title: Extra length of stay and costs because of health care-associated infections at a German university hospital.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  HAIs generated substantial extra costs by prolonging hospitalization. Potential clinical and financial savings may be realized by implementing effective infection prevention programs.
authors.affiliation: Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Hospital Pharmacy, Jena University Hospital, Jena, Germany. Electronic address: Habibollah.Arefian@med.uni-jena.de.
authors.forename: Habibollah
authors.initials: H
authors.lastname: Arefian
authors.affiliation: Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Department of Internal Medicine IV, Jena University Hospital, Jena, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hagel
authors.affiliation: Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Hospital Pharmacy, Jena University Hospital, Jena, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Heublein
authors.affiliation: Center for Clinical Studies, Jena University Hospital, Jena, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Rissner
authors.affiliation: Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Research Group, Clinical Epidemiology, Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany.
authors.forename: André
authors.initials: A
authors.lastname: Scherag
authors.affiliation: Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Center for Clinical Studies, Jena University Hospital, Jena, Germany; Paul-Martini-Clinical Sepsis Research Unit, Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
authors.forename: Frank Martin
authors.initials: FM
authors.lastname: Brunkhorst
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA.
authors.forename: Ross J
authors.initials: RJ
authors.lastname: Baldessarini
authors.affiliation: Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Hospital Pharmacy, Jena University Hospital, Jena, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Hartmann
mesh_terms: D015331:Cohort Studies; D017046:Cost Savings; D003428:Cross Infection / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000191:economics*; D015233:Models, Statistical; D011446:Prospective Studies
keywords: Cost; Health care–associated infection; Hospital; Inpatients; Length of stay