Objective To analyze the targeted surveillance data of healthcare-associated infection (HAI) in the intensive care units (ICUs) of a tertiary hospital in Sichuan Province from 2019 to 2024, timely identified the deficiencies in HAI prevention and control, and provide a basis for formulating effective prevention and control strategies. Methods Targeted surveillance data of patients in 4 ICUs in the hospital from January 2019 to December 2024 were collected through HAI surveillance system. The occurrence of HAI, distribution of HAI sites, catheter use and associated infections, as well as the epidemic trends and distribution of pathogens were analyzed. Results A total of 12 751 inpatients in 4 ICUs were surveilled, 417 patients had 454 cases of HAI, the incidence of HAI was 3.27%, and the case incidence was 3.56%. The main type of HAI was lower respiratory tract infection (excluding ventilator-associated pneumonia ［VAP］), accounting for 37.44%. There were a total of 244 cases (53.74%) with device-associated infection, in which VAP, catheter-associated urinary tract infection (CAUTI), and central line-associated bloodstream infection (CLABSI) accounted for 31.06%, 18.72%, and 3.96%, respectively. The incidence of VAP was the highest (5.08 ‰), the incidences of CLABSI and CAUTI were 0.49 ‰ and 1.18 ‰, respectively. The usage rate of urinary catheter (89.21%) was higher than usage rates of ventilator (34.36%) and central venous catheter (45.50%). A total of 242 pathogens were isolated from 244 cases of device-associated infection, mainly Gram-negative bacteria (76.03%); 131(54.13%) multidrug-resistant organisms (MDROs) were detected. Among device-associated infection, the overall detection proportion of Escherichia coli presented a declining trend (P=0.026). Conclusion The overall incidence of HAI in ICU patients remains stable, with lower respiratory tract infection being the main infection. HAI control departments should strengthen VAP prevention and control, establish early warning system for MDRO infection, and dynamically adjust prevention and control strategies, so as to reduce the occurrence of HAI in ICUs.