organizations]," he said.
A Lack of Incentives?
While infection problems in hospitals have been highlighted before, that hasn't led to their elimination.
The problem, Laxminarayan said, is a lack of incentives.
"Hospitals may not have adequate incentives to really address this problem, because infection control costs money but stopping infections doesn't necessarily save them money," he said, explaining that insurers and others have to pay for the re-hospitalization from an infection.
At the same time, he said, hospitals have many other priorities when it comes to patient care, and may not undertake necessary infection measures.
"I recognize that they have other, competing priorities," said Laxminarayan, explaining that the data in his study indicate hospital infections are not a new problem
"There's not a sharp increasing trend," he said. "We've been living with this problem for years, it's just not been properly quantified."
Reversing the Trend
Infections from hospital stays themselves have drawn increased scrutiny in recent years, as well as measures designed to curb their occurrence.
Last year, Medicare stopped paying for re-hospitalization for patients who were infected during a previous hospital stay.
But Laxminarayan said such measures were not enough to make a difference.
"The problem with that is that in trying to draw the boundary very carefully [between infections the hospital could prevent and infections beyond its control] the number of hospitalizations or deaths that were influenced by that rule is very small. So that didn't really change the incentives," he said.
Instead, he proposed, hospitals should receive money to begin programs of infection prevention, with enough given to make up for any losses incurred by infections that may be beyond the control of staff.
While that measure sounds compelling, it isn't necessary for the first steps of infection control, said Pamela Brier, CEO of Maimonides Medical Center in New York.
"I wouldn't turn down money. Hospitals can always use money," she said. But for steps like encouraging hand-washing among staff, "You really don't need money for that."
At Maimonides, staffers began wearing badges reading "Please Ask Me If I Cleaned My Hands" to encourage patients to do just that. Brier said they have proven very popular.
But ultimately, she said, hospital infections need to be publicized, as they are in New York State, so patients know about them and can use it to compare hospitals.
Santa agreed, explaining that it is something the Consumers Union has pushed for nationwide.
"We feel, first of all, that it's time hospital-acquired infections were reported to the public so that we all had a much better sense of what's going on here," he said.
Brier explained that having those number public in New York means a healthy competition between the hospitals for better patient care.
"We're very competitive; we want to make sure we measure up," she said. "We don't want to see something another hospital is doing and we know we could."