Objective To understand the current situation of healthcare-associated infection (HAI) management in old-age care institutions in Changsha. Methods On-site and written survey were adopted to investigate current situa-tion of HAI prevention and control in old-age care institutions in Changsha, questionnaire on HAI management in old-age care institutions was filled in, knowledge about HAI among health care workers (HCWs) was evaluated and relevant data were analyzed. Results A total of 40 old-age care institutions were surveyed, 148 HCWs filled in the questionnaire. Only 3 of 40 old-age care institutions (7.5%) had independent HAI management departments and full-time HAI management personnel. There was a significant difference in the scores of HAI management system in different scales of old-age care institutions (F=12.058, P<0.001). The higher scores in the scoring system of HAI were:safe injection system (5.08±0.66), aseptic operation system (4.35±0.48), occupational exposure and protection system (3.38±0.77). Except for aseptic operation system and infection reporting system, there were significant differences in scoring of implementation of other core systems in different scale of old-age care institutions (all P< 0.05). The total qualified rate of knowledge assessment of HAI among HCWs was 62.2%, and the total score was (55.58±8.52). The high scores were as follows:prevention and control of HAI (13.00±4.33), basic knowle-dge of HAI (12.30±3.45), and management of medical waste (10.96±3.80). Except for occupational exposure and standard prevention as well as HAI surveillance and report, scores of other knowledge among HCWs in diffe-rent occupations were all significantly different (all P<0.05). Conclusion HAI management organization of old-age care institutions is not perfect, and core system is not implemented. Support and supervision should be enhanced, training for HCWs should be strengthened, and formulation of HAI control standard in local old-age care institutions should be completed as soon as possible.