BACKGROUND: Healthcare-associated infections (HAIs), antibiotic use (AMU) and antimicrobial resistance (AMR) are critical indicators of healthcare quality and antimicrobial stewardship. Point prevalence surveys provide essential data for optimizing infection prevention and control (IPC) strategies. OBJECTIVE: To describe the prevalence of HAIs, AMU and AMR across hospital levels and wards in Piedmont, Italy, highlighting associations with hospital complexity and patient care characteristics. METHODS: Data included hospital charatheristics, demographics, HAI, AMU, AMR, and clinical characteristics. Prevalence ratios (PRs) were calculated to compare rates across subgroups. RESULTS: The prevalence of HAIs was 8%, with increased invasive device usage contributed (PR 1.71, 95% CI 1.64-1.78). AMU prevalence decreased to 40% from 42.8% in 2016. Trends in antibiotic use aligned with the "Italian National Action Plan to contrast AMR" (PNCAR) goals, showing reduced fluoroquinolone use and increased amoxicillin prescriptions. AMR trends showed improvements in oxacillin-resistant Staphylococcus aureus and cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae. DISCUSSION AND CONCLUSION: The results highlight the critical importance of sustained investment in IPC measures and robust antimicrobial stewardship programs. Addressing these key areas will be essential to mitigating the burden of HAIs, promoting the judicious use of antibiotics, and ultimately enhancing patient care and outcomes across the region.