Objective To systematically evaluate the incidences and risk factors of healthcare-associated infection (HAI) in adult patients during extracorporeal membrane oxygenation (ECMO) treatment, and provide evidence-based reference for healthcare workers (HCWs) to early identify HAI and formulate preventive measures. Methods Literatures related to the incidences and risk factors of HAI in adult patients during ECMO treatment period were retrieved from Wanfang, China Biomedicine (CBM), China National Knowledge Infrastructure (CNKI), VIP Database, Cochrane Library, Web of Science, PubMed, and Embase. The search time was from the establishment of the databases to February 1, 2025. Stata 12.0 software was used for analysis. Results 28 literatures were included in this study, and a total of 24 690 patients receiving ECMO treatment were monitored, out of which 3 244 had HAI. Meta-analysis showed that the incidence of HAI in adult patients during ECMO treatment period was 31.0%. Subgroup analysis showed that in the studies that the survey time was 2020 and later, the main type of infection was lower respiratory tract infection, and the main infection flora was Pseudomonas aeruginosa, the incidences of HAI in patients were higher (36.5%, 41.4%, 40.6%, respectively). The risk factors for HAI in adult patients during ECMO treatment period included tracheal intubation or tracheotomy (OR=7.838), combined continuous renal replacement therapy (CRRT, OR=1.578), veno-venous ECMO (V-V ECMO) treatment mode (OR=2.022), duration of ECMO treatment ≥72 hours (OR=1.022), duration of mechanical ventilation ≥9 days (OR=1.051), body mass index (BMI) ≥24 kg/m² (SMD=0.154), age ≥45 years old (OR=1.043), high score of sequential organ failure score (OR=1.058), infection on admission (OR=3.035), combined history of diabetes mellitus (OR=2. 242), and history of staying in intensive care unit(ICU) (OR=2.324). Conclusion There are multiple risk factors for HAI in adult patients during ECMO treatment period, and the incidence is high. HCWs should pay more attention to HAI, accurately identify high-risk populations and risk factors, and formulate comprehensive, detailed, and personalized intervention measures through multidisciplinary collaboration, so as to prevent HAI during treatment period.