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Home Eurosurveillance Monthly Release  2000: Volume 5/ Issue 4 Article 5
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Eurosurveillance, Volume 5, Issue 4, 01 April 2000
Research Articles
The socioeconomic burden of hospital acquired infection

Citation style for this article: Plowman R. The socioeconomic burden of hospital acquired infection . Euro Surveill. 2000;5(4):pii=4. Available online:

R. Plowman, London School of Hygiene and Tropical Medicine, London, United Kingdom

  Adult inpatients in common specialties who developed hospital acquired infection (HAI) remained in hospital 2.5 times longer, incurred hospital costs almost three times higher, and incurred higher general practitioner, district nurse, and hospital costs after discharge from hospital than uninfected patients, according to a study reported recently (1). The study, carried out by the Public Health Laboratory Service and London School of Hygiene and Tropical Medicine on behalf of the Department of Health in the United Kingdom (UK), also found that infected patients incurred higher personal costs and returned to normal daily activities and/or paid employment later than uninfected patients (1).

The study was based on a survey of adult, non day-case patients who were admitted to selected specialties (general surgery, general medicine, gynaecology, orthopaedics, urology, care of the elderly, ear nose and throat, and obstetrics (caesarean sections only)) of a district general hospital between April 1994 and May 1995 (1). Patients admitted to these specialties at other National Health Service (NHS) hospitals in England accounted for about 70% of all adult, non-day case, admissions in 1994/5. Complete inpatient data sets were obtained for 3980 of the 4000 patients recruited into the study. Three hundred and nine (7.8%) of these were identified as having acquired and presented with one or more infections while in hospital.

A total of 1449 patients were selected for follow up into the community, in 215 of whom an HAI had been identified during admission. Forty-one (4/215 with and 37/1234 without an HAI identified) died before the follow up questionnaires were sent and were excluded from the response rates. Seventy-one per cent of patients (150 with HAI and 855 without) returned the questionnaire after a maximum of two reminders.

Symptoms and treatment after discharge that met the study criteria for a urinary tract, chest, and/or surgical wound infection were reported by 30% of patients in whom an HAI had been identified in hospital (45/150) and 19% of patients in whom an HAI had not been identified in hospital (163/855).

The largest costs associated with HAI were for nursing care (42%) and hospital overheads, capital charges, and management (33%) but varied with the specialty and the site of infection. Patients who acquired more than one infection generated the highest costs, followed by those with bloodstream infections, ‘other’ infections, lower respiratory tract infections, skin, surgical wound, and urinary tract infections.

After discharge from hospital, patients who had an HAI identified in hospital and/or reported symptoms and treatment that met the criteria for a urinary tract, chest and/or surgical wound infection after discharge from hospital tended to have more contact with their general practitioners, district nurses, and other health care professionals than uninfected patients. They also incurred higher personal costs, and returned to normal daily activities and/or employment later.

The data derived were used to estimate the economic burden associated with HAIs in adult patients admitted to the specialties covered in the study at NHS hospitals throughout England. HAIs were estimated to cost the health sector in England almost £1 billion (about 1.6 billion Euros) a year, with patients remaining in hospital an extra 3.6 million days. Urinary tract infections, which, on average, had a low cost per case, were the most costly single site infection because of their relatively high incidence. The report also presents national estimates of the costs to general practitioners, district nurses, patients, and carers (1).

This study represents the most comprehensive attempt to date to assess the economic burden associated with these infections (1). Earlier studies had indicated the burden of these infections on the hospital sector, but had provided few data on the distribution of inpatient costs, or the costs that fall on the health sector, patients, and carers after discharge from hospital (2). HAIs are a worldwide problem. Prevalence studies in several countries have shown that at any one time between 6% and 12% of hospital inpatients acquire an infection after admission (3-15). The English study indicated the size and distribution of the burden and points for the need for cost-effective interventions to reduce infection (1).

