Skip Navigation LinksNHSN_AR_OptionImplementationToolkit

healthcare-associated infections (hai) program

National Healthcare Safety Network (NHSN) Antimicrobial Resistance (AR) Option Implementation Toolkit

This toolkit serves as a one-stop resource for California facilities looking to implement the Antimicrobial Resistance (AR) Option of the NHSN Antimicrobial Use and Resistance (AUR) Module. The NHSN AUR Module provides a mechanism for health care facilities to track and analyze antimicrobial use and resistance for guiding local or regional efforts to reduce antimicrobial resistant infections through antimicrobial stewardship and infection prevention.

The target audience for this toolkit includes physicians, pharmacists, infection preventionists, microbiologists, hospital leadership and any other staff seeking guidance, resources, and practical examples for implementing the NHSN AR option.

Looking for AU? The NHSN AU Option Implementation Toolkit is found here (to be completed)

To participate in either the AU or AR option, facility personnel responsible for reporting NHSN data  must coordinate with their laboratory and/or pharmacy information software providers to configure their system to enable generation of standard formatted file(s) for importation into NHSN. The format for data submission follows the Health Level (HL7) Clinical Document Architecture (CDA). Manual data entry is not available for the AUR Module. Facilities can participate in one (AU or AR) or both (AU and AR) options.

Where to start?

  • If your facility is still in the decision-making process, begin with Element 1 for guidance on software solution approaches and investments.
  • If your facility has started the implementation process, begin with Element 5 for guidance on data verification and submission.

Need help choosing which program to implement and what resources are needed? E-mail us at and we can set up a call. CDPH support is available through July 2019.

If you are an information technology specialist implementing AU or AR at a facility, additional technical information is provided by the CDC, at the  NHSN CDA Submission Support Portal

Implementation Elements

​CDPH Support
(offered through July 2019)

Element 1: Program Introduction

This section provides a complete overview of the AR program.

Here are past trainings which go over the whole AR program.

​General CDPH Support

Need help understanding the calculation algorithms? General questions about benefits?

E-mail us  at and we can set up a call.

Element 2: Program Requirements

​This section provides an overview of systems and data elements needed for calculating an AR report

Program Requirements CDPH Support

CDPH can provide support assessing the capabilities of your current system by reviewing data outputs from relevant electronic systems.

​Element 3: Calculating an AR Report

This section provides an overview of how an AR report is calculated. Calculation walkthroughs can be found here.

Calculation Support with CDPH

CDPH can help provide answers to calculating special cases of Antimicrobial Resistance.

​Element 4: CDA and Report Validation

This section provides an overview of the CDA format for AR reports and how to ensure they are valid CDA documents.
AR file validation is ensuring the formatting of the report is correct. It does not verify that the reported values are accurate. For verifying that the values are accurate, see Element 5. 

​Validation support with CDPH

CDPH can provide services validating outputs from implemented systems.

​Element 5: Verification

This section provides an overview of reviewing generated AR reports and ensuring the contents within the files are accurate.

AR file verification is ensuring that the contents of the AR report were calculated correctly and are accurate for the facility. If guidance is needed for CDA and CDA validation, see Element 4.

​Verification support with CDPH

CDPH can provide services verifying outputs from implemented systems.

​Element 6: Success Stories

This section contains case studies of successful implementations by other facilities in California. Learn what benefits they gained through successful AR reporting.


​Get Connected through CDPH

Want to learn from facilities who have successfully implemented? Get connected through CDPH’s learning collaborative.

Element 7: Additional NHSN Support Links

Page Last Updated :