A review of the analytical methodology used to estimate excess length of stay due to health care associated infections

Sarkis Manoukian, Sally Stewart, Agi McFarland, Jacqui Reilly, Nick Graves

Research output: Contribution to journalMeeting abstractpeer-review


Background: Accurately quantifying the additional costs of healthcare associated infections (HAIs) is essential for developing cost-effective infection prevention and control measures. A major component of the economic cost due to health care associated infections can be captured my measuring the additional length of stay (LOS) due to these infections.
Aim(s)/Objective(s): The preference for modelling LOS instead of monetary valuation of hospital cost stems from a belief that many decisions about healthcare investments are made in the short term where most financial expenditures are made for costs which are fixed. However, estimating excess LOS due to HAI is complicated due to the fact an infection increases duration of hospital stay but at the same time risk of infection increases with duration of stay. This problem of endogenous variables can potentially be addressed by using appropriate statistical methods.
Method(s): This systematic review examined papers in PubMed published between 1997 and 2016 and identified English language studies that estimated increased LOS due to HAIs.
Results: The methodological approaches used in the literature to estimate excess LOS due to HAIs include case reviews, matched comparisons and regression analyses. The choice of estimation methodologies can affect the accuracy of the resulting estimates and due to that estimates of LOS varied widely between studies reviewed. Studies examining LOS attributed to HAI varied considerably in design and data collected.
Discussion and/or Conclusion(s): This review summarises the most recent statistical methodologies and the message is that a robust application of these can address key gaps in our understanding of HAIs and their effects on healthcare.
Original languageEnglish
Pages (from-to)S124
Number of pages1
JournalJournal of Hospital Infection
Issue numberSupplement 1
Publication statusPublished - Nov 2016


  • healthcare associated infections
  • length of stay
  • additional costs
  • analytical methodology review


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