The emerging infectious challenge of clostridium difficile-associated disease in Massachusetts hospitals: clinical and economic consequences.

OBJECTIVE: To estimate the clinical and economic burden of Clostridium difficile-associated disease (CDAD) in Massachusetts over 2 years. DESIGN: A retrospective analysis of Massachusetts hospital discharge data from 1999-2003 was conducted. Cases of CDAD in 2000 were identified using code 008.45 from the International Classification of Diseases, Ninth Revision, Clinical Modification; patients were excluded if they had a hospitalization in the prior year during which a diagnosis of CDAD was recorded. Hospitalizations for CDAD during 2001 and 2002 were examined. For primary case patients (ie, those for which CDAD was the principal diagnosis), all inpatient costs were deemed to be related, whereas for secondary case patients, all-patient refined diagnosis-related group assignment, case severity level, and length of stay (LOS) were used to calculate incremental costs attributable to CDAD. Costs were adjusted to the national level and reported in 2005 US dollars. RESULTS: The CDAD cohort consisted of 3,692 patients; 59% were women, and the mean age was 70 years. This group represented 1% of all patients hospitalized in Massachusetts in 2000 (96% of hospitals treated at least 1 case; range, 1-257 cases). Of patients who received a first hospital diagnosis of CDAD in 2000, a total of 28% were primary case patients; their mean LOS was 6.4 days, and the mean cost per stay was $10,212. For secondary case patients, the mean CDAD-related incremental LOS was 2.95 days, and the mean incremental cost per stay was $13,675 per patient. Of patients with CDAD who survived their index stay in 2000, a total of 455 (14%) had at least 1 readmission for CDAD within the subsequent 2 years (mean number of readmissions, 1.4 per patient; range, 1-7 readmissions), with a mean time to first readmission of 3 months. Over 2 years, a total of 55,380 inpatient-days and $51.2 million were consumed by CDAD management. CONCLUSION: CDAD is widespread in Massachusetts hospitals. Rehospitalization with CDAD, if it occurs, generally happens within a few months and happens multiple times for some patients. Based on this study's findings, a conservative estimate of the annual US cost for CDAD management is $3.2 billion dollars.     

Hospital-acquired, laboratory-confirmed bloodstream infection: increased hospital stay and direct costs.

OBJECTIVES: To determine increased hospital stay and direct costs attributable to hospital-acquired, laboratory-confirmed bloodstream infection (BSI), and to evaluate the matching variable length of stay (LOS). DESIGN: Retrospective (historical) cohort study with 1:2 matching in intensive care units and surgical wards. SETTING: A 2,000-bed university hospital in Rome, Italy. PATIENTS: All patients admitted between January 1994 and June 1995 who had hospital-acquired, laboratory-confirmed BSI were considered cases; all others were eligible as controls. METHODS: Two controls (A and B) were selected per case in a stepwise fashion. Controls in group A were selected according to the following six criteria: ward, gender, age, diagnosis, central venous catheter, and LOS equal to the interval from admission to infection in a matched case +/- 20% (LOS +/- 20%). Controls in group B were selected according to the first five criteria, but excluded LOS +/- 20%. RESULTS: One hundred five of 108 patients were each matched with two controls. The matching appropriateness score was greater than 90%. With the use of controls in groups A and B, the case-fatality rates attributable to hospital-acquired, laboratory-confirmed BSI were 35.2% and 40.9%, respectively; the estimated risk ratios for death were 2.60 and 3.52 (P = .0001), respectively. The increased hospital stay per case attributable to hospital-acquired, laboratory-confirmed BSI was 19.1 (mean) and 13.0 (median) days for matched pairs in control group A and 19.9 (mean) and 15.0 (median) days for matched pairs in control group B. With controls in group A, the cost of increased hospital stay per patient attributable to hospital-acquired, laboratory-confirmed BSI was Euro 15,413. The additional cost per patient due to treatment was Euro 943, making the overall direct cost Euro 16,356 per case. CONCLUSIONS: This study should make it possible to estimate the cost of hospital-acquired, laboratory-confirmed BSI in most hospitals after adjusting for incidence rate. It also confirmed the use of LOS +/- 20% as a matching variable to limit overestimation of increased hospital stay. To our knowledge, this is among the first such studies in Europe.     

The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost.

