Each year, millions of Americans enter hospitals seeking treatment, comfort, and care. Yet for nearly 800,000 patients in the United States, hospitalization brings an unexpected and potentially dangerous complication: a hospital-acquired infection (HAI).1 Recognizing the alarming prevalence of these infections, per diem healthcare staffing platform Nursa conducted an extensive analysis to uncover the state of hospital hygiene across the nation. By examining infection rates, inspection records, and patient feedback, the study identifies which states boast the cleanest hospitals—and which are struggling to maintain basic standards.
Key Findings from the Study
The study highlights several striking statistics about hospital cleanliness in the United States:
Nearly 800,000 hospital-acquired infections were reported in 2023, accounting for 2.23% of all hospitalizations nationwide.
Texas recorded the highest number of infections at 81,457 cases, ranking it 21st in hospital hygiene.
Utah emerged as the cleanest state, scoring 2.71/10 on Nursa’s Dirty Hospital Index.
Delaware ranked the dirtiest, with a score of 9.59/10.
Patient experience matters: 8.96% of U.S. hospital patients reported that their room and bathroom were “sometimes” or “never” clean.
The research draws on data from 13,323 hospital inspection reports spanning 2010 to 2025, incorporating keywords such as “biohazard,” “dirty,” “unsanitary,” “infected,” and “contaminated.” This comprehensive approach provides a rare insight into the ongoing challenges of hospital cleanliness in America.
America’s Cleanest Hospitals: Top 10 States
Nursa’s research revealed the states where patients are least likely to encounter hygiene issues. Below is a detailed look at the top 10 cleanest states based on infection rates, inspection findings, patient satisfaction, and the Dirty Hospital Index.
| Rank | State | 2023 Infections | Poor Hygiene Inspections (2010–2025) | Cleanliness Rating (/5) | % Patients Reporting “Sometimes/Never” Clean | Dirty Hospital Score (/10) |
|---|---|---|---|---|---|---|
| 1 | Utah | 6,192 | 62 | 3.79 | 6.31% | 2.71 |
| 2 | Hawaii | 2,081 | 24 | 3.54 | 6.86% | 3.48 |
| 3 | Nebraska | 5,159 | 205 | 3.89 | 5.38% | 4.51 |
| 4 | Indiana | 17,447 | 245 | 3.49 | 8.28% | 5.02 |
| 5 | Kansas | 8,243 | 372 | 3.85 | 5.72% | 5.16 |
| 6 | Wisconsin | 15,374 | 374 | 3.66 | 6.53% | 5.20 |
| 7 | New Hampshire | 3,137 | 57 | 3.50 | 7.27% | 5.33 |
| 8 | Alaska | 1,248 | 60 | 3.40 | 7.69% | 5.40 |
| 9 | Wyoming | 750 | 108 | 3.77 | 7.96% | 5.46 |
| 10 | Rhode Island | 2,656 | 27 | 3.73 | 7.82% | 5.54 |
Utah stands out as a model of hospital cleanliness. In 2023, the state reported just over 6,000 infections and received a 3.79/5 star cleanliness rating from patients. Only 6.31% of patients reported dissatisfaction with room and bathroom hygiene—the lowest in the nation.
Texas: High Infection Numbers Despite Moderate Cleanliness
While some states excel, others are struggling with high infection rates despite moderate overall hygiene scores. Texas, for example:
Ranks 21st nationwide in hospital cleanliness.
Recorded 81,457 hospital-acquired infections in 2023, the highest of any state.
Had 1,179 poor hygiene inspections from 2010 to 2025.
Received a 3.49/5 star cleanliness rating, with 8.02% of patients reporting unsanitary rooms and bathrooms.
These figures highlight that hospital hygiene is not just about the number of inspections, but also about day-to-day operational cleanliness that affects patient safety.
