A Critical Contrast: Washington State's Case for Critical Access Hospital Benchmarks

We appreciate the report by O'Leary et al. 1 summarizing hospitals' progress in implementing antimicrobial stewardship (AS) as tracked by the National Healthcare Safety Network (NHSN) annual hospital survey.We also support the request by Ryder et al. for stratification of NHSN hospital survey data by facility type and geographic location (e.g., state and region) 2 and wanted to share our own state-specific findings.Critical access hospitals (CAHs) face unique challenges compared to larger acute care hospitals (ACHs) 2,3 .Based on our efforts to promote AS in Washington hospitals, CAHs struggle to access resources to develop a robust AS program.Stratifying AS performance by hospital type with benchmarking can help public health incorporate health equity goals into stewardship support strategies 4 and prioritize hospital outreach.Limited data exist to guide stewardship in CAHs, 3,5 making it important to leverage all available sources.We analyzed Washington (WA) state-specific 2022 NHSN annual hospital survey data to assess the usefulness of a stratified facility average for CAHs.