A recent study has highlighted which US states have hospitals where patients might face a higher risk of contracting serious infections during their stay. This alarming finding comes from an in-depth investigation conducted by healthcare staffing platform Nursa.

In their analysis, Nursa experts meticulously reviewed nearly 800,000 reports of infections nationwide, alongside around 13,000 inspections that evaluated hospital cleanliness. These infections, often contracted in the very places meant for healing, are usually the result of contaminated equipment and surfaces, where harmful bacteria thrive. Patients with weakened immune systems are particularly vulnerable, unable to fend off these infections effectively.

The most frequently encountered hospital-acquired infections are urinary tract infections, often stemming from contaminated catheters, and pneumonia, linked to ventilators. More severe cases involve methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile, and sepsis, all of which pose significant health risks.

The study’s findings indicate that Delaware’s hospitals rank as the dirtiest in the nation, with a concerning score of 9.6 out of 10, where higher scores reflect poorer conditions. In 2023, Delaware reported nearly 2,800 hospital-related infections across only 19 facilities. Patient feedback paints a troubling picture, with local hospitals receiving just two out of five stars for cleanliness. Moreover, one in eight patients reported that their hospital room and bathroom were not consistently cleaned, further contributing to the state’s dismal ranking.

Based on infection and hygiene reports, the study found Delaware had the country’s dirtiest hospitals, scoring 9.6 out of 10, with Higher scores indicating worse ratings. 

Delaware recorded nearly 2,800 hospital-acquired infections in 2023 among just 19 facilities. Patients surveyed also gave their local hospital just two out of five stars in terms of cleanliness, and one in eight patients said their room and bathroom were not consistently cleaned. 

Washington DC followed closely behind with a score of 9.4 out of 10, with 33 government inspections on cleanliness and the nation’s highest rate of dissatisfaction at 16 percent, while Alabama rounded out the top three worst states at 9.1 out of 10. 

Utah, meanwhile, turned out to have the nation’s cleanest hospitals, scoring 2.7 out of 10 on the dirtiness scale across 69 facilities. 

A new study has ranked each state in terms of how dirty their hospitals are and how many infections patients get during their stay (stock image)

The findings come as about 1.7million Americans suffer a hospital-acquired infection every year, which result in almost 100,000 deaths.  About one in every 31 hospitalized patients are thought to contract one at any given time. 

These infections also rose sharply during the Covid pandemic by up to 47 percent, a CDC analysis published in 2021 found. Experts believe this was because patients with Covid more frequently needed equipment like catheters and ventilators, prime sources of lingering pathogens.

It wasn’t until 2023 that hospital-acquired infections appeared to dip with an 11 to 15 percent decline compared to the year before.

However, a recent report from the University of Utah found rates of the hospital bacteria infection Clostridium difficile, also known as C. diff, is spreading in US hospitals three times faster than experts previously thought. 

C. diff infects around 500,000 patients every year in the US, triggering symptoms including diarrhea, abdominal pain and fever. Of these, about 30,000 die from the infection. 

Many hospital-acquired infections are also resistant to common antibiotics, making them harder to treat.   

And these infections cost the US between $28billion and $45billion every year.

The new Nursa study looked at nationwide infection totals reported by hospitals in 2023 along with inspection reports from 2010 through 2025 that featured keywords related to cleanliness. 

Hospitals often undergo inspections by government agencies like state health departments to look for cleanliness every 18 months to three years, depending on the state. 

Patient answers were taken from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), a national survey that collects data on how patients feel about their hospital care. 

The team took the number of infection reports, cleanliness score and percentage of answers saying the hospitals were ‘sometimes or never’ clean and combined them into an average score out of 10, with higher scores signaling a state with dirtier hospitals. 

There was no data on how many deaths resulted from these infections.

Among 19 hospitals in Delaware, each one had an average of 365 infection reports in 2023. In total, the state recorded 2,763 hospital-acquired infections in 2023 and 48 cleanliness inspection reports since 2010 that used keywords related to ‘dirty hospital.’ 

In Washington DC, which had the second-dirtiest hospitals, there were 2,253 hospital infections among 14 facilities, 33 poor hygiene inspections, and the overall cleanliness rating was 2.3 out of five stars. 

Beauden Baumkirchner (left) became septic from scraping his leg. Lochlin DeSantis became septic after contracting the flu. Sepsis is a condition that can be acquired in hospitals

Delaware had the dirtiest hospitals in America in the new study, with one in eight patients saying their rooms were not consistently cleaned. Wilmington, Delaware, is pictured above (stock image)

The District also had the highest rate of patient dissatisfaction, with 16 percent of patients claiming their rooms and bathrooms were only sometimes or never cleaned. The overall score was 9.4 out of 10. 

Alabama, Michigan and Connecticut rounded out the top five with scores of 9.1, 8.5 and 8.4 out of 10, respectively. 

On the other end of the spectrum, Utah scored 2.7 out of 10 and had only 190 infection reports among 69 hospitals. Patients on average gave the cleanliness 3.8 out of five stars.

It’s unclear exactly why hospitals in Delaware differed so strongly from those in Utah in terms of cleanliness, but there are potential factors that may have increased infection risk. 

Delaware has a rapidly aging population, with about one in four residents over 60 and that figure IS expected to grow to one in three by 2040. 

The immune system naturally weakens with age and risks of conditions like cancer, obesity and diabetes increase, all of which leave older people at greater risk of infection. 

Utah, meanwhile, has the smallest portion of residents over 60 at 12 percent and has lower rates of behaviors, like smoking and drinking, that are linked to obesity and diabetes, which also suppress the immune system.