OBJECTIVE: To measure the impact of orthopedic surgical-site infections (SSIs) on quality of life, length of hospitalization, and cost. DESIGN: A pairwise-matched (1:1) case-control study within a cohort. SETTING: A tertiary-care university medical center and a community hospital. PATIENTS: Cases of orthopedic SSIs were prospectively identified by infection control professionals. Matched controls were selected from the entire cohort of patients undergoing orthopedic surgery who did not have an SSI. Matching variables included type of surgical procedure, National Nosocomial Infections Surveillance risk index, age, date of surgery, and surgeon. MAIN OUTCOME MEASURES: Quality of life, duration of postoperative hospital stay, frequency of hospital readmission, overall direct medical costs, and mortality rate. RESULTS: Fifty-nine SSIs were identified. Each orthopedic SSI accounted for a median of 1 extra day of stay during the initial hospitalization (P = .001) and a median of 14 extra days of hospitalization during the follow-up period (P = .0001). Patients with SSI required more rehospitalizations (median, 2 vs 1; P = .0001) and more total surgical procedures (median, 2 vs 1; P = .0001). The median total direct cost of hospitalizations per infected patient was $24,344, compared with $6,636 per uninfected patient (P = .0001). Mortality rates were similar for cases and controls. Quality of life was adversely affected for patients with SSI. The largest decrements in scores on the Medical Outcome Study Short Form 36 questionnaire were seen in the physical functioning and role-physical domains. CONCLUSIONS: Orthopedic SSIs prolong total hospital stays by a median of 2 weeks per patient, approximately double rehospitalization rates, and increase healthcare costs by more than 300%. Moreover, patients with orthopedic SSIs have substantially greater physical limitations and significant reductions in their health-related quality of life.     

Impact of an outbreak of norovirus infection on hospital resources.

OBJECTIVE: To describe a nosocomial norovirus outbreak, its management, and its financial impact on hospital resources. DESIGN: A matched case-control study and microbiological investigation. METHODS: We compared 16 patients with norovirus infection with control-patients matched by age, gender, disease category, and length of stay. Bed occupancy-days during the peak incidence period of the outbreak were compared with the corresponding periods in 2001 and 2002. Expenses due to increased workload were calculated based on a measuring system that records time spent for nursing care per patient per day. RESULTS: The attack rates were 13.9% among patients and 29.5% among healthcare workers. The median number of occupied beds was significantly lower due to bed closure during the peak incidence in 2003 (29) compared with the median number of occupied beds in 2001 and 2002 combined (42.5). Based on this difference and a daily charge of 562.50 dollars per patient, we calculated a revenue loss of 37,968 dollars. Additional expenses totaled 10,300 dollars for increased nursing care. Extra costs for microbiological diagnosis totaled 2707 dollars. Lost productivity costs due to healthcare workers on sick leave totaled 12,807 dollars. The expenses for work by the infection control team totaled 1408 dollars. The financial impact of this outbreak on hospital resources comprising loss of revenue and extra costs for microbiological diagnosis but without lost productivity costs, increased nursing care, and expenses for the infection control team totaled 40,675 dollars. CONCLUSIONS: Nosocomial norovirus outbreaks result in significant loss of revenue and increased use of resources. Bed closures had a greater impact on hospital resources than increased need for nursing care     

Nosocomial blood-stream infection in patients with end-stage renal disease: excess length of hospital stay, extra cost and attributable mortality

Patients with end-stage renal disease undergoing haemodialysis are at high risk of nosocomial blood-stream infection (BSI), but data on the associated costs in this patient population are not available. Therefore, we conducted a retrospective matched (1:2) case-control study of such patients undergoing haemodialysis from January 1998 to December 1998 in a medical centre in southern Taiwan to determine the excess length of hospital stay, attributable mortality, and the extra cost caused by nosocomial BSI. The excess length of hospital stay was 30 days for cases vs. 16 days for controls (P<0.001), the mortality rate was 26.3% for cases vs. 0 for controls (P=0.003) (attributable mortality being 26.3%), and the median of overall costs was 131,584 dollars NT for cases vs. 65,282 dollars NT for controls (P<0.001). Based on these findings, we believe that an effective programme to minimize nosocomial BSI in this patient population would greatly reduce their medical and economic burdens.     

