Health Care–Associated Infections in U.S. Hospitals, 2023 versus 2015

Health Care–Associated Infections in U.S. Hospitals, 2023 versus 2015 Published July 15, 2026 N Engl J Med 2026;395:255-266 DOI: 10.1056/NEJMoa2510881 Abstract Background Prevalence surveys in U.S. hospitals showed that on any given day, 1 of 25 patients had a health care–associated infection in 2011, as compared with 1 of 31 patients in 2015. We repeated the survey in 2023 to assess changes in the prevalence of such infections. Methods Using established methods, 10 Emerging Infections Program (EIP) sites recruited up to 25 hospitals each. Hospitals selected a survey day between May 1 and September 30, 2023. EIP staff reviewed medical records of randomly selected patients to identify health care–associated infections using National Healthcare Safety Network definitions. We described patient and hospital characteristics, compared the prevalence of health care–associated infections in 2023 and 2015, and estimated the national burden of health care–associated infections in 2023. Results In 2023, of 13,653 patients in 218 hospitals, 355 (2.6%; 95% confidence interval [CI], 2.3 to 2.9) had at least one health care–associated infection, as compared with 394 of 12,299 patients (3.2%; 95% CI, 2.9 to 3.5) in 199 hospitals in 2015. Approximately 60% of the health care–associated infections were not associated with devices or procedures. Among 151 hospitals in both surveys, patients were less likely to have a health care–associated infection in 2023 than in 2015, after adjustment for other factors (risk ratio, 0.73; 95% CI, 0.63 to 0.85). We estimated that there were 518,000 health care–associated infections (95% CI, 494,500 to 542,000) in U.S. hospitals in 2023. Conclusions The prevalence of health care–associated infections was lower in 2023 than in 2015, with 1 of 38 patients on any given day having such an infection; however, the burden of health care–associated infections in U.S. hospitals continued to be high. A majority of the health care–associated infections that were identified were not associated with a device or procedure. (Funded by the Emerging Infections Program cooperative agreement from the Centers for Disease Control and Prevention.) Are you a member of an institution such as a university or hospital?Learn more about Institutional Access Notes The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC). Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services. Supported by the Emerging Infections Program cooperative agreement (CDC-RFA-CK17-1701) from the CDC. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org. We thank the hospital staff who participated in each phase of this prevalence survey effort, from 2009 to the present; colleagues at the Emerging Infections Program sites and the CDC who contributed to this work (see the Supplementary Appendix); and the staff of the Healthcare Cost and Utilization Project data partners (https://hcup-us.ahrq.gov/partners.jsp). Supplementary Material Information & Authors Information Published In Copyright Copyright © 2026 Massachusetts Medical Society. All rights reserved. For personal use only. Any commercial reuse of NEJM Group content requires permission. History Published online: July 15, 2026 Published in issue: July 16, 2026 Topics Authors Metrics & Citations Metrics Altmetrics Citations Export citation Select the format you want to export the citation of this publication.