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10 States with the Most Hospital-Acquired Infections

May 20, 2019 BY Alanna Moriarty

10 States with the Most Hospital-Acquired Infections

Hospital-acquired conditions (HACs) prevalence is one of the clinical quality measures tracked by the Centers for Medicare and Medicaid Services (CMS) with the goal of improving care quality and patient outcomes. In 2016, more than 3,000 patient deaths resulted from HACs, resulting in $2 billion of excess medical spending. In addition to increased care costs, HACs are linked to longer patient stay lengths and higher mortality risks.

Care facilities that report higher-than-average rates of HACs may face fines from CMS. In 2015, CMS launched the HAC Reduction Program to reduce preventable complications through financial penalties for the lowest-performing hospitals. The bottom 25 percent of hospitals received a 1 percent reduction in payments.

Below, we’ve compiled lists of the states with the greatest number of reported hospital-acquired infections. Definitive Healthcare tracks quality metrics for more than 7,900 hospitals, including the number of reported cases for catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs) for hysterectomies and colorectal procedures, Clostridium difficile (C. diff.) intestinal infections, Methicillin-resistant Staphylococcus Aureus (MRSA) blood infections, and Central Line-associated Blood Stream Infection (CLABSI).

States with the Highest Observed CAUTI Cases

Rank State Cases Total Discharges
1.  CA  2,078  3,335,055 
2.  NY  1,511  2,139,881 
3.  TX  1,268  2,828,293 
4.  FL  1,158 2,607,375 
5.  PA  945 1,546,006 
6.  OH  734 1,332,996 
7.  NC  637 998,768 
8.  GA  633 1,033,878 
9.  MA  586 787,046 
10.  IL  584 1,311,853 
All-State Total    10,134 17,921,151 

Fig 1 Data from Definitive Healthcare’s platform on hospitals and IDNs. Hospital-acquired infections (HAIs) and other quality measures sourced from the CMS Quality Metrics Update released in 2019.

Catheter-associated urinary tract infection (CAUTI) is an infection affecting any part of the urinary system. Between 15 and 25 percent of hospitalized patients receive a catheter during their hospital stays, and roughly 75 percent of UTIs contracted in hospitals are associated with catheterization.

Like other infections, CAUTIs are associated with increased risk of comorbidities, higher care costs, and longer patient stays.

States with the Highest Observed SSI: Hysterectomy Cases

Rank State Cases Total Discharges
1.  TX 181 2,828,293 
2.  CA 167 3,335,055 
3.  NY 124 2,139,881 
4.  FL 115 2,607,375
5.  GA 88 1,033,878 
6.  IL 85 1,311,853 
7.  MI 84 1,127,081 
8.  PA 83 1,546,006 
9.  OH 78 1,332,996 
10.  TN 64 820,392 
All-State Total    1,069 18,082,810 

Fig 2 Data from Definitive Healthcare’s platform on hospitals and IDNs. Hospital-acquired infections (HAIs) and other quality measures sourced from the CMS Quality Metrics Update released in 2019.

A surgical site infection (SSI) is an infection that occurs in the area where a procedure took place. Approximately 2 percent of hysterectomy patients are impacted by an SSI every year. Surgeons can reduce the risk of SSI through use of specific wound closure techniques, including avoidance of local hair removal, use of antimicrobial suture materials, and more.

States with the Highest Observed SSI: Colon Cases

Rank State Cases Total Discharges
1.  CA 698 3,335,055 
2.  TX 563 2,828,293 
3.  FL 491 2,607,375 
4.  NY 451 2,139,881 
5.  PA 337 1,546,006 
6.  MI 312 1,127,081 
7.  IL 300 1,311,853 
8.  OH 294 1,332,996 
9.  NC 243 998,768 
10.  GA 235 1,033,878 
All-State Total    3,924 18,261,186 

Fig 3 Data from Definitive Healthcare’s platform on hospitals and IDNs. Hospital-acquired infections (HAIs) and other quality measures sourced from the CMS Quality Metrics Update released in 2019.

