California spends billions each year on hospital-acquired infections1

Hospital acquired conditions are complications such as injuries or infections that can occur in the course of receiving healthcare services.2 Measuring the incidence of hospital acquired conditions is one way to assess healthcare safety. With sustained and system-wide quality improvement efforts in hospitals, safety and quality of care for patients can be enhanced and billions of dollars saved.

This indicator tracks the incidence of measurable hospital-acquired conditions (per 1,000 discharges). It is a composite patient safety indicator that is an average of the observed-to-expected ratios of several other selected indicators of quality. The available data is not a definitive measure of hospital quality and there may be opportunities for further development to establish a more definitive measure.

Indicator Progress

In 2021 (baseline year), there were 0.84 hospital-acquired conditions per 1,000 discharges. The most recent rate available is 0.84 (2021). We hope to reach a target of 0.50 or lower by 2034.

More Data about Hospital Acquired Conditions

Hospital Acquired Conditions

Note: Due to the incorporation of ICD-10 codes and other factors into the measure composition, values for this indicator (include baseline) will likely change next year.

Baseline

0.84

Current Rate

0.84

Target

0.50

Indicator Highlights

A woman washing her hands.

Healthcare Associated Infections Program (HAI)

Healthcare Associated Infections (HAI) Program is part of the Center for Health Care Quality of the California Department of Public Health. The Program was created by mandate to oversee the prevention, surveillance and reporting of healthcare-associated infections in California’s general acute care hospitals.

HAIs are the most common complication of hospital care. The vision of the HAI Program is to eliminate HAIs for all Californians. The HAI Program produces annual public reports of hospital HAI data to inform choices of healthcare consumers and prompt providers to take actions to prevent infections; actively engages in HAI prevention by performing site visits to hospitals with high infection rates, convening prevention collaboratives, and provides infection prevention education; and consultation and assistance to local public health for infection outbreaks that occur in healthcare facilities.

Healthcare associated infections (HAIs) result in an estimated $3.1 billion in excess healthcare costs in California and $28-$45 billion nationally each year.1,3

Healthcare-associated Infections (HAIs) are common, affecting 1 in 25 hospital patients during the course of their hospital care.2

Consistent use of evidence-based infection prevention approaches in health care settings can reduce hospital acquired infections.2

Following antibiotic stewardship best practices can reduce antimicrobial resistance.4

Data Snapshot: Trends & Disparities

Three hospitals with higher rates of hospital acquired infection than the national baseline are located in California’s Central Valley and Southern California.6

Asian, Black, and Latino patients have a higher incidence of certain hospital-acquired infections relative to White patients.5

The rate of hospital acquired infections has consistently decreased over time.

Incidence of Hospital-Acquired Conditions per 1,000 Discharges, Over Time

Download the Data Visualization Help

|

Indicator: Incidence of measurable hospital-acquired conditions per 1,000 discharges, California

Indicator Description: This data contains composite patient safety and adverse events indicator (PSI), which is the weighted average of the reliability-adjusted observed-to-expected ratios for selected indicators. The composite PSI includes the following component indicators: pressure ulcer, iatrogenic pneumothorax, in-hospital fall with hip fracture, postoperative hemorrhage or hematoma rate, postoperative acute kidney injury requiring dialysis, postoperative respiratory failure, postoperative pulmonary embolism or deep vein thrombosis, postoperative sepsis, postoperative wound dehiscence, and abdominopelvic accidental puncture or laceration. The indicator was calculated using the California Department of Health Care Access and Information (HCAI) Patient Discharge Data run through the Agency for Healthcare Research and Quality’s Patient Safety Indicator Software, v2022.

Data Limitations: California hospital medical record data for the reported medical conditions and procedures have not been validated through medical record reabstraction to demonstrate that patient severity-of-illness and complications are accurately and reliably coded across all hospitals. HCAI views these indicators as potentially useful starting points for examining hospital quality but does not regard them as definitive measures of quality. Estimates are produced using AHRQ’s Prevention Quality Indicator Software v2022, and are back-compatible with older data years. Estimates generated using v2022 should not be compared to estimates produced using other software versions, as they may be calculated using different condition lists or population definitions. Because the AHRQ software is back-compatible with older data years, the baseline and target values for the indicator may change when data is updated.

Indicator Source: Department of Health Care Access and Information

Data Sharing Agreement:  Data is available on the open data portal: https://data.ca.gov/dataset/measurable-hospital-acquired-conditions-composite-patient-safety-and-adverse-events-indicator-s

Indicator Calculation Methodology: The indicator was calculated using the California Department of Health Care Access and Information (HCAI) Patient Discharge Data run through AHRQ’s Prevention Quality Indicator Software Version v2022 (2022). More detail about the calculation methodology can be found on AHRQ’s website: https://qualityindicators.ahrq.gov/measures/PSI_TechSpec

Data Collection Methodology: https://hcai.ca.gov/data-and-reports/submit-data/patient-data/

Program URL Link: https://www.qualityindicators.ahrq.gov/Modules/psi_resources.aspx

Reporting Cycle: Annually (April)

1. Let’s Get Healthy California Task Force. (2012, December). Let’s Get Healthy California Task Force Final Report. Let’s Get Healthy California Task Force. https://letsgethealthy.ca.gov/wp-content/uploads/2019/02/Lets-Get-Healthy-California-Task-Force-Final-Report.pdf

2. California Department of Public Health. (2023, March 14). Healthcare-Associated Infections (HAI) Program. https://www.cdph.ca.gov/Programs/CHCQ/HAI/Pages/HAIProgramHome.aspx

3. Stone P. W. (2009). Economic burden of healthcare-associated infections: an American perspective. Expert Review of Pharmacoeconomics & Outcomes Research, 9(5), 417–422. https://doi.org/10.1586/erp.09.53

4. Centers for Disease Control and Prevention. (2021, December 14). Actions to Fight Antimicrobial Resistance. https://www.cdc.gov/drugresistance/actions-to-fight.html

5. Chen, J., Khazanchi, R., Bearman, G., & Marcelin, J. R. (2021). Racial/ethnic inequities in healthcare-associated infections under the shadow of structural racism: Narrative review and call to action. Current Infectious Disease Reports, 23, https://doi.org/10.1007/s11908-021-00758-x

6. Center for Health Care Quality. (2021, October). Making healthcare safer for all Californians: Healthcare-associated infections in California hospitals. California Department of Public Health. https://www.cdph.ca.gov/Programs/CHCQ/HAI/CDPH%20Document%20Library/HAI-2020-Report-Final_041822.pdf

Share Your Story

Want to engage in moving the dial on the Redesigning the Health System goal? Share your impact story!

Submit Your Story

More From Let’s Get Healthy California

book

Get Informed

three dots

Get Involved

magnifying glass

Get Data