**5. Surveillance**

Surveillance systems allow the evaluation of the local and regional healthcare associated infections (HAI) and antimicrobial resistance (AMR) patters. Surveillance systems contribute to the early detection of HAI and new patterns of AMR, including identifying new clusters or outbreaks. Surveillance is a key component on a local, regional, national, and even on a global scale (WHO) for determining these patterns [44]. Knowing and identifying resistance patterns can help provide guidance to practitioners by means of antibiograms. Antibiograms give the clinician the most appropriate empiric antibiotic information choice while awaiting further confirmation by either phenotypic or genotypic means. The CDC will soon require hospitals to report their antimicrobial use and resistance patterns into the National Healthcare Safety Network (NSHN). This tracking system is the nation's most widely used for healthcare-associated infection. This process will enable the CDC to benchmark hospitals and assess antimicrobial use by measuring the Standardized Antimicrobial Administration Ratio (SAAR). The measurement is a ratio of observed-to-expected (O-to-E). Ratio values greater than 0, and a value of 1.0 suggests equivalency between the observed and predicted antimicrobial use. Values above 1.0 may indicate statistically significant excessive antimicrobial use [44]. In addition to the CDC, many hospital regulatory agencies such as the Joint Commission and CMS will be enforcing this element as part of complying with antimicrobial stewardship program mandates [42, 43].