Costs of nosocomial pneumonia caused by meticillin-resistant Staphylococcus aureus

Nosocomial infections with meticillin-resistant Staphylococcus aureus (MRSA) lead to increased health and economic costs. The purpose of this study was to determine costs for?nosocomial MRSA pneumonia compared with meticillin-susceptible S. aureus (MSSA) pneumonia. A case-control study was conducted with patients who acquired nosocomial pneumonia?with either MRSA or MSSA between January 2005 and December 2007. Patients were matched for age, severity of underlying disease, stay on intensive care units and non-intensive care units, admission and discharge within the same year, and in-hospital stay at least as long as that of cases before MRSA pneumonia. Our analysis includes 82 patients (41 cases, 41 controls). The overall costs for patients with nosocomial MRSA pneumonia were significantly higher than for patients with MSSA pneumonia (?0,684 vs ?8,731; P=0.01). The attributable costs for MRSA pneumonia per patient were ?7,282 (P<0.001). The financial loss was higher for patients with MRSA pneumonia than for patients with MSSA pneumonia (?1,704 vs ?,662; P=0.002). More cases died than controls while in the hospital (13 vs 1 death, P<0.001). Hospital personnel should be aware of the attributable costs of MRSA pneumonia, and should implement control measures to prevent MRSA transmission.     

Cost of intensive care unit-acquired bloodstream infections

Intensive care unit-acquired (ICU-acquired) bloodstream infections (BSI) are an important complication of critical illness. The objective of this study was to quantify the excess length of stay, mortality and cost attributable to ICU-acquired BSI. A matched cohort study was conducted in all adult ICUs in the Calgary Health Region between 1 May 2000 and 30 April 2003. One hundred and forty-four patients with ICU-acquired BSI were matched (1:1) to patients without ICU-acquired BSI. Patients with ICU-acquired BSI had a significantly increased median length of ICU stay {15.5 [interquartile range (IQR) 8-26] days vs 12 [IQR 7-18.5] days, P=0.003} and median costs of hospital care [85,137 dollars (IQR 45,740-131,412 dollars) vs 67,879 dollars (IQR 35,043-115,915 dollars, P=0.02) compared with patients without ICU-acquired BSI. The median excess length of ICU stay was two days and the median cost attributable to ICU-acquired BSI was 12,321 dollars per case. Sixty (42%) of the cases died compared with 37 (26%) of the controls [P=0.002, attributable mortality 16%, 95% confidence interval (CI) 5.9-26.0%]. Patients with ICU-acquired BSI were at increased risk for in-hospital death (odds ratio=2.64, 95%CI 1.40-5.29). Among survivor-matched pairs, the median excess lengths of ICU and hospital stay attributable to development of ICU-acquired BSI were two and 13.5 days, respectively, and the attributable cost due to ICU-acquired BSI was 25,155 dollars per case survivor. Critically ill patients who develop ICU-acquired BSI suffer excess morbidity and mortality, and incur significantly increased healthcare costs. These data support expenditures on infection prevention and control programmes and further research into reducing the impact of these infections.     

Hospital economic impact of an outbreak of Pseudomonas aeruginosa infections

A total of 67 patients involved in an outbreak of Pseudomonas aeruginosa in the intensive care unit (ICU) were retrospectively followed to determine whether case patients experienced differences in cost, length of stay and survival rates when compared with non-affected patients. The method of microcosting, a technique that involves detailed identification and measurement of all care items and services offered by the hospital, was used to identify attributable costs related to diagnostic procedures, pharmacy and ICU stay of each patient. Seventeen patients developed nosocomial P. aeruginosa infection. On average, these patients incurred adjusted hospital costs of euro 27,917, 66% higher than non-case patients (P=0.002). The extra length of ICU stay attributable to P. aeruginosa infection was 70 days (P=0.0001). In multiple linear regression analysis, we found that P. aeruginosa infection was an independent predictor of increased hospital costs and length of hospital stay. On the basis of these findings, a conservative estimate of the extra cost attributable to P. aeruginosa infection in our ICU was euro 312,936 (95% confidence interval: 305,676-320,196).     