In the UK, as in other countries, much is already being done to minimise the risk of acquiring an infection in hospital. Infection control is the responsibility of all health care professionals, including managers, and infection control standards have been developed as part of a controls assurance programme ( Each hospital in the UK has an infection control team, responsible for promoting infection prevention and control practices, and national surveillance systems are in operation. Infection prevention guidelines are being developed in England in a Department of Health funded project led by the Thames Valley University (

An effective infection control programme would benefit patients and their carers, and release considerable health care resources for alternative use. For example, the results of the study described suggest that, if the incidence of HAI observed could be reduced nationally by 10%, resources to the value of £93.1 million (about 150 million Euros) might be released. This would be equivalent - for example, to 364 056 bed days, or 47 902 finished consultant episodes. These estimates may be considered the ‘gross’ benefits of prevention. Further work is now needed to assess the cost and effectiveness of selected infection control and prevention practices and so establish the ‘net’ benefits. The results of these analyses may then be used to inform infection control practice and the overall allocation of infection control resources.


1. Plowman R, Graves N, Griffin M, Roberts JA, Swan A, Cookson B, et al. The socio-economic burden of hospital acquired infection. London: PHLS, 2000. (executive summary: Copies of the full report can be obtained from the Publications Department, Public Health Laboratory Service, 61, Colindale Avenue, London NW9 5HT. ISBN 0 901144 48 7 (£15 postage and packing)

2. Plowman R, Graves N, Roberts JA. Hospital acquired infection. London: Office of Health Economics, 1997.

3. Bernander S, Hambraeus A, Myrback KE, Nystrom B, Sundelof B. Prevalence of hospital-associated infections in five Swedish hospitals in November 1975. Scand J Infect Dis 1978; 10 : 66-70.

4. Jepsen OP, Mortensen N. Prevalence of nosocomial infections and infection control in Denmark. J Hosp Infect 1980; 1: 237-44.

5. Meers PD, Ayliffe GA, Emmeron AM, Leigh DA, Mayon-White RT, Mackintosh CA, et al. Report of the national survey of infection in hospitals 1980. J Hosp Infect 1981; 2(suppl): 1-11.

6. Hovig B, Lystad A, Opsjon H. A prevalence survey of infections among hospitalised patients in Norway. NIPH Ann 1981; 4: 49-60.

7. Moro ML, Stazi MA, Marasca D, Greco D, Zampieri A. National prevalence survey of hospital-acquired infections in Italy. J Hosp Infect 1983; 8: 72-85.

8. Mayon-White RT, Ducel G, Kereselidze T, Tikomirov E. An international survey of the prevalence of hospital-acquired infection. J Hosp Infect 1988; 11(suppl A): 43-8.

9. McLaws ML, Gold J, King K, Irwig LW, Berry G. The prevalence of nosocomial and community-acquired infections in Australian hospitals. Med J Aust 1988; 149: 582-90.

10. Sramova H, Bartonova A, Bolek S, Krecmerova M, Subertova V. National prevalence survey of hospital-acquired infections in Czechoslovakia. J Hosp Infect 1988; 11: 328-34.

11. Danchaivijitir S, Chokloikaew S. A national prevalence study on nosocomial infections. J Med Assoc Thai 1989; 72(suppl): 1-6.

12. EPINE Working Group. Prevalence of hospital-acquired infections in Spain. J Hosp Infect 1992; 20: 1-13.

13. Kam KM, Mak WP. Territory-wide survey of hospital infection in Hong Kong. J Hosp Infect 1993; 23: 143-51.

14. Sartor C, Sambuc R, Bimar MC, Gulian C, De Micco P. Prevalence surveys of nosocomial infections using a random sampling method in Marseille hospitals. J Hosp Infect 1995; 29: 209-16.

15. Emmerson AM, Enstone JE, Griffin M, Kelsey MC, Smyth ETM. Second national prevalence survey of infections in hospitals - Overview of the results. J Hosp Infect 1996; 32: 175-90.

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