When Nearly 125,000 Hospital Infections Is Good News

Later this month, we’ll mark the 25^th anniversary of the publication of To Err Is Human: Building a Safer Health System. Released by the Institute of Medicine (now the National Academy of Medicine) on Nov. 29, 1999, the report touched off the modern patient safety movement after the IOM estimated nearly 100,000 people die each year from medical mistakes.

The Centers for Disease Control and Prevention (CDC) on Nov. 6 released its latest annual report on healthcare-associated infections, or HAIs. The 2023 National and State Healthcare-Associated Infections Progress Report tracks six types of infections acquired by patients in general acute-care hospitals, critical access hospitals, inpatient rehabilitation facilities and long-term acute care hospitals. Nearly 4,000 acute-care hospitals reported data to the CDC.

This year’s report said the “direction” of five of the six infections at acute-care hospitals is down, while the “direction” of one is up. What does that mean? It means the ratio of observed infections to predicted infections in 2023 was lower (or higher) than the ratio of observed infections to predicted infections in 2022.

It was lower last year for:

• Central line-associated bloodstream infections (CLABSI) — a 15% drop in the ratio.
• Catheter-associated urinary tract infections (CAUTI) — an 11% drop in the ratio.
• Ventilator-associated events (VAE) — a 5% drop in the ratio.
• Hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) — a 16% drop in the ratio.
• Hospital-onset Clostridioides difficile (CDI) — a 13% drop in the ratio.

It was higher last year for:

• Surgical site infections (SSI) — a 3% increase in the ratio.

The healthcare trade press and the mainstream media hailed the drop in five of the six infection ratios. Here’s a sample of some of the headlines:

• “Hospital infection rates dropped in 2023”
• “U.S. hospitals saw declines in healthcare-associated infections last year”
• “CDC report shows decreases in certain healthcare-associated infections in 2023”

The report is good news. In short, the chances of getting an infection in the hospital were lower than expected last year than they were in 2022. It’s good news for statisticians, health services researchers, public health agencies and infection control people. But is it good news for hospitalized patients?

I added up the observed, or actual, number of infections each year for the six types of infections that the CDC used to make its ratio calculations for acute-care hospitals.

• In 2022, there were a total of 143,142 infections.
• In 2023, there were a total of 124,385 infections.
• That’s a 13.1% reduction in actual infections last year.

That’s great news for the 18,757 patients who the CDC expected to get an infection in the hospital last year but didn’t. It doesn’t mean much to the 124,387 patients who the CDC expected to get an infection and did. They got sicker, stayed in the hospital longer or died.

I guess good patient safety news is relative.

Thanks for reading.

To learn more on this topic, please read:

• “Yes, Some Good Patient Safety News”
• “Hospital Infection Regression”