Hospital reimbursement patterns among patients with surgical wound infections following open heart surgery

Of the more than 200,000 patients who undergo open heart surgery annually in the United States, 2% to 10% will develop a post-operative infection related to their surgery. The economic impact of such infections on hospitals under the prospective payment system is unclear. To study the effect of such infections on hospital costs and reimbursement patterns, we compared case patients with controls of similar age, sex, urgency of surgery and type of surgery. The postoperative stay for cases was significantly longer than for matched controls (26.8 days and 8.3 days, respectively; p = .0002). The mean hospital cost for case admissions ($25,957) was twice as high as for control admissions ($12,795) (p = .0002). Cases resulted in an average net loss to the hospital of $2,344 per patient, while controls yielded an average net gain of $3,196 per patient (p = .02). We conclude that hospitals have substantial financial incentives to minimize the incidence of postoperative wound infections associated with open heart surgery.     

Impact of nosocomial infection on cost of illness and length of stay in intensive care units.

OBJECTIVE: Economic evaluation has become increasingly important in healthcare and infection control. This study evaluated the impact of nosocomial infections on cost of illness and length of stay (LOS) in intensive care units (ICUs). DESIGN: A retrospective cohort study. SETTING: Medical, surgical, and mixed medical and surgical ICUs in a tertiary-care referral medical center. PATIENTS: Patients admitted to adult ICUs between October 2001 and June 2002 were eligible for the study. METHODS: Estimates of the cost and LOS for patients who acquired a nosocomial infection were computed using a stratified analysis and regression approach. RESULTS: During the study period, 778 patients were admitted to the ICUs. Total costs for patients with and without nosocomial infections (median cost, 10,354 dollars and 3985 dollars, respectively) were significantly different (P < .05). The costs stratified by infection site (median differences from 4687 dollars to 7365 dollars) and primary diagnosis (median differences from 5585 dollars to 16,507 dollars) were also significantly different (P < .05) except for surgical-site infection. After covariates were adjusted for in the multiple linear regression, nosocomial infection increased the total costs by 3306 dollars per patient and increased the LOS by 18.2 days per patient (P < .001). Each additional day spent in the ICU increased the cost per patient by 353 dollars (P < .001). CONCLUSIONS: Nosocomial infections are associated with increased cost of illness and LOS. Prevention of nosocomial infections should reduce direct costs and decrease the LOS.     

Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs?

OBJECTIVE: To determine the attributable hospital stay and costs for nosocomial methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA) primary bloodstream infections (BSIs). DESIGN: Pairwise-matched (1:1) nested case-control study. SETTING: University-based tertiary-care medical center. PATIENTS: Patients admitted between December 1993 and March 1995 were eligible. Cases were defined as patients with a primary nosocomial S. aureus BSI; controls were selected according to a priori matching criteria. MEASUREMENTS: Length of hospital stay and total and variable direct costs of hospitalization. RESULTS: The median hospital stay attributable to primary nosocomial MSSA BSI was 4 days, compared with 12 days for MRSA (P=.023). Attributable median total cost for MSSA primary nosocomial BSIs was $9,661 versus $27,083 for MRSA nosocomial infections (P=.043). CONCLUSION: Nosocomial primary BSI due to S. aureus significantly prolongs the hospital stay. Primary nosocomial BSIs due to MRSA result in an approximate threefold increase in direct cost, compared with those due to MSSA.     

不同病原体术后院感的直接经济损失分析

目的 分析不同病原体的医院感染对术后患者住院费用、住院天数的影响,为优化院感防控措施提供依据。方法回顾性收集2019年住院手术患者35 223例,分为术后院感组和无院感组。采用1∶10病例对照比进行倾向性评分匹配,联合广义线性回归模型估计额外住院费用均值（即边际费用）,分析因不同病原体术后院感的直接经济损失差异。结果术后院感组336例与无院感组3 295例匹配成功。倾向性评分匹配示,术后院感组较无院感组住院费用中位数增加43 455.77元、住院天数中位数延长13 d（均P<0.001）;用广义线性回归模型进一步分析归因于不同病原体感染的直接经济损失差异发现,铜绿假单胞菌术后感染导致的住院费用增加倍数最高,其额外住院费用均值为162 631.55 (95%CI:80 431.95～244 831.15)元,是无院感组的4.80 (95%CI:3.28～7.37)倍;住院天数增加倍数排第3,是无院感组的2.69(95%CI:2.19～3.35)倍。结论 不同病原体导致的术后医院感染中,铜绿假单胞菌对患者直接经济损失影响最为显著,建议明确铜绿假单胞菌感染控制的优先干预环节,采取相应防...     

