Extra length of stay and costs because of health care–associated infections at a German university hospital

Published:October 29, 2015DOI:


      • We examined extra length of stay and associated per diem costs attributable to health care–associated infections.
      • Extra length of stay was estimated by multistate modeling.
      • Health care–associated infection increased hospital length of stay and cost of care.
      • Additional costs attributable to health care–associated infections were €5,823-€11,840 ($7,453-$15,155) per infected patient.
      • Potential cost savings of at least €2 million ($2.5 million) per year were estimated for a major tertiary care center.


      Health care–associated infections (HAIs) can be associated with increased health care costs. We examined extra length of hospital stay (LOS) and associated per diem costs attributable to HAIs in a large academic medical center.


      Data for analysis were acquired in a preinterventional phase of a prospective cohort study (ALERTS) conducted over 12 months in 27 general and 4 intensive care units at Jena University Hospital. HAIs were identified among patients hospitalized for ≥48 hours with at least 1 risk factor for HAI and new antimicrobial therapy; the diagnosis was confirmed by U.S. Centers for Disease Control and Prevention criteria. Extra LOS was estimated by multistate modeling, and associated extra costs were based on average per diem costs for clinical units sampled.


      Of a total of 22,613 patients hospitalized for ≥48 hours, 893 (3.95%) experienced 1,212 episodes of HAI during 12 months. The associated mean extra LOS ± SEM in general units was 8.45 ± 0.80 days per case and 8.09 ± 0.91 days for patients treated in both general and intensive care units. Additional costs attributable to HAIs were €5,823-€11,840 ($7,453-$15,155) per infected patient.


      HAIs generated substantial extra costs by prolonging hospitalization. Potential clinical and financial savings may be realized by implementing effective infection prevention programs.

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