Surveillance of healthcare-associated infections (HAIs) is a critical component of infection prevention and control activities. The methodology is frequently prospective active surveillance of an outcomes or process. As regards scope, surveillance is usually targeted covering specific types of HAIs in specific hospital units for specific durations after risk assessment. The key point in HAI surveillance is standardization of methods and outcomes. HAI surveillance has several challenges, specially in low-resource countries. There is usually limited number of competent IPC staff who can conduct HAI surveillance as per the specified standards. The surveillance definitions of HAI events are complex and usually difficult to implement compared with clinical definitions. They are heavily dependent on the presence of accessible microbiological laboratory services and liberal microbiological requests. There is usually insufficient communication between IPC staff and the staff of the units where data were collected and IPC staff at the microbiological laboratory. Several solutions are discussed to minimize these challenges.