Deep wound infection after proximal femoral fracture: consequences and costs

The purpose of this study was to assess the impact of deep wound infection after surgery for proximal femoral fracture (PFF) on the patient in terms of mortality and social consequences, and on the National Health Service in terms of financial burden. Sixty-one cases of PFF over a six-year period were complicated with deep surgical wound infection. These cases were compared with a matched control group of 122 patients without infection. Infected cases had greatly increased hospital stay (P<0.001), were 4.5 times less likely to survive to discharge (P=0.002), and if they survived, were three times less likely to return to their original residence (P=0.05). The total cost of treatment per infected case was 24,410 pound sterling compared with 7210 pound sterling for controls (P<0.001). Meticillin-resistant Staphylococcus aureus (MRSA) infection increased admission length and cost compared with non-MRSA infection (P=0.02). Deep wound infection after PFF is a devastating and costly complication for both the patient and the healthcare services. The cost consequences should be considered when allocating resources to trauma services to ensure adequate provision to minimize infection risks and to accommodate treatment costs in this vulnerable group.     

Nosocomial infection in surgery wards: A controlled study of increased duration of hospital stays and direct cost of hospitalization

Excess length of hospital stays and associated costs were assessed in patients hospitalized in the department of general and digestive surgery who acquired nosocomial infections. A prospective study of matched infected-uninfected patients nested in a cohort was used to estimate the length of the hospital stay of infected patients. Matched controls were obtained with respect to patient exact primary diagnosis, operative procedure and classification, age and, if possible, underlying disease, elective or emergency procedure and invasive devices. Superficial surgical wound infection prolonged the average hospital stay of the nosocomially infected patient by an average of 12.6 days, wound infection (deep and superficial) by 14.3 days and infections other than wound infection by 7.3 days as compared to the uninfected matched controls.     

Costs of nosocomial infection in a neonatal unit

Hospital costs for 61 neonates with acquired nosocomial infection were compared with 61 matched, uninfected controls. The increase in length of hospital stay (+23 per cent) added to the number of laboratory tests increase total hospitalization costs to 32 per cent. An additional US $1250 for each case of infection is the cost to the Social Security system. The importance of this increase, contrasted with the generally benign nature of the infections studied, justifies the maintenance of high standards of quality in neonatal care.     

Costs associated with hospital-acquired bacteraemia in a Belgian hospital

Studies from around the world have shown that hospital-acquired infections increase the costs of medical care due to prolongation of hospital stay, and increased morbidity and mortality. The aim of this study was to determine the extra costs associated with hospital-acquired bacteraemias in a Belgian hospital in 2001 using administrative databases and, in particular, coded discharge data. The incidence was 6.6 per 10000 patient days. Patients with a hospital-acquired bacteraemia experienced a significantly longer stay (average 21.1 days, P<0.001), a significantly higher mortality (average 32.2%, P<0.01), and cost significantly more (average 12853 euro, P<0.001) than similar patients without bacteraemia. At present, the Belgian healthcare system covers most extra costs; however, in the future, these outcomes of hospital-acquired bacteraemia will not be funded and prevention will be a major concern for hospital management.     

Impact of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species on clinical outcomes and hospital costs: a matched cohort study.

OBJECTIVES: To evaluate the economic and clinical impact of infection with extended-spectrum beta -lactamase (ESBL)-producing Escherichia coli and Klebsiella species (ESBL-EK). DESIGN: A matched-cohort analysis of the cost of illness. SETTING: An 810-bed, urban, community hospital in Hartford, Connecticut. PATIENTS: Twenty-one case patients infected with ESBL-EK at a site other than the urinary tract were matched with 21 control subjects infected with a non-ESBL-producing organism on the basis of pathogen species, age, anatomic site of infection, hospitalization in the intensive care unit (ICU) during the time of infection, date of hospitalization, and initial antibiotics received. RESULTS: Mean infection-related costs per patient were significantly greater for case patients than for control patients ($41,353 vs $24,902; P=.034). Infection-related length of stay was the main driver of cost, which was prolonged for case patients, compared with control patients (21 vs 11 days; mean difference, 9.7 days [95% confidence interval {CI}, 3.2-14.6 days]; P=.006). The additional cost attributed to the presence of an ESBL-EK infection was $16,450 per patient (95% CI, $965-$31,937). Case patients were more likely than control patients to have clinical failure (P=.027), and the rate of treatment success for case patients whose initial treatment involved antibiotics other than carbapenems was lower than that for their matched control patients (39% vs 83%; P=.013). Treatment was successful in patients for whom initial treatment was with a carbapenem, regardless of the ESBL status of the pathogen. CONCLUSION: The cost of non-urinary tract infections caused by ESBL-EK was 1.7 times the cost of non-urinary tract infections caused by non-ESBL producers. Prompt recognition and appropriate antimicrobial selection may minimize this ESBL-related impact on hospital costs.     