 

States with the Highest Observed C.Diff Cases

Rank State Cases Total Discharges
1.   CA  6,824  3,335,055 
2.  TX 5,456 2,828,293 
3.   NY 5,147 2,139,881 
4.   FL 5,095 2,607,375 
5.   PA 4,057 1,546,006 
6.   IL 3,964 1,311,853 
7.   OH 3,348 1,332,996 
8.   MI 2,761 1,127,081 
9.   NC 2,697 998,768 
10.   NJ 2,474 922,482 
All-State Total    41,823 18,149,790 

Fig 4 Data from Definitive Healthcare’s platform on hospitals and IDNs. Hospital-acquired infections (HAIs) and other quality measures sourced from the CMS Quality Metrics Update released in 2019.

Clostridium difficile (C. Diff) is a bacteria that can cause fever, diarrhea, and life-threatening colon inflammation known as colitis. According to the CDC, roughly 500,000 cases of C.Diff are reported every year, and 20 percent of those patients will contract the illness multiple times. Patients with C.Diff are contagious, and are encouraged to prevent the spread of bacteria through hand washing and other enhanced hygienic efforts.

States with the Highest Observed MRSA Cases

Rank State Cases Total Discharges
1.  FL 749 2,607,375 
2.   NY  679  2,139,881 
3.  CA 656 3,335,055 
4.  TX 583 2,828,293 
5.   PA  355 1,546,006 
6.   OH  339 1,332,996 
7.   GA 295 1,033,878 
8.   NC 290 998,768 
9.   TN 280 820,392 
10.   MI 276 1,127,081 
All-State Total    4,502 17,169,725 

Fig 5 Data from Definitive Healthcare’s platform on hospitals and IDNs. Hospital-acquired infections (HAIs) and other quality measures sourced from the CMS Quality Metrics Update released in 2019.

Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterial infection that can lead to sepsis and death if left untreated. However, MRSA is resistant to some forms of antibiotics, making it difficult to treat. The staph bacteria can case blood stream infections, surgical site infections, and pneumonia.

Though anyone can contract MRSA through skin-to-skin contact, the risk increases for military personnel, athletes, students, and those receiving inpatient medical care or undergoing surgical procedures. This is one of many reasons medical equipment should be properly sterilized between patients.

Some experts believe widespread opioid use is connected to a rise in staph infections like MRSA due to needle sharing. Injection drug users are 16 times more likely to develop a serious staph infection than non-injection drug users.

States with the Highest Observed CLABSI Cases

Rank State Cases Total Discharges
1.   CA  1,471  3,335,055 
2.  TX 1,174 2,828,293 
3.  NY 1,088 2,139,881 
4.  FL  1,023 2,607,375 
5.  PA  780 1,546,006 
6.  GA 570 1,033,878 
7.   NC  569 998,768 
8.  OH 504 1,332,996 
9.  MI 431 1,127,081 
10.   IL  418 1,311,853 
All-State Total    8,028 18,261,186 

Fig 6 Data from Definitive Healthcare’s platform on hospitals and IDNs. Hospital-acquired infections (HAIs) and other quality measures sourced from the CMS Quality Metrics Update released in 2019.

Central line-associated bloodstream infections (CLABSIs) are linked to thousands of patient deaths every year. A “central line” refers to a venous catheter, or a long-term IV, that is placed in a jugular, femoral, or subclavian vein. Central lines are most commonly used for patient rehydration, drug infusions, blood pressure monitoring, and more. To reduce the risk of patients contracting CLABSI, the CDC released guidelines for providers, with recommendations such as bathing patients in chlorhexidine, when to replace dressings, and more.

Using Definitive Healthcare’s platform on hospital and IDN intelligence, we analyzed the states with the highest reported cases of hospital-acquired infections.

California appears on every list. This is likely attributed to the state’s high patient population, as rankings were calculated on volume and not ratio. Similarly, Texas and Florida appear on all six lists. Florida’s patient population is especially prone to HAIs and other complications, with people aged 60 or older making up nearly one-fifth of the population.

Large patient populations do have an impact on sheer volume of HAI cases reported, with the majority of states on the above lists reporting more than 1 million discharges annually. Massachusetts is the state with the lowest number of patient discharges in CY 2017 with 787,000.

Looking for more information on HAIs and other complications? Definitive Healthcare tracks hospital performance metrics including financial, clinical, and quality measures.

 

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