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Healthcare-associated infections (HAI) continue to be associated with considerable morbidity and mortality in healthcare facilities across the globe. Because of the well-recorded impact on HAI prevention and control, surveillance of these infections has become a priority in most facilities in North America, Europe, and countries across the globe. A key objective in the endeavor to improve patient outcomes is the enhancement of the quality of medical care provided by hospitals through reduction of HAI occurrence while simultaneously controlling costs. The importance of surveillance, prevention, and control of HAI within acute-care hospitals is rendered even more compelling by data from the Centers for Disease Control and Prevention (CDC) showing that while the number of general hospital beds have been decreasing in the United States, the number of beds in intensive care units (ICUs), where patients are most at risk for HAIs, is increasing. Currently, HAI rates are key markers of quality of care and must be meaningful for interhospital comparison. A crude HAI rate provides no means of adjustment for patients' intrinsic or extrinsic risks. CDC has recommended that a crude HAI rate should not be used for interhospital comparison. Rather, HAI rates should be adjusted for risk factors, such as exposure and duration of exposure to invasive medical devices. Interhospital comparison of rates requires that a hospital participate in a multicenter surveillance system or aggregated national database. There are several factors to consider when contemplating participation in such a HAI surveillance system. This chapter addresses a series of questions that healthcare-facility administrations need to consider before instituting HAI surveillance activities.