Benchmarks are typically public reports that apply a standard methodology and estimate risk-stratified or risk-adjusted HAIs and/or their preventive processes across a large network of healthcare facilities. Recognized benchmarks for HAI include the NHSN [23], INICC [24], European Centre for Disease Prevention and Control (ECDC), and World Health Organization (WHO) estimates [1]. The characteristics of these four benchmarks, including the advantages and limitations, are shown in Table 1. (1) NHSN reports: NHSN is a secure, internet-based surveillance system at the US Centers for Disease

Control and Prevention (CDC) [23]. It was established in 2005 to integrate and replace three different surveillance systems at the CDC, including the NNIS, and NHSN is by far the most important and well-established surveillance NVP-BKM120 manufacturer system worldwide. One of its main stated purposes is to provide enrolled facilities with risk-adjusted metrics that can be used for inter-facility comparisons and local quality improvement Belnacasan activities. Starting in 2007, NHSN published a yearly report to estimate the magnitude of HAI, mainly in regards

to risk-stratified pooled means and percentiles of device-associated and procedure-associated HAIs [14] and [16]. However, ignoring non-device-associated pneumonia, bloodstream infections, and urinary tract infections as well as some surgeries limits the comprehensiveness of the NHSN surveillance system [25]. The last antimicrobial resistance report was published by NNIS in 2004 [26], pointing to the infrequency of reporting Isotretinoin for some NHSN modules. NHSN is widely used as a benchmark even outside of the US because its surveillance methodology is implemented in many hospitals worldwide. However, frequent changes in NHSN definitions, especially for catheter-associated urinary tract infection (CAUTI),

dialysis events, antimicrobial use, and neonatal central line associated bloodstream infection (CLABSI), make it difficult for any healthcare facility outside the NHSN to interpret the results of their benchmarking if they do not incorporate these changes into their own surveillance system on a timely basis [27], [28] and [29]. Approximately 90% of enrolled hospitals are general hospitals, including acute, trauma, and teaching facilities, although the number of enrolled hospitals has increased sharply during the last few years and now includes a larger representation of smaller hospitals. The recent availability of benchmark reports from different parts of the world has widened the benchmarking options for new hospitals in GCC states.