States with the dirtiest hospitals
In this DML Report…
A new report by healthcare staffing platform Nursa ranks U.S. states based on hospital cleanliness and infection rates, analyzing nearly 800,000 nationwide hospital infection reports from 2023 and about 13,000 government inspections from 2010 to 2025 that focused on hygiene keywords. The study also incorporated patient surveys from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) regarding room and bathroom cleanliness, averaging scores out of 10 where higher numbers indicate poorer conditions. Delaware ranks as the dirtiest with a score of 9.6 across 19 facilities, reporting 2,763 infections in 2023 and 48 poor hygiene inspections since 2010, resulting in an average of 365 infections per hospital; one in eight patients there reported inconsistent cleaning. Washington, D.C., follows at 9.4 with 2,253 infections across 14 facilities, 33 poor inspections, a 2.3 out of 5 star cleanliness rating, and 16 percent patient dissatisfaction. Alabama scores 9.1, Michigan 8.5, and Connecticut 8.4, while Utah ranks as the cleanest at 2.7 across 69 facilities, with 190 infections and a 3.8 out of 5 star rating. Inspections are conducted by state health departments every 18 months to three years.
Hospital-acquired infections stem from pathogens on dirty equipment and surfaces, particularly affecting patients with weakened immune systems, and include urinary tract infections from unsanitary catheters, pneumonia from ventilators, methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile, and sepsis. Nationally, about 1.7 million Americans contract such infections annually, leading to nearly 100,000 deaths, with one in 31 hospitalized patients affected. Infections increased 47 percent during the COVID-19 pandemic due to greater use of catheters and ventilators, according to a 2021 CDC analysis, but declined 11 to 15 percent in 2023 compared to 2022. Clostridium difficile alone infects 500,000 patients yearly, causing symptoms like diarrhea, abdominal pain, and fever, and resulting in about 30,000 deaths; many infections are antibiotic-resistant. The annual economic cost ranges from $28 billion to $45 billion.
(read more below)
Poor hospital hygiene poses heightened risks for vulnerable populations, especially in aging states like Delaware where one in four residents is over 60, projected to rise to one in three by 2040, exacerbating susceptibility due to age-related immune decline and conditions such as cancer, obesity, and diabetes. In contrast, Utah's cleaner hospitals correlate with a younger population (12 percent over 60) and lower rates of smoking, drinking, obesity, and diabetes. Real-world examples include 3-year-old Beauden Baumkirchner, who developed sepsis from a leg scrape, and 4-year-old Lochlin DeSantis, who contracted it from the flu, underscoring sepsis as a common hospital-acquired condition. The Nursa study emphasizes the need for improved cleanliness to mitigate these preventable risks.