Top 10 states with the most hospital-acquired conditions (HACs)

What are the most common hospital-acquired conditions (HACs)? 

In this blog, we focus on the most common hospital-acquired infections – C, Diff, CAUTI, CLABSI, MRSA, SSI – Colon and SSI – Hysterectomy.  

How are hospital-acquired conditions (HACs) tracked?  

HAC prevalence is one of the clinical quality measures tracked by the Centers for Medicare and Medicaid Services (CMS) to improve care quality and patient outcomes. In 2016, more than 3,000 patient deaths resulted from HACs, resulting in $2 billion of excess medical spending. In addition to increased care costs, HACs link to longer patient stay lengths and higher mortality risks. 

Care facilities that report higher-than-average rates of HACs may face a 1% payment reduction from CMS. In 2015, CMS launched the HAC Reduction Program to reduce preventable complications through financial penalties for the lowest-performing hospitals. 

Below, we’ve compiled lists of the states with the greatest number of reported hospital-acquired conditions. Definitive Healthcare tracks quality metrics for more than 7,900 hospitals, including the number of reported cases for catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs) for hysterectomies and colorectal procedures, Clostridium difficile (C. diff.) intestinal infections, Methicillin-resistant Staphylococcus Aureus (MRSA) blood infections and Central Line-associated Blood Stream Infection (CLABSI). 

10 states with the highest overall observed hospital-acquired conditions 

Rank	State	Cases
1	CA	9,861
2	TX	7,816
3	NY	6,754
4	FL	6,481
5	PA	5,016
6	OH	4,313
7	IL	3,976
8	NC	3,531
9	GA	3,395
10	MI	3,369
All-state total		54,512

Fig. 1 Data is from Definitive Healthcare’s Hospitals & IDN database. Data accessed February 9, 2022.

From most to least cases, the ten states with the most HAC cases were: California, Texas, New York, Florida, Pennsylvania, Ohio, Illinois, North Carolina, Georgia and Michigan.  

10 states with the highest observed CAUTI Cases 

Rank	State	Cases in ICUs and other Wards	Patient Days in ICUs and other Wards
1	CA	2,102	1,890,111
2	TX	1,334	1,619,525
3	NY	1,218	1,229,723
4	PA	980	943,989
5	FL	931	1,213,478
6	OH	684	772,790
7	NC	631	588,506
8	GA	630	664,066
9	IL	619	715,404
10	MI	518	539,687
All-state total		9,647	10,177,279

Fig. 2 Data is from Definitive Healthcare’s Hospitals & IDN database. Data accessed February 9, 2022. 

What is CAUTI?  

Catheter-associated urinary tract infection (CAUTI) is an infection affecting any part of the urinary system. Between 15 and 25% of hospitalized patients receive a catheter during their hospital stays, and roughly 75% of UTIs contracted in hospitals are associated with catheterization. CAUTI prevention is reliant on antimicrobial stewardship and correct catheter use.    

Much like other infections, CAUTIs correlate with increased risk of comorbidities, higher care costs and longer patient stays. 

10 states with the highest observed SSI: Hysterectomy Cases 

Rank	State	Cases	Number of Procedures
1	TX	228	28,898
2	FL	144	20,986
3	GA	134	13,206
4	CA	132	20,109
5	MI	114	9,588
6	NY	100	13,601
7	OH	89	11,582
8	IL	76	10,842
9	IN	73	8,163
10	NC	72	10,889
All-state total		1,162	147,864

Fig. 3 Data is from Definitive Healthcare’s Hospitals & IDN database. Data accessed February 9, 2022.  

What is SSI? 

A surgical site infection (SSI) is an infection that occurs in the area where a procedure took place. Approximately 2% of hysterectomy patients are impacted by an SSI every year. Surgical site infection prevention includes specific wound closure techniques, like avoiding local hair removal, using antimicrobial suture materials and more. Causes of surgical site infections include exogenous infection and endogenous infection.  

10 states with the highest observed SSI: Colon Cases 

Rank	State	Cases
1	CA	602
2	TX	522
3	FL	444
4	OH	364
5	PA	337
6	NY	331
7	MI	299
8	NC	275
9	IL	253
10	GA	235
All-state total		3,662

Fig. 4 Data is from Definitive Healthcare’s Hospitals & IDN database. Data accessed February 9, 2022.  

