Which U.S. States Have The Dirtiest Hospitals? Delaware Tops 2025 Rankings

Visiting the hospital can be harrowing no matter the location, but some states rank especially high for poor facility hygiene.

Delaware sits atop of a list no state wants to lead: the dirtiest hospitals in America. The state-by-state ranking looks at three simple measures of cleanliness (reported infections, inspection write-ups, and patient feedback). According to the research, Delaware is the worst and Utah is the best when it comes to hospital hygiene. While these findings are more of a snapshot, not a final verdict, the trends are hard to ignore.

The study, conducted by researchers from healthcare staffing platform Nursa, blends three public signals: how many hospital-acquired infections (HAIs) were reported in 2023, how often federal inspection reports used words tied to dirty or hard-to-clean conditions, and how patients rated cleanliness on HCAHPS, the government’s standard patient-experience survey. HAIs matter because they can lengthen hospital stays, drive up costs, and sometimes turn life-threatening.

Nationwide, hospitals reported 794,619 infections in 2023. About 8.96% of surveyed patients said their room and bathroom were “sometimes” or “never” clean. Nursa’s review also counted 13,323 inspection reports since 2010 that used terms like “dirty” or “contaminated.”

Nursa compiled the data in September 2025 and converted each state’s numbers into a single “Dirty Hospital Index” using a relative ranking method. The result is a leaderboard meant to compare states, not to certify individual hospitals as safe or unsafe. Reporting is voluntary in several areas, so the true picture could be better (or worse) than the numbers suggest.

Delaware Hospitals Score Worst For Cleanliness

Delaware tops the “dirtiest” list with a score of 9.59 out of 10. In 2023, the state logged 2,763 hospital-acquired infections and, since 2010, 48 inspection reports using “dirty-hospital” keywords. Patients gave Delaware hospitals an average cleanliness rating of 2.29 out of 5, and 13.43% said their room and bathroom weren’t consistently clean.

The District of Columbia ranks second, with a score of 9.41, 2,253 infections, 33 flagged inspections, a 2.33 out of 5 cleanliness rating, and the nation’s highest dissatisfaction share (16.14%). Alabama is third at 9.11, tied to 15,772 infections, 348 flagged inspections, a 2.62 out of 5 cleanliness rating, and 11.27% dissatisfaction.

Utah Hospitals Rank Cleanest In America

On the other end of the list, Utah posts the lowest (cleanest) score at 2.71. Its hospitals reported 6,192 infections in 2023; patients rated cleanliness 3.79 out of 5, and 6.31% said their room and bathroom weren’t consistently clean. Hawaii follows at 3.48, with 2,081 infections and a 3.54 out of 5 rating. Nebraska is third-cleanest at 4.51, with 5,159 infections and the lowest dissatisfaction share (5.38%).

One key caveat: large states with many hospitals can show big raw infection totals without ranking near the top of the “dirtiest” list, because the index weighs multiple inputs and normalizes them. Texas, for example, recorded the most infections by count—81,457—but doesn’t lead the “dirtiest” rankings. The combined score tells the fuller story.

Below is the top-10 “dirtiest” list with the inputs Nursa used. (The cleanest list appears afterward for comparison.) Specific hospitals were not named in the dataset provided by Nursa. Just because a state has a higher score does not necessarily mean every hospital in the state should be considered dirtier.

Where To Find America’s Dirtiest Hospitals

Rank	State	HAIs (2023)	Poor-hygiene inspections (2010–2025)	Cleanliness rating (/5)	“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

Where To Find America’s Most Hygienic Hospitals

Rank	State	HAIs (2023)	Poor-hygiene inspections (2010–2025)	Cleanliness rating (/5)	“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

What These Rankings Really Mean

Think of the index as three windows into hospital hygiene: clinical results (infections), oversight language (inspections), and what patients see and smell (surveys). Each window has blind spots. Inspection counts rely on keywords like “dirty,” “odor,” or “contaminated,” which can over- or under-capture real problems. Patient surveys vary in response rates. And because some reporting is voluntary, the data can miss issues—or exaggerate them. Still, taken together, the measures point in the same direction: some states consistently perform better on cleanliness than others.

How To Choose A Clean Hospital

Use the state score as a starting point, not a verdict. Conditions can differ widely within a state. If a facility is in a “dirtier” state, ask for its latest infection-prevention data, recent inspection outcomes, and cleaning protocols. If a hospital touts strong patient ratings, look for stability: are those scores steady over time, or did they dip last quarter? The more data points line up, the more confident a patient can feel.

Full List: Dirty Hospitals Index

Rank	Abbrev.	Number of hospitals (2024)	Total infection reports per hospital	Cleanliness star rating	“Sometimes/Never” clean (%)	Score /10
1	DE	19	365	2.29	13.43	9.59
2	AL	129	292	2.62	11.27	9.11
3	MI	182	290	2.72	10.95	8.54
4	CT	52	322	3.23	9.38	8.41
5	NC	183	298	2.96	10.67	8.39
6	ND	56	263	2.00	8.81	8.27
7	MO	169	294	3.12	9.12	8.20
8	MD	72	277	2.74	11.30	8.19
9	AZ	156	293	2.78	11.13	8.18
10	WA	119	343	3.20	8.50	8.16
11	NJ	126	291	2.84	10.66	8.11
12	FL	361	331	2.99	10.40	8.11
13	NY	264	263	2.79	10.54	7.98
14	MA	128	274	2.92	9.76	7.95
15	AR	119	233	2.95	10.13	7.90
16	SC	109	273	2.65	11.93	7.90
17	MT	67	254	3.11	8.48	7.89
18	NV	68	396	3.22	9.46	7.81
19	TN	177	291	2.97	10.25	7.70
20	GA	194	357	2.99	9.82	7.68
21	IL	235	240	3.01	9.47	7.60
22	OR	70	347	3.32	8.42	7.58
23	MS	124	260	2.68	10.48	7.56
24	CO	124	329	3.59	7.32	7.26
25	ME	41	207	3.23	8.34	7.13
26	CA	514	206	3.19	9.52	6.96
27	VA	141	315	3.35	8.93	6.89
28	PA	279	281	3.42	8.86	6.82
29	TX	757	320	3.49	8.02	6.78
30	MN	151	292	3.31	7.26	6.73
31	OK	170	248	3.24	8.23	6.46
32	LA	251	198	3.35	8.10	6.45
33	ID	56	302	3.70	7.03	6.20
34	SD	70	222	3.58	7.14	6.08
35	NM	67	151	3.00	9.27	6.07
36	KY	137	226	3.12	8.73	5.99
37	OH	282	269	3.42	8.10	5.94
38	WV	73	257	3.54	7.33	5.88
39	IA	132	222	3.50	6.48	5.77
40	RI	17	281	3.73	7.82	5.65
41	VT	17	192	3.77	7.21	5.54
42	WY	35	78	3.77	7.96	5.46
43	AK	29	155	3.40	7.69	5.40
44	NH	35	242	3.50	7.27	5.33
45	WI	179	230	3.66	6.53	5.20
46	KS	165	233	3.85	5.72	5.16
47	IN	208	226	3.49	8.28	5.02
48	NE	103	233	3.89	5.38	4.51
49	HI	31	164	3.54	6.86	3.48
50	UT	69	190	3.79	6.31	2.71

Note: The District of Columbia ranks second overall in the dataset (14 hospitals; infection reports per hospital: 340; inspections per hospital: 2.36; cleanliness rating: 2.33; “Sometimes/Never” clean: 16.14%; score: 9.41) but is not a state, so it’s listed here separately on request.