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

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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 

CA 

        9,861  

TX 

        7,816  

NY 

       6,754  

FL 

        6,481  

PA 

       5,016  

OH 

        4,313  

IL 

       3,976  

NC 

        3,531  

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 

CA 

                                        2,102  

                                              1,890,111  

TX 

                                        1,334  

                                             1,619,525  

NY 

                                         1,218  

                                             1,229,723  

PA 

                                          980  

                                              943,989  

FL 

                                           931  

                                             1,213,478  

OH 

                                          684  

                                              772,790  

NC 

                                           631  

                                              588,506  

GA 

                                          630  

                                              664,066  

IL 

                                           619  

                                               715,404  

10 

MI 

                                           518  

                                              539,687  

All-state total 

  

                                        9,647  

                                           10,177,279  

Fig. 2Data 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 

TX 

      228  

                        28,898  

FL 

       144  

                        20,986  

GA 

       134  

                         13,206  

CA 

       132  

                        20,109  

MI 

        114  

                          9,588  

NY 

      100  

                         13,601  

OH 

        89  

                          11,582  

IL 

        76  

                         10,842  

IN 

        73  

                           8,163  

10 

NC 

        72  

                         10,889  

All-state total 

  

     1,162  

                       147,864  

Fig. 3Data 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 

CA 

    602  

TX 

    522  

FL 

    444  

OH 

    364  

PA 

    337  

NY 

     331  

MI 

    299  

NC 

    275  

IL 

    253  

10 

GA 

    235  

All-state total 

  

 3,662  

Fig. 4Data 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 

CA 

     4,219  

    13,155,439  

NY 

    3,347  

      9,415,576  

TX 

    2,970  

     11,634,182  

FL 

    2,949  

    11,838,554  

PA 

   2,380  

      6,675,177  

IL 

     2,137  

      5,617,634  

OH 

   2,056  

     5,703,327  

MI 

    1,700  

     4,628,977  

NC 

     1,575  

    4,883,609  

10 

NJ 

     1,469  

       4,111,022  

All-state total 

  

 24,802  

   77,663,497  

Fig. 5Data 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 

TX 

   897  

   12,666,494  

FL 

   883  

    12,525,166  

CA 

   823  

    14,199,875  

NY 

   642  

   10,125,502  

OH 

   479  

    6,023,902  

GA 

   447  

      5,196,978  

TN 

   420  

     3,968,437  

PA 

    417  

       7,118,479  

NC 

   324  

     5,289,277  

10 

AL 

   299  

    2,925,870  

All-state total 

  

 5,631  

 80,039,980  

Fig. 6Data 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 

CA 

                                        1,983  

                                             1,888,941  

TX 

                                        1,865  

                                            1,665,086  

FL 

                                         1,130  

                                            1,284,209  

NY 

                                          1,116  

                                             1,232,180  

PA 

                                           831  

                                                 911,571  

GA 

                                          753  

                                              702,059  

NC 

                                          654  

                                              638,504  

OH 

                                           641  

                                                708,171  

IL 

                                         600  

                                               739,497  

10 

MO 

                                          442  

                                              439,243  

All-state total 

  

                                      10,015  

                                          10,209,461  

Fig. 7Data 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 

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