Abstract: OBJECTIVE To explore the construction of a health care-associated infection risk management system, optimize the risk assessment matrix, achieve precise and quantitative risk assessment, and assist dedicated personnel in efficiently completing hospital-level risk assessment and management work. METHODS The baseline values that were related to infections were obtained from 44 clinical departments of Guizhou Provincial People's Hospital from Jan. 2024 to Dec. 2024. A risk management matrix was constructed. Totally 4 risk identification indicators, namely, a large number of patients with HAIs, a large number of patients with MDROs, a large number of patients with infectious diseases and a large number of patients undergoing invasive procedures, were determined by the Delphi method and brainstorming. These indicators were applied to the risk matrix method from three dimensions: the possibility of risk, severity of consequences, and the current system, and a percentile ranking was carried out for comprehensive assessment with the combination of case-mix index (CMI). RESULTS The risk rating was estimated for the 44 clinical departments after the assessment scores were adjusted based on CMI, and it was concluded that 4 extremely high risk departments involving internal medicine system were as follows: emergency internal medicine department, cardiology department, hematology department and infectious disease department; 1 extremely high risk department involving ICU system was critical care medicine department; 5 extremely high risk department involving surgery system were as follows: cardiac surgery department, neurosurgery department, third department of hepatobiliary surgery, emergency surgery department and thoracic surgery department. CONCLUSION The HAIs risk management system that sets the precise quantitative risk assessment matrix as the evaluation criteria and assesses the scores based on adjustment of CMI can make the assessment result scientific, reasonable, and clinically practical, further enhance the decision-making of risk management, and improve the hospital management level.