America’s Germiest Hospitals: Top 10 States
Conversely, Nursa’s analysis identified the states with the dirtiest hospitals, where patient experiences often reflect critical lapses in hygiene.
| Rank | State | 2023 Infections | Poor Hygiene Inspections (2010–2025) | Cleanliness Rating (/5) | % Patients Reporting “Sometimes/Never” Clean | Dirty Hospital Score (/10) |
|---|---|---|---|---|---|---|
| 1 | Delaware | 2,763 | 48 | 2.29 | 13.43% | 9.59 |
| 2 | District of Columbia | 2,253 | 33 | 2.33 | 16.14% | 9.41 |
| 3 | Alabama | 15,772 | 348 | 2.62 | 11.27% | 9.11 |
| 4 | Michigan | 23,810 | 370 | 2.72 | 10.95% | 8.54 |
| 5 | Connecticut | 8,270 | 163 | 3.23 | 9.38% | 8.41 |
| 6 | North Carolina | 25,908 | 317 | 2.96 | 10.67% | 8.39 |
| 7 | North Dakota | 1,888 | 144 | 2.00 | 8.81% | 8.27 |
| 8 | Missouri | 18,334 | 444 | 3.12 | 9.12% | 8.20 |
| 9 | Maryland | 11,278 | 107 | 2.74 | 11.30% | 8.19 |
| 10 | Arizona | 15,521 | 197 | 2.78 | 11.13% | 8.18 |
Delaware leads the list with a Dirty Hospital Score of 9.59/10, suggesting severe hygiene problems. Over 13% of patients reported that their rooms and bathrooms were “sometimes” or “never” clean, reflecting a significant gap between patient expectations and actual hospital conditions.
Patient Safety and Hygiene: A Critical Connection
Hospital-acquired infections are more than an inconvenience—they can be life-threatening. The 794,619 reported HAIs in 2023 included:
Catheter-associated urinary tract infections (CAUTIs)
Surgical site infections (SSIs)
Both types of infections are strongly linked to facility cleanliness and hygiene practices, underscoring the importance of maintaining strict standards.
Furthermore, the voluntary nature of infection reporting suggests that the actual figures may be higher, and hospitals might be underreporting incidents due to regulatory or reputational concerns.
Why Hospital Hygiene Matters
Beyond statistics, poor hospital hygiene affects patient trust, recovery times, and healthcare costs. Consider the following consequences:
Increased recovery time: Patients may require longer stays or additional treatments to manage infections.
Higher medical costs: Treating HAIs can add thousands of dollars to a patient’s bill.
Strained healthcare resources: Infections increase demand for antibiotics, isolation rooms, and nursing care.
Patient dissatisfaction: Poor hygiene ratings impact hospital reputations and patient choice.
How Nursa Evaluated Hospital Cleanliness
The Dirty Hospital Index used in this study combines multiple factors:
Number of hospital-acquired infections per state
Historical inspection data (2010–2025)
Patient-reported cleanliness ratings from the HCAHPS survey
Proportion of patients reporting rooms and bathrooms as “sometimes” or “never” clean
The score ranges from 1 to 10, with lower scores indicating cleaner hospitals. Utah achieved the best rating at 2.71/10, while Delaware recorded the worst at 9.59/10.
Looking Ahead: Improving Hospital Hygiene
Healthcare providers and state authorities can take several steps to reduce hospital-acquired infections and improve patient safety:
Regular, transparent inspections: Monitoring cleanliness standards frequently can prevent lapses.
Enhanced staff training: Cleaning protocols and infection control measures must be consistently applied.
Patient feedback integration: Hospitals should act on patient reports of unclean rooms or bathrooms.
Investment in sanitation technologies: UV disinfection, antimicrobial surfaces, and rigorous hand hygiene can reduce HAIs.
Conclusion
The Nursa study exposes a stark reality: while some states provide safe, clean environments for patients, others struggle to meet even basic hygiene standards. Utah sets a benchmark for excellence, while Delaware highlights the urgent need for improvements. Patients, caregivers, and policymakers must recognize that hospital cleanliness is not a luxury—it is a vital component of patient safety and quality healthcare.
As the healthcare system continues to evolve, monitoring hospital hygiene through inspections, surveys, and infection data remains essential. Only by addressing these gaps can hospitals ensure that patient safety is truly a top priority.
Contact for More Information:
Roxann Yus | Digital PR Executive
Email: roxann@journalistic.org
Per diem healthcare staffing platform Nursa