[How many hospital insurance claims are based on infection control failures?]

It can be expected that hospital insurance claims based on health care-associated infections (HCAI) will increase in German hospitals because of growing media and patient interest in this topic. It was the aim of this study to determine the percentage of insurance claims because of HCAI among all potential cases of avoidable HCAI.

Data of a core group of 254 hospitals continuously working with one of the largest German hospital insurance companies (ECCLESIA) over an eleven-year period were used. The observed number of cases caused by infection control failures (ICF) was compared with the potential number of avoidable HCAI in the entire patient group treated in these hospitals. The type of the failure as well as the probability of an actual ICF were evaluated in each case of ICF by a team of experts.

A hospital insurance claim was made in only 0.2 % of all avoidable HCAI cases. Among the 117 cases with payments exceding 700 Euro, only 39 were found to have had a specific infection control problem. Fewer than half of these cases were considered as probable infection control failures by the experts in this field.

Hospital insurance claims because of HCAI are still rare in German hospitals. In the group of insurance claims because of ICF, some cases had been classified incorrectly.