Utah hospitals ranked as the cleanest in the nation. (Credit: S.Phoophinyo on Shutterstock)

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 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.

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.