10 states with the Highest Observed C. Diff Cases

Rank	State	Cases	Patient Days
1	CA	4,219	13,155,439
2	NY	3,347	9,415,576
3	TX	2,970	11,634,182
4	FL	2,949	11,838,554
5	PA	2,380	6,675,177
6	IL	2,137	5,617,634
7	OH	2,056	5,703,327
8	MI	1,700	4,628,977
9	NC	1,575	4,883,609
10	NJ	1,469	4,111,022
All-state total		24,802	77,663,497

Fig. 5 Data is from Definitive Healthcare’s Hospitals & IDN database. Data accessed February 9, 2022.  

What is C. Diff?  

Clostridium difficile (C. Diff) is a bacterium that can cause fever, diarrhea and life-threatening colon inflammation known as colitis. According to the CDC, roughly 500,000 cases of C. Diff are reported every year, and 20% of those patients will contract the illness multiple times. Patients with C. Diff are contagious and are encouraged to prevent the spread of bacteria through hand washing and other enhanced hygienic efforts. 

10 states with the highest observed MRSA Cases 

Rank	State	Cases	Patient Days
1	TX	897	12,666,494
2	FL	883	12,525,166
3	CA	823	14,199,875
4	NY	642	10,125,502
5	OH	479	6,023,902
6	GA	447	5,196,978
7	TN	420	3,968,437
8	PA	417	7,118,479
9	NC	324	5,289,277
10	AL	299	2,925,870
All-state total		5,631	80,039,980

Fig. 6 Data is from Definitive Healthcare’s Hospitals & IDN database. Data accessed February 9, 2022.  

What is MRSA? 

Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterial healthcare-acquired infection that can lead to sepsis and death if left untreated. MRSA treatment includes antibiotics; however, the MRSA infection is resistant to some forms of antibiotics, making it difficult to treat. The staph bacteria can cause bloodstream infections, surgical site infections and pneumonia. 

Though anyone can contract MRSA through skin-to-skin contact, the risk increases for military personnel, athletes, students and those receiving inpatient medical care or undergoing surgical procedures. Healthcare providers should properly sterilize medical equipment between patients. 

Some experts believe widespread opioid use correlates to a rise in staph infections like MRSA due to needle sharing. Injection drug users are 16 times more likely to develop a serious staph infection than non-injection drug users.  

Globally, there is a rise in antibiotic resistance due to new resistance mechanisms that threaten treatments. As the effectiveness of antibiotics decreases, infections become more difficult to treat. Additionally, areas where people can buy antibiotics without a prescription have greater antibiotic resistance. 

10 states with the highest observed CLABSI Cases 

Rank	State	Cases in ICUs and other Wards	Patient Days in ICUs and other Wards
1	CA	1,983	1,888,941
2	TX	1,865	1,665,086
3	FL	1,130	1,284,209
4	NY	1,116	1,232,180
5	PA	831	911,571
6	GA	753	702,059
7	NC	654	638,504
8	OH	641	708,171
9	IL	600	739,497
10	MO	442	439,243
All-state total		10,015	10,209,461

Fig. 7 Data is from Definitive Healthcare’s Hospitals & IDN database. Data accessed February 9, 2022.  

What is CLABSI? 

Central line-associated bloodstream infections (CLABSIs) are linked to thousands of patient deaths every year. A “central line” refers to a venous catheter, or a long-term IV, placed in a jugular, femoral or subclavian vein. Healthcare providers most use central lines for patient rehydration, drug infusions, blood pressure monitoring and more. CLABSI prevention involves CDC guidelines for providers, with recommendations such as bathing patients in chlorhexidine, when to replace dressings and more. 

What is a hospital-acquired condition (HAC)?  

A hospital-acquired condition (HAC), also known as a nosocomial infection, is an infection that arises during an inpatient stay. HACs often lead to deaths and excess medical spending.

Which states had the highest number of hospital-acquired infections (HACs)? 

As shown in the data above, California makes the top ten list for each HAC category. This is likely attributed to the state’s high patient population, as we calculated rankings on volume and not ratio. Similarly, Texas and Florida appear on all six lists. Florida’s patient population is especially prone to HACs and other complications, with people aged 60 or older making up nearly one-fifth of the population. 

What role does infection prevention and control play? 

The World Health Organization (WHO) states infection prevention and control (IPC) is an evidence-based method to prevent and stop transmittable illnesses. Infection control protects patients and healthcare providers from becoming ill with preventable conditions. IPC is especially relevant to injection safety, hand hygiene and hospital operations and demands action at all health system levels. There is infection control training for healthcare workers. 

Learn more 

Healthcare Insights are developed with healthcare commercial intelligence from the Definitive Healthcare platform. Want even more insights? Start a free trial now and get access to the latest healthcare commercial intelligence on hospitals, physicians and other healthcare providers.