The Fiscal Case for Fighting Hospital-Acquired Infections (Part 1)

In 2014, an outbreak of carbapenemase-producing Enterobacteriaceae (CPE)—a bacteria dubbed the “nightmare superbug”—struck 40 patients across five West London hospitals.

The outbreak placed emergency and operational resources under immense strain:

• Facility Closures: 8 bays and 4 wards were closed, forcing dozens of elective procedures to be canceled and new patients turned away.
• Infrastructure & Testing: Temporary waste storage rooms and en-suite isolation facilities were built. CPE patients required isolation and high-cost last-resort medications, while nearly 10,000 other patients were screened.
• Decontamination: Curtains were replaced, mattresses disposed of, and ward cleaning frequency tripled from once to three times daily.
• Specialist Intervention: External epidemiologists, data analysts, microbiologists, and disinfection specialists were brought in to manage containment.

Containing the outbreak took 10 months, resulting in 1,206 lost bed-days and costing over €1.1 million ($1.2M USD).

This represents a single outbreak from one pathogen in one city—a small window into the growing global economic burden of healthcare-associated infections (HAIs). In the United States alone, at least 1 in 31 hospital patients contracts at least one HAI, driving up healthcare delivery costs worldwide.

“With rising levels of antimicrobial resistance worldwide, investment in infection prevention and control is an increasing priority.”

— Clinical Microbiology and Infection

Hospital-Acquired Infections: Following the Money

While direct outbreak expenses (medications, personal protective equipment, and specialized testing) are substantial, the largest financial loss stems from opportunity cost—specifically, the lost capacity to admit new patients and perform elective surgical procedures.

Bed Closures and Extended Stays

A study of 68 Chinese hospitals revealed that nearly 50,000 HAIs occurred in a single year. On average, infected patients required 10.4 additional days in the hospital—effectively doubling their length of stay and cutting available admission capacity in half.

Similarly, a Dutch study evaluating seven hospital outbreaks found that bed closures accounted for 50% of total outbreak costs:

“One of the biggest cost drivers is the closure of wards and the subsequent drop in revenue, especially when this closure has consequences for scheduled procedures.”

How Infection Location Affects Overall Cost

HAIs most frequently target the bloodstream, surgical sites, urinary tract, and lungs. The financial impact varies significantly depending on the infection type:

1. Central Line-Associated Bloodstream Infections (CLABSIs)

On a per-case basis, bloodstream infections carry the highest individual price tag:

• Standard Hospital Ward: A single central line-associated bloodstream infection averages $46,000 (JAMA Internal Medicine).
• Intensive Care Unit (ICU): A catheter-related bloodstream infection in the ICU can reach $80,000 per patient.

2. Surgical-Site Infections (SSIs)

Surgical-site infections cost American hospitals approximately $20,000 per occurrence, but contribute more to overall institutional expenditure due to high procedure volumes (e.g., C-sections, hip replacements, spinal fusions, and bypass surgeries).

• Reoperation & Readmission: European research indicates surgical-site infections roughly double the financial burden per patient because many require secondary surgeries.
• Readmission Rates: U.S. data shows surgery patients who contract infections face a readmission rate of nearly 52 per 100 procedures, compared to just 8 per 100 for uninfected patients.

As global demand for surgical care continues to rise, the total expenditure linked to preventable infections will expand accordingly—making proactive infection control an operational and financial imperative.