National Healthcare Safety Network (NHSN)
OMB Control No. 0920-0666
Revision Request February 2011
Itemized IC Revisions and Justifications
Form No. |
Name |
Name in last ICR |
Itemized Changes |
Justifications |
57.100 |
NHSN Registration Form |
No change |
Changed the CMS identifiers used to register. |
To clarify which CMS number facilities should use to enroll in NHSN. No change in burden. |
57.101 |
Facility Contact Information |
No change |
|
These changes do not result in a significant change to the previously estimated response burden of 10 minutes for this form. |
57.102 |
N/A-Remove from ICR |
Agreement to Participate and Consent |
Form 57.102 is being removed from the OMB ICR, with approval from ICRO. Hereafter, it will only be referred to as the “NHSN Agreement to Participate and Consent” signature page. |
This is the NHSN Agreement to Participate and Consent signature page. The contact information on this form is populated in the NHSN web interface with the data collected on form 57.101. The facility only prints, signs, and mails this pre-populated form to CDC. It was included in previous OMB ICRs by mistake. Removing this form from the package results in a decrease of 1500 total burden hours. |
57.103 |
Patient Safety Component--Annual Facility Survey |
No change |
|
These changes result in a net increase of 10 minutes per response for this form, equating to an increase of 1,000 annual burden hours. |
57.104 |
Patient Safety Component--Outpatient Dialysis Center Practices Survey |
Dialysis Survey |
|
Expanding the scope of the survey results in an estimated annual increase of 5,275 hours for this form. |
57.105 |
Group Contact Information |
No change |
No changes |
NA |
57.106 |
Patient Safety Monthly Reporting Plan |
No change |
|
All: User clarifications that do not result in a change in burden for data collected on this form. |
57.108 |
Primary Bloodstream Infection (BSI) |
No change |
|
The additional pathogens and antimicrobials added to this form result in an estimated increase of 2 minutes per response, which equates an increase of 7,200 hours for this form. |
57.109 |
Dialysis Event |
No change |
|
The changes in required event-type reporting result in a decrease in the number of responses expected per user from 200 to 75 per year, while the response population has been increased from 225 to 500. With respect to these changes, the change in total estimated annualized burden is a decrease of 1,875 burden hours for this form. |
57.111 |
Pneumonia (PNEU) |
No change |
Updated pathogens and antimicrobials. |
To match the current Clinical Laboratory Standards Institute (CLSI) testing panels and the information that is reported by clinical microbiology laboratories to physicians who treat HAIs. The additional pathogens and antimicrobials added to this form result in an estimated increase of 2 minutes per response, which equates to an increase of 14,400 hours for this form. |
57.112 |
N/A-Remove from ICR |
Any Patient – Pneumonia Flow Diagram |
Obsolete. Remove from ICRAS. |
This was a decision flow chart, not a form, and is no longer in use. This form number will not be included in future burden tables. |
57.113 |
N/A-Remove from ICR |
Infant and Children – Pneumonia Flow Diagram |
Obsolete. Remove from ICRAS. |
This was a decision flow chart, not a form, and is no longer in use. This form number will not be included in future burden tables. |
57.114 |
Urinary Tract Infection (UTI) |
No change |
Updated pathogens and antimicrobials. |
To match the current Clinical Laboratory Standards Institute (CLSI) testing panels and the information that is reported by clinical microbiology laboratories to physicians who treat HAIs. The additional pathogens and antimicrobials added to this form result in an estimated increase of 2 minutes per response, which equates to a net increase of 5,400 hours for this form. |
57.116 |
Denominators for Neonatal Intensive Care Unit (NICU) |
No change |
No changes |
NA |
57.117 |
Denominators for Specialty Care Area (SCA) |
No change |
No changes |
NA |
57.118 |
Denominators for Intensive Care Unit (ICU)/Other locations (not NICU or SCA) |
No change |
No changes |
NA |
57.119 |
Denominator for Outpatient Dialysis |
No change |
|
Expanding the scope of the survey results in an estimated annual increase of 332 hours for this form. |
57.120 |
Surgical Site Infection (SSI) |
No change |
Updated pathogens and antimicrobials. |
