Nine-point-eight billion dollars. Billion, with a B. That’s what the US healthcare system spends each year as a result of commonly acquired bloodstream and respiratory infections contracted by patients at hospitals and other medical facilities, according to a study by researchers from Brigham and Women’s Hospital and Harvard Medical School.1

Among the chief offenders for healthcare-associated infections (HAIs) are ventilator-associated pneumonia (VAP) and surgical site infections, which contribute to nearly two-thirds of the $9.8B total. The research, which was published online in the September installment of JAMA Internal Medicine, estimates the per-case and overall costs of five major HAIs, a combination of their direct attributable costs and length of hospital stay.

Overall, the infections stack up as follows1:

  • Surgical site infections (33.7% of the total $9.8B cost)
  • Ventilator-associated pneumonia (31.6%)
  • Central line–associated bloodstream infections (18.9%)
  • Clostridium difficile infections (15.4%)
  • Catheter-associated urinary tract infections (<1%)

However, on a per-case basis, the study found that central line–associated bloodstream infections were the most costly HAI, averaging $45,814 per patient. VAP was a close second at $40,144 per patient, followed by surgical site infections ($20,785), C. difficile infections ($11,285), and catheter-associated urinary tract infections ($896).1

While the number is staggering, the CDC issued a report in 2009 that calculates the true cost of HAIs to be 3 to 4 times this $9.8B figure. With an estimated 1,737,125 healthcare-associated infections annually, the CDC report calculates the annual direct, indirect, and intangible costs associated with HAIs to range from $28.4 to $33.8 billion (based on the Consumer Price Index for all urban consumers: CPI-U).2 But when calculating based on the CPI for inpatient hospital services, the range jumps to $35.7 to $45 billion annually.2

As respiratory care professionals, you no doubt have encountered ventilator-associated pneumonia, as 52,543 cases of VAP occur annually, according to the same CDC estimates.2 Although VAP may not be the most frequent HAI, it is the most deadly, with an average of 35,947 attributable deaths per year.3

With an aging population and expanding number of chronic respiratory cases, the solution, at least for VAP, is multitiered: develop healthcare strategies to limit number of patients ventilated and to limit the amount of time spent on a ventilator; create more comprehensive hospital-wide sanitation protocols; continue to develop safer intubation products; and create viable treatment alternatives to ventilation.

Because as the JAMA study concluded: “While [certain] quality improvement initiatives have decreased HAI incidence and costs, much more remains to be done.” Considering the fact that the number of HAIs in the United States has increased by 36% in the past 20 years4 and the fact they are costing us an estimated $18,645 every minute, I agree. Much more. RT

Mike Fratantoro is the managing editor for RT Magazine. For more information, contact [email protected]


  1. Zimlichman E, Henderson D, Tamir O, et al. Health Care–Associated Infections: A Meta-analysis of Costs and Financial Impact on the US Health Care System. JAMA Intern Med. 2013. Retrieved from:
  2. Scott, R.D. The Direct Medical Costs of Healthcare Associated Infections in U.S. hospitals and the Benefits of prevention. U.S. Centers for Disease Control. March 2009. Retrieved from:

  3. Stone, P. Economic burden of healthcare-associated infections: an American perspective. Expert Rev Pharmacoecon Outcomes Res. 2009 October; 9(5): 417–422. Retrieved from!po=4.54545.
  4. Institute of Medicine. To Err is Human: Building a Safer Health System. DC, USA: National Academy Press; 2000.