Economic evaluation and survival analysis of immunoglobulin adsorption in patients with idiopathic dilated cardiomyopathy

Idiopathic dilated cardiomyopathy (DCM) is a life-threatening heart disease and a major reason for heart transplantations. The medical efficacy of immunoadsorption (IA) for DCM patients has been demonstrated in initial clinical studies. This prospective matched-case control study examined 5-year survival rates, direct medical costs, and cost-effectiveness in Germany (n=34) from a health-care system perspective. In a cost-effectiveness analysis costs per life year gained were calculated. Patients treated with IA showed a greater survival rate: 5-year survival rate in the intervention group was 82% vs. 41% in controls. Log rank statistics after Kaplan-Meier analysis of cumulated survival probability were highly significant. Initial intervention costs for IA were found to be 28,400 euro per patient treated. Direct medical costs for a 5-year follow-up were 128,600 euro per patient treated with IA and 75,500 euro in controls. Considering only the actual survival time we calculated annual treatment costs of 24,900 euro in the IA group and 28,900 euro in controls. The cost-effectiveness ratio expressed in costs per life year gained was 34,400 euro. This is the first controlled study to perform 5-year survival analysis and economic evaluation of this new emerging technology for patients with DCM. Although high initial treatment costs for IA are incurred, the significantly better survival rates lead to reasonable costs per live year gained.     

Outcomes of nosocomial bloodstream infections in adult neutropenic patients: a prospective cohort and matched case-control study.

OBJECTIVE: To examine the clinical and epidemiologic features, excess length of stay, extra costs, and mortality attributable to bloodstream infection (BSI) in neutropenic patients with hematologic malignancies. DESIGN: Prospective cohort and matched case-control study. PATIENTS: All adult neutropenic patients with hematologic malignancies admitted to Cologne University Hospital between May 1, 1997, and April 30, 1998, were prospectively observed. Case-patients were defined as patients with nosocomial BSI; control-patients were selected among patients without BSI. RESULTS: During the study period, the BSI rate in neutropenic patients was 14.3 per 100 neutropenic episodes. Eighty-four case-patients were included. Matching was successful for 96% of the cohort; 81 matched pairs were studied. The mean total length of stay was significantly longer for patients with BSI than for control-patients (37 vs 29 days; P = .002). Extra costs attributable to the infection averaged 3,200 dollars (U.S.) per patient. The crude mortality rates of case-patients and control-patients were 16% and 4%, respectively (P = .013), with an attributable mortality of 12% (odds ratio, 11). Eighty-seven percent of patients met the criteria for sepsis according to the American College of Chest Physicians/Society of Critical Care Medicine. Severe sepsis or septic shock occurred in 13% of patients and was correlated with mortality (55% vs 10% in patients without severe sepsis or septic shock; P = .01). CONCLUSIONS: Nosocomial BSI in neutropenic patients is significantly associated with an excess length of hospital stay, extra costs, and excess mortality. Severe sepsis and septic shock are closely correlated with an adverse outcome.     

Cost of nosocomial infection in Turkey: an estimate based on the university hospital data.

Nosocomial infections significantly affect the resource needs of hospitalized patients. They increase the mortality and morbidity of affected individuals and expose hospital staff to increased risk of infection. To estimate the additional resources needed in the hospital sector to deal with such infections, a sample of infection cases was selected from the Hacettepe University Hospital in Ankara, Turkey. Each case of nosocomial infection was matched with a noninfected case after controlling for age, sex, clinical diagnosis etc. of the patients. The empirical results indicate that hospital infection increases the average hospital stay by about four days. Total cost of an infected case, on average, was found to be $442 higher than that for a matched noninfected case. Using this incremental cost estimate, projections for Turkey implies that the hospital sector had to spend an additional $48 million in 1995 for medical management of nosocomial infections. The benefit: cost ratio for a hospital-based infection control programme is found to be about 4.6. Clearly, a programme for preventing nosocomial infections will not only pay for itself but also will generate other direct and indirect benefits to patients and society as a whole.