Leveraging National Health Safety Network Antibiotic Use Data to Inform, Implement and Assess Antibiotic Stewardship Activities

Implement - Assess - Inform

Tracking and Reporting antibiotic use are Core Elements of successful hospital stewardship programs.  In the 2019 update Hospital Core Elements by the US Center for Disease Control & Prevention, particular emphasis was given to hospitals electronically submitting antibiotic use data to the National Healthcare Safety Network (NHSN) Antimicrobial Use (AU) option. Beginning in 2024, this reporting, along with reporting data to the Antimicrobial Resistance (AR) option will become required for hospitals participating in the Centers for Medicare and Medicaid (CMS) Promoting Interoperability Program.

Having robust, risk adjusted antibiotic use data that can be used for benchmarking antibiotic use, identifying target areas for optimized prescribing and tracking stewardship work already underway are just some of the many advantages to a universal method to track and report nation-wide antibiotic use.  In fact, nationwide data and risk adjusted use trends, reported as the Standardized Antimicrobial Administration Ratio (SAAR) are already available from the more than 1,700 facilities reporting AU data to NHSN for 2021 via the Antibiotic Resistance & Patient Safety Portal

As the number of hospitals reporting to NHSN increases to nearly 4,000 in the coming years, more hospitals will be contributing and using these data.  Therefore, our group at the Duke Center for Antimicrobial Stewardship and Infection Prevention (DCASIP), which leverages the stewardship expertise of the Duke Antimicrobial Stewardship Outreach Network (DASON,  Duke Health System Antimicrobial Stewardship and Evaluation Team (ASET) and the Carolina Antimicrobial Stewardship Program (CASP), along with our CDC content experts prepared this implementation guide to aid hospitals in using the NHSN data to inform, implement and assess stewardship initiatives.

Our goal for this guide it highlight ways that the NHSN AU data, including the SAAR can be used to immediately inform stewardship work.  We do this through a series of Clinical Stewardship Scenarios.  These scenarios are based on our real-world stewardship work.  Each scenario include quick guides prepared by the CDC as well as additional instructional step by step guides with embedded “stew-tube” videos from our team to facilitate easy use of the data even for teams with minimal data analytic experience. 

We have also prepared slide templates for presenting to facility administrators as well as prescribers.  These can be downloaded here:

Facility Administrator PowerPointTM Template

Facility Administrator User Guide

Prescriber PowerPointTM Template

We hope you find these tools useful and wish you well in your stewardship work!

For more information or to submit comments & recommendations, please contact us.


CDC. Core Elements of Hospital Antibiotic Stewardship Programs.  Atlanta, GA: US Department of Health and Human Services, CDC; 2019. Available at https://www.cdc.gov/antibiotic-use/core-elements/hospital.html.

CDC. 2021 National Healthcare Safety Network Antimicrobial Use Option Report. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2022. Available at: https://www.cdc.gov/nhsn/pdfs/datastat/2021-AU-Report-508.pdf


This work was funded by Centers for Disease Control & Prevention Safety and Healthcare Epidemiology Prevention Research Development (SHEPheRD) Program- Contract 2022 Domain 1-A001.