Healthcare-associated infections (HAIs) occur in hundreds of millions of patients each year globally, causing increased illness, death and costs. HAIs typically involve four types of infections and rates are usually higher in developing countries. HAIs prolong hospital stays by up to 3 weeks and increase costs by USD $4,888 to $11,591 per infection episode. It is estimated that 65-70% of HAIs are preventable. While preventing HAIs requires initial investment, it can free up hospital beds and resources in the long-run, improving outcomes and making more efficient use of limited healthcare funds.

1. APEC High Level Meeting on Health & the Economy
“A Model for a Sustainable Healthcare System”
24-25 September 2013 │ Nusa Dua, Bali, Indonesia
Disease Cost Drivers: Anti-Microbial Resistance
and Healthcare Associated Infections
Prof. Dr. Alessandro Pontes-Arruda
MD, MSc, PhD, FCCM

2.  HAI occur throughout the world, affecting hundred of millions of patients
each year, causing increased morbidity, mortality and cost1
 Typically, 75% of HAIs are due to four types of infections: urinary tract,
surgical site, bloodstream, and pneumonia2
 Rates are usually much higher in developing than in developed countries (1
in 20 in US/EU vs. 1 in 4 in developing countries)3,4,5
 HAI increases the cost of healthcare and unnecessarily prolongs hospital
stays up to 3 weeks (up to USD16,550/episode)6
 It has been estimated that 65-70% of HAI are preventable by implementing
evidence-based interventions7
1 WHO. The burden of health care-associated infection worldwide: A summary 2010.
2 US Health and Human Services. Health-care associated infections.
3 Allegranzi et al. Lancet. 2011
4 European Center for Disease Prevention and Control. Annual Epidemiological Report on Communicable Diseases in Europe. Available at:
http://ecdc.europa.eu/en/files/pdf/Publications/081215_AER_long_2008.pdf. Accessed July 2009.
5Wenzel RP, Edmond MB. Emerg Infect DIs. 2001;7:174-177.
6 Centers for Disease Control and Prevention. Vital signs: Central-line associated blood-stream infections – United States, 2001, 2008 and 2009. MMWR 2011
7Umscheid et al. Infect Control Hosp Epidemiol. 2011.

3. BSI Length of Stay and Cost
Argentina1 Brazil 2 Mexico 3
Extra length of stay 11.9 days 23.6 days 6.1 days
Costs USD 4,888 USD 7,906
USD 11,591 for
hospital +
USD 598 for
antibiotics
1. Rosenthal VD, et al. Am J Infect Control 2003;31(8):475-80 ,
2. Salomao R , Rosenthal, VD et al. APIC Meeting. Tampa, USA. June 2006
3. Higuera F, Rangel-Frausto M, Rosenthal VD, et al. Infect Control Hosp Epidemiol. 2007 Jan;28(1):31-5.
 HAI lead to prolonged hospital/ICU stay, taking up bed space and requiring
additional use of medications (including broad spectrum and usually more
expensive antibiotics)
 Treating preventable HAI is therefore an inefficient allocation of scarce resources.
Prevention would be a more proactive and efficient allocation

4. Source: US Senate Labor & Human Resources Committee
$490B
$18B
$180B
$330B
$100B
Adverse Drug Effects
Administrative Costs
Avoidable
or
Inappropriate Care
Logistics
& Supplies
Inefficiencies
Total Cost: $1Trillion
Required care

5. Prevent Rather Than Treat

6.  Investment in HAI prevention and control enables the payer to allocate
resources to other critical areas
 Shorter LOS in the hospital frees up beds and time (human resources)
which is likely to be of value given the increasing constrains on hospital
infrastructure
 Lower incidence of HAI potentially leads to reduced morbidity and mortality
improving patient outcomes
 Better surveillance and reporting systems may serve as the alert frontline
leading to epidemic and pandemic readiness

7.  Under Indonesian leadership this year the APEC Health Working Group and
APEC Life Sciences Innovation Forum have made much progress in
transform some of the ideas for HAI prevention and control into concrete
policy recommendations by adopting the “ HAI Prevention Toolkit” (Medan –
July, 2013)
 Important elements of the Toolkit: Establish a body at central government
level that take ownership of advancing HAI prevention and control (for
instance using a dedicated agency); recommendations on the scope of
data surveillance; recommendations on capacity building through
training and also development of public-private partnerships

8.  We need to define HAI as a healthcare priority
 Data surveillance in order to understand the magnitude of the problem and
the actual savings of the implemented solutions
 We need sufficient and well trained infection control staff with enough time in
their jobs allocated to prevention
 We need to improve communication (real time communication is essential to
take the right actions and for this reason surveillance must be also an
integrant part of the process)
 Although an initial investment may have an impact on the healthcare budget,
long term efficiencies can be gained by re-allocating funds from HAI
treatment to other critical patient care