For example, the incidence of device-associated HAI is two- to three-fold higher in low-resources countries than in high-resources countries (Table

2). Additionally, even within high-resource countries, the incidence of SSIs is considerably different, as the incidence is lower in the NHSN than the ECDC for many procedures (Table 3). Moreover, the change in HAI incidence in consecutive reports from the same benchmark organization (Fig. 1) and the underlying Cobimetinib in vitro contributing causes may complicate the selection and interpretation of the benchmarking process [14], [16], [26], [37], [38], [39], [40], [41] and [42]. For example, several causes that may affect fair comparisons were hypothesized to explain the downward trend in device-associated HAI rates in consecutive NHSN reports, including (1) changes in HAI definitions to reduce the percentage of non-objective diagnoses (e.g., abandoning clinical sepsis as an acceptable diagnosis for CALBSI); (2) complying with regulations for mandatory HAI reporting in many states (this represented 70% of contributing hospitals in the 2010 data); (3) enrollment of many hospitals with smaller bed numbers, which generally have a lower risk of HAIs (this represented two-thirds of contributing hospitals in the 2010 data); and (4) implementation of multiple infection control strategies by many hospitals, which may have resulted in an actual

decrease in HAI incidence. Benchmarking local GCC

data is challenging, although benchmarking to NHSN reports learn more is preferred because the case definitions and methodologies are similar and differences in HAI rates will likely encourage improvements. However, differences in surveillance environments, including regulations in GCC and NHSN hospitals, should be taken into consideration. Additionally, delays in implementing frequent NHSN changes in case definitions and methodologies could further complicate interpretation of the data. Benchmarking to INICC seems legitimate because of similar methodologies and challenges, as well as the availability Farnesyltransferase of unique data on mortality, length of stay, and prevention. However, the use of aggregate data from enrolled hospitals does not account for the variability in surveillance adjudication between and within participating countries. Moreover, the benchmarking process is expected to improve infection control practices when using a benchmark of a higher standard. ECDC may be an alternative benchmark to GCC hospitals for SSIs and antimicrobial use and resistance. However, the considerable differences in device-associated HAI definitions likely limit its use as a benchmark for that purpose. WHO estimates for high-resources countries are driven by NHSN and ECDC data, while the estimates for low-resources countries are largely fragmented and not derived from a clear source.