Objective To study the economic burden caused by healthcare-associated infection (HAI) in patients with hemorrhagic stroke. Methods Patients with hemorrhagic stroke in a tertiary first-class hospital from January 1, 2021 to December 31, 2022 were surveyed retrospectively. Data on demographic characteristics, clinical information, and hospitalization expenses were collected. According to the occurrence of HAI, patients were divided into the HAI group and control group. The length of hospital stay, increase in hospitalization expense, and hospital economic burden of the HAI group and control group were studied by propensity score matching (PSM) method and generalized linear model method. Results A total of 688 patients were included in the study, with 266 cases experiencing HAI and a HAI incidence of 38.66%. After propensity score matching, 199 patients in the HAI group were successfully matched. Compared with the control group, the median length of hospital stay in the HAI group doubled, increasing by 16 days (Z=11.779, P < 0.001); the median hospitalization expense increased by 34 597.42 Yuan, with an increase of 85% (Z=6.299, P < 0.001). Based on the generalized linear model method, length of hospital days attributed to HAI increased by 1.24 times, hospitalization expense increased by 76% (both P < 0.001). Except surgical expenses, the HAI group had higher single medical expenses than the control group (all P < 0.05). Economic burden to hospital caused by HAI was 541 900 Yuan. Conclusion HAI significantly increases the economic burden of hemorrhagic stroke patients and hospitals, and prolongs the length of hospital stay. Clinical staff should enhance the awareness on infection control, reduce the incidence of HAI, and save medical resources.