Health Care–Associated Infections in U.S. Hospitals, 2023 versus 2015
Nora Chea, Rongxia Li, Taniece Eure, et al
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.)
