Adverse outcomes from hospital-acquired infection in Pennsylvania cannot be attributed to increased risk on admission

In July 2005, Pennsylvania became the first state in the nation to publicly report statewide data on hospital-acquired infections (HAI). The published research brief revealed that 11 668 hospitalizations with HAI had markedly different mortality rates, lengths of stay (LOS), and charges than cases without HAI did. To avoid a possibly biased comparison, a 5 to 1 propensity-matched cohort study was performed. Nine cohorts (ie, heart failure, chronic obstructive pulmonary disease, respiratory failure, pneumonia, hip fracture, major surgical complications, colonic resection, diabetes, and gastrointestinal bleeding) were examined for differences in mortality, LOS, and hospital charges. Statistically significant increases in mortality, LOS, and charges were found among HAI cases. HAI cases had more than a 4 times higher median charge than nonHAI controls did. Observed differences in mortality, LOS, and charges between HAI and non-HAI cases in Pennsylvania cannot be explained on the basis of increased disease-specific severity at the time of admission.