Diagnostic Stewardship for Healthcare-Associated Infections: Opportunities and Challenges to Safely Reduce Test Use

Abstract

Healthcare-associated infections (HAIs) are associated with increased morbidity and mortality, prolonged hospital stays, and unnecessary cost. The financial stakes of HAIs for hospitals were underscored in 2008 when the Centers for Medicare and Medicaid Services (CMS) began to withhold payment for certain "reasonably preventable" HAIs, including catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), and surgical site infections (SSIs). Accurate diagnostics are critical for safe patient care and have additional impacts in our environment of valuebased payment, public reporting, and quality metrics, where hospitals may incur penalties for HAI test overuse, including lost reimbursement, financial penalties, and damage to institutional reputation and rankings. From a patient care perspective, overdiagnosis of HAIs could lead to inappropriate antimicrobial use and attendant unnecessary cost and risks antimicrobial resistance and adverse drug effects.