To match the current Clinical Laboratory Standards Institute (CLSI) testing panels and the information that is reported by clinical microbiology laboratories to physicians who treat HAIs. The additional pathogens and antimicrobials added to this form result in an estimated increase of 2 minutes per response, which equates to a net increase of 5,400 hours for this form. |
57.121 |
Denominator for Procedure |
No change |
Stratified risk factor data collection by procedure type. |
There are 10 general surgical risk factors currently required for each of the 40 NHSN operative procedures that can be reported to NHSN. To better predict the risk of surgical site infection, we conducted multivariable modeling of these factors as well as reported patient- and facility-level factors and have determined that we can reduce the number of general surgical risk factors to 6 for all NHSN operative procedures. Currently, for 5 of the NHSN operative procedures, between 1 and 4 additional factors are also required. Again, based on the models, we have determined that we can eliminate one of these factors for one of these procedures. Two of the 3 general surgical risk factors we propose adding for this data collection are new (diabetes mellitus, height, and weight). We estimate that there will be a small increase in the per response burden (from 8 minutes to 10 minutes) to account for these changes. However, a facility's overall burden may vary depending on which NHSN operative procedures are selected for reporting. For example, if a facility chooses to monitor any of the 11 procedures that require only the 6 general surgical risk factors, its burden may be less than a facility that monitors any of the 10 procedures that require 9 factors. The changes made to this form results in a burden increase of approximately 2 minutes per response, equating to an increased estimated burden of 108,000 hours per year. |
57.123 |
Antimicrobial Use and Resistance (AUR)-Microbiology Data Electronic Upload Specification Tables |
Antimicrobial Use and Resistance (AUR) – Microbiology Laboratory Data |
The data will be collected via monthly CDA upload only. Individual, manual entry of this data will be completely eliminated. The data collected on this form will be downloaded from the facilities’ existing software, packaged into an XML file, and uploaded directly into NHSN. Data transfer will occur once per month and is expected to take, at most, 5 minutes per monthly data transfer. |
Previously, collection and reporting this data put considerable burden on the respondents. We have discontinued manual data collection and entry of these data for ALL facilities. In a future release of NHSN, we will make available electronic data collection and upload via Clinical Document Architecture (CDA) for these data. Facilities will only be able to enter this data via monthly data transfer. Due to the decrease in number of responses and the considerable decrease in response burden, this change eliminates 804,000 burden hours from the ICR. |
57.124 |
Antimicrobial Use and Resistance (AUR)-Pharmacy Data Electronic Upload Specification Tables |
Antimicrobial Use and Resistance (AUR) – Pharmacy Data |
The data will be collected via monthly CDA upload only. Individual, manual entry of this data will be completely eliminated. The data collected on this form will be downloaded from the facilities’ existing software, packaged into an XML file, and uploaded directly into NHSN. Data transfer will occur once per month and is expected to take, at most, 5 minutes per monthly data transfer. |
Previously, collection and reporting this data put considerable burden on the respondents. We have discontinued manual data collection and entry of these data for ALL facilities. In a future release of NHSN, we will make available electronic data collection and upload via Clinical Document Architecture (CDA) for these data. Facilities will only be able to enter this data via monthly data transfer. Due to the decrease in number of responses and the considerable decrease in response burden, this change eliminates 426,000 burden hours from the ICR. |
57.125 |
Central Line Insertion Practices Adherence Monitoring |
No change |
|
