Abstract: OBJECTIVE To explore the predictive effect of National Institute of Health stroke scale（NIHSS）score on healthcare-associated infection（HAI） in stroke patients undergoing surgery.METHODS Prospective target monitoring was conducted on stroke patients in Neurosurgery Department of a tertiary first-class teaching hospital from Jan 1, 2016 to Jan 1, 2020. The patients who met the inclusion criteria were enrolled and filled in the Nosocomial Infection Monitoring Questionnaire for Patients undergoing Stroke Surgery we designed. Demographic characteristics such as age, gender, types of stroke, NNIS, number of drainage tube, number of operations, NIHSS score and other information were collected. Relationship between NIHSS score and healthcare-associated infection was analyzed and the accuracy of NIHSS score in predicting HAI was analyzed by receiver operating characteristic curve（ROC）.RESULTS A total of 983 stroke patients were enrolled, 226（22.99%） of whom had HAIs. Pulmonary infection occurred most frequently in patients with NIHSS score of 0, 5-15, 16-20, 21-42 groups, and surgical site infection occurred in most patients with NIHSS score 1-4. ROC curve analysis showed that the area under the curve of NIHSS score in stroke patients with HAI, pulmonary infection, urinary tract infection, surgical site infection and blood stream infection were 0.678（95% CI:0.633-0.723, P＜0.001）, 0.700（95% CI: 0.646-0.754,P＜0.001）, 0.724（95% CI: 0.650-0.844, P＜0.001）, 0.597（95% CI: 0.525-0.669, P=0.008）, 0.731（95% CI: 0.539-0.923, P=0.017）, respectively.CONCLUSION NIHSS score of stroke patients has a significant predictive effect on HAI. For patients with high NIHSS score, we should take effective measures to prevent HAIs and reduce hospital infection rate.