Objective To analyze the current status and trend of main healthcare-associated infection (HAI) indicators in national tertiary public hospitals. Methods The hospital self-reported data investigated by the institutional group of "third party evaluation of action plan for further improvement of medical services" were adopted for analysis. Results In 2018-2020, prevalence rates (cases) of HAI of 142 sample hospitals in 2018-2020 were 1.91%, 1.86% and 1.65% respectively, the missed reporting rates of HAI were 2.39%, 1.23% and 1.44% respectively, incidence of ventilator-associated pneumonia were 2.72‰, 2.68‰ and 1.82‰ respectively, incidence of intra-vascular catheter-related bloodstream infection were 0.48‰, 0.35‰ and 0.31‰ respectively, incidence of catheter-associated urinary tract infection were 0.71‰, 0.66‰ and 0.53‰ respectively, indicators of hospitals in the central region decreased significantly. Hand hygiene compliance rate of medical staff in sample hospitals increased year by year, which were 74.66%, 78.60% and 83.55% respectively (P < 0.05). Compared with 2018, the number of full-time HAI professionals in the sample hospitals increased by an average of 1 person in 2019 and 2020. Conclusion The main indicators of HAI in national tertiary public hospitals generally shows a downward trend, construction of HAI management and prevention capacity as well as talent team achieved certain results. In the future, it is still necessary to continue to strengthen the monitoring of HAI and explore the construction of multi-system information collaboration platform.