1-5) The Central Line Insertion Practices Adherence Monitoring form has been revised for two main reasons: 1) to make data collection and entry for the existing questions easier for the user and 2) to ensure that the data collected will provide the necessary measures to calculate the relevant HHS Action Plan National Metric and to indicate and track adherence to the updated CDC “Guidelines for Prevention of Intravascular Catheter-Related Infections”. In addition, we will now ask whether or not central line placement attempt was successful. Currently recorders enter a central line insertion practice (CLIP) event for every attempted central line placement, whether it was successful or not. Because the risk of central line-associate bloodstream infection (CLABSI) from an unsuccessful line insertion is thought to be negligible, adding this question informs data analysis attempts to associate line insertions with CLABSI occurrence. Obtaining the information about the number of unsuccessful attempts may assist in determining whether unsuccessful attempts are in fact related to subsequent CLABSI. Overall, these changes result in a simplification of data entry; therefore the response burden has been revised from 10 minutes to 5 minutes for this form, resulting in a reduction of 50,000 burden hours from the ICR. |
57.126 |
MDRO or CDI Infection Form |
MDRO Infection Form |
|
The additional pathogens and antimicrobials added to this form result in an estimated increase of 2 minutes per response, which equates to a net increase of 14,400 hours for this form. |
57.127 |
MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring |
Multi-drug Resistance Organism (MDRO) Prevention Process and Outcome Measures Monthly Monitoring Form |
|
These changes do not result in a change in burden for this form. |
57.128 |
Laboratory-identified MDRO or CDI Event |
Laboratory-identified MDRO Event |
|
The Laboratory-Identified (LabID) Event form has been revised for ease of data entry and to increase standardization across all users for appropriate comparative reasons and for viable data collection through electronic data capture. The simplifications allow us to decrease the estimated burden of each response, equating to a reduction of 120,000 burden hours for this form. |
57.130 |
Vaccination Monthly Monitoring Form–Summary Method |
High Risk Inpatient Influenza Vaccination Monthly Monitoring Form – Method A |
|
The changes made to this form results in a burden decrease of approximately 2 hours per response, equating to a decreased estimated burden of 60,000 hours per year. |
57.131 |
Vaccination Monthly Monitoring Form–Patient-Level Method |
High Risk Inpatient Influenza Vaccination Monthly Monitoring Form – Method B |
Removed this question: “Total # of patients meeting high risk criteria previously vaccinated during current influenza season.” |
The current influenza vaccination recommendation includes all persons six months old or older, which makes the concept of “high risk” no longer valid for influenza vaccination surveillance. The changes made to this form results in a burden decrease of approximately 2 hours per response, equating to a decreased estimated burden of 20,000 hours per year. |
57.132 |
N/A-Remove from ICR |
High Risk Inpatient Influenza Vaccination Method B Form-Part 1 |
The data collected on this form is being combined with form 57.133, rendering this form obsolete. Form 57.132 should be removed from ICRAS. |
The data collected on this form pertained primarily to high-risk inpatients and their underlying conditions. Because influenza vaccination recommendation is no longer limited to high-risk inpatient populations, it is no longer necessary to capture this information. The only information left on this form is the “date admitted to the facility”, which has been moved to form 57.133. The removal of this form results in a burden decrease of 41,667 hours in the ICR. |
57.133 |
Patient Vaccination |
High Risk Inpatient Influenza Vaccination Method B Form-Part 2 |
Moved one question from form 57.132: “Date admitted to facility.” |
Consolidated forms 57.132 and 57.133. The single question added to form 57.133 does not increase the estimated response burden. |
57.135 |
N/A-Remove from ICR |
List of Blood Isolates |
Obsolete. Remove from ICRAS. |
This form was developed for potential use as a validation for electronic data capture but was never put into use. We do not foresee ever implementing this form and would like to remove it from this ICR. Removal of this form from the package saves 6,000 total burden hours. |
57.136 |
N/A-Remove from ICR |
Manual Categorization of Positive Blood Cultures |
Obsolete. Remove from ICRAS. |
This form was developed for potential use as a validation for electronic data capture but was never put into use. We do not foresee ever implementing this form and would like to remove it from this ICR. Removal of this form from the package saves 6,000 total burden hours. |
57.137 |
