Carol A. Keohane

Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system.

IMPORTANCE Health care-associated infections (HAIs) account for a large proportion of the harms caused by health care and are associated with high costs. Better evaluation of the costs of these infections could help providers and payers to justify investing in prevention. OBJECTIVE To estimate costs associated with the most significant and targetable HAIs. DATA SOURCES For estimation of attributable costs, we conducted a systematic review of the literature using PubMed for the years 1986 through April 2013. For HAI incidence estimates, we used the National Healthcare Safety Network of the Centers for Disease Control and Prevention (CDC). STUDY SELECTION Studies performed outside the United States were excluded. Inclusion criteria included a robust method of comparison using a matched control group or an appropriate regression strategy, generalizable populations typical of inpatient wards and critical care units, methodologic consistency with CDC definitions, and soundness of handling economic outcomes. DATA EXTRACTION AND SYNTHESIS Three review cycles were completed, with the final iteration carried out from July 2011 to April 2013. Selected publications underwent a secondary review by the research team. MAIN OUTCOMES AND MEASURES Costs, inflated to 2012 US dollars. RESULTS Using Monte Carlo simulation, we generated point estimates and 95% CIs for attributable costs and length of hospital stay. On a per-case basis, central line-associated bloodstream infections were found to be the most costly HAIs at

Effect of bar-code technology on the safety of medication administration.

45,814 (95% CI,

Medication Dispensing Errors and Potential Adverse Drug Events before and after Implementing Bar Code Technology in the Pharmacy

30,919-

Rates of Medical Errors and Preventable Adverse Events Among Hospitalized Children Following Implementation of a Resident Handoff Bundle

65,245), followed by ventilator-associated pneumonia at

Errors associated with outpatient computerized prescribing systems

40,144 (95% CI,

Quantifying Nursing Workflow in Medication Administration

36,286-

The Costs of Adverse Drug Events in Community Hospitals

44,220), surgical site infections at

Risk Factors in Preventable Adverse Drug Events in Pediatric Outpatients

20,785 (95% CI,

Occurrence of adverse, often preventable, events in community hospitals involving nephrotoxic drugs or those excreted by the kidney

18,902-

Off the Hamster Wheel? Qualitative Evaluation of a Payment-Linked Patient-Centered Medical Home (PCMH) Pilot

22,667), Clostridium difficile infection at