By Amanda Sounart, associate editor

As economic woes continue to plague U.S. hospitals, one of the areas seeing the deepest cutbacks is infection prevention. Leading epidemiologists point out that these budget cuts could become detrimental to both patient care and the financial health of hospitals.

"In addition to the human toll, the infections cost hospitals money," said Kathy L. Warye, chief executive officer for the Association for Professionals in Infection Control and Epidemiology (APIC).

Hospital-acquired infections (HAIs) are one of the top ten leading causes of death in the U.S, according to APIC. They account for approximately 1.7 million infections each year, lead to 99,000 deaths and incur more than $20 billion in medical costs.

According to a recent APIC survey of 2,000 hospital infection preventionists, 41 percent of respondents have experienced budget cuts within the last 18 months.

"The problem is that, in recent years, the scope of work for infection preventionists has increased but the resources have decreased," said Christine Nutty, RN, MSN, CIC, the 2009 president for APIC.  "According to the survey, almost two-thirds of the respondents have one or less than one full-time-equivalent employee dedicated for infection prevention and 39 percent have no clerical support."

Infection preventionists are instrumental in reducing HAIs among inpatients. They survey infection rates, educate hospital staff on new and emerging infections and implement methods of infection prevention. A reduction in staff infection preventionists could lead to greater HAI rates, more deaths and mounting costs.

With the growing number of drug-resistant infections such as Methicillin-resistant staphylococcus aureus (MRSA) and Clostridium difficile (C. diff), as well as emerging novel flu viruses such as H1N1, Nutty worries that reducing the number of infection preventionists will only increase the financial strain on hospitals and the danger to patients.

"This is a problem because we can’t protect patients from hospital-acquired infections without adequate numbers of trained professionals," said Nutty. "A third of survey respondents said the cuts have made it harder to do the work that protects patients."

The recent and ongoing changes to the Center for Medicare and Medicaid’s (CMS) Inpatient Prospective Payment System have effectively ceased reimbursements for several hospital-associated conditions, including several HAIs. As infection prevention budgets decrease, infections such as bloodstream infections, surgical site infections and catheter-associated urinary tract infections will are likely to increase in prevalence. No longer reimbursable by CMS, hospitals that reduce prevention budgets are likely to incur up to $100,000 in uncompensated costs per infection.

"For surgical site infections, the cost is about $25,000 in excess of what the surgery alone would normally cost," said Denise Murphy, RN, MPH, CIC, vice president for quality at Main Line Health System and past president of APIC. "If you were to avoid only ten bloodstream infections per year, that would pay for an entire infection prevention program that would include two infection preventionists and a clerical person."

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