It’s not how sick you are but how clean the healthcare facility is that determines your likelihood of developing a nosocomial infection, according to three separate studies in the American Journal of Medical Quality.

Hospital-acquired infections result mostly from poor hygiene within the facilities and are not predicated on how sick patients were at the time of admission, according to two of the studies, which are based on data collected from the Pennsylvania Health Care Cost Containment Council. Data from 2005 indicated that among 1.6 million hospital patients in the state, more than contracted in-hospital infections.

A separate study of more than 180,000 surgical patients by researchers at the Pennsylvania State University College of Medicine found that hospital procedures such as hand washing, length of surgeries and traffic through the operating room predicted a patient’s risk of acquiring a surgical wound infection more than underlying factors such as age, obesity and diabetes.