Patient Safety Component--Annual Facility Survey for LTCF |
N/A-This is a new form. |
These four forms, intended for use in long-term care facilities (LTCFs), are adaptations of previously-approved NHSN data collection forms specific to acute-care facilities. NHSN plans to expand its current HAI surveillance population to include LTCFs in the near future to support CMS and HHS HAI directives toward HAI surveillance in this setting. As the LTCF HAI data collection capabilities will be built within the existing NHSN web interface, we request approval of these forms as a revision the current NHSN ICR (0920-0666). |
LTCFs are highly regulated at the federal level by the Centers for Medicare and Medicaid Services (CMS). CMS released a revised version of the “Interpretive Guidance for Infection Control in Nursing Homes – F441” in September 2009 which sets an expectation for LTCFs to perform HAI surveillance as part of their infection control program activity. However, no current standardized methodology for defining and reporting HAIs exists in this setting. The use of the NHSN system in acute care hospitals for setting national benchmarks and supporting facility-level quality improvement activity serves as a model for addressing the same HAI reporting needs in LTCFs. Adapting the current HAI reporting forms for LTCFs required only small changes and will provide setting specific data to provide an accurate comparison of facility-level rates, based on characteristics of the facility and resident population. Additionally, the inclusion of LTCFs in NHSN will provide the infrastructure necessary to support the expansion of the Department of Health and Human Services (HHS) HAI Prevention Action Plan into non-hospital settings. Expanding NHSN surveillance to LTCFs with the use of these four forms will add approximately 2320 burden hours to this ICR. |
57.138 |
Laboratory-identified MDRO or CDI Event for LTCF |
N/A-This is a new form. |
||
57.139 |
MDRO and CDI Prevention Process Measures Monthly Monitoring for LTCF |
N/A-This is a new form. |
||
57.140 |
Urinary Tract Infection (UTI) for LTCF |
N/A-This is a new form. |
||
57.200 |
Healthcare Personnel Safety Component Annual Facility Survey |
No change |
No changes |
The data collected on this form has not changed, however the total number of respondents is being revised from 600 to 6000 to include all acute care facilities expected to enroll in NHSN to submit the Healthcare Personnel Influenza Vaccination Monthly Summary (57.213) in accordance with proposed CMS requirements. The net burden increase for this revision is 43,200 hours. See expanded justification for form 57.213. |
57.202 |
Healthcare Worker Survey |
No change |
No changes |
NA |
57.203 |
Healthcare Personnel Safety Monthly Reporting Plan |
Healthcare Personnel Safety Reporting Plan |
No changes |
NA |
57.204 |
Healthcare Worker Demographic Data |
No change |
No changes |
NA |
57.205 |
Exposure to Blood/Body Fluids |
No change |
No changes |
NA |
57.206 |
Healthcare Worker Prophylaxis/Treatment |
No change |
No changes |
NA |
57.207 |
Follow-Up Laboratory Testing |
Laboratory Testing |
No changes |
NA |
57.208 |
Healthcare Worker Vaccination History |
No change |
No changes |
NA |
57.209 |
Healthcare Worker Influenza Vaccination |
No change |
Added product types for non-seasonal influenza vaccination types. |
To capture vaccination events related to non-seasonal influenza vaccinations. These changes do not change the burden estimates for this form. |
57.210 |
Healthcare Worker Prophylaxis/Treatment-Influenza |
Healthcare Worker Influenza Antiviral Medication Administration |
Changed name of form to “Healthcare Worker Prophylaxis/Treatment-Influenza.” |
To more accurately describe the data collected on this form. These changes do not change the burden estimates for this form. |
57.211 |
Pre-season Survey on Influenza Vaccination Programs for Healthcare Personnel |
No change |
|
These changes do not change the burden estimates for this form. |
57.212 |
Post-season Survey on Influenza Vaccination Programs for Healthcare Personnel |
No change |
Added “Vaccination Campaign” question at beginning of form. |
To characterize the type of vaccination effort undertaken at facility. These changes do not change the burden estimates for this form. |
57.213 |
Healthcare Personnel Influenza Vaccination Monthly Summary |
N/A-This is a new form. |
|
This new form adds an estimated 72,000 burden hours to this ICR. |
57.300 |
Hemovigilance Module Annual Survey |
No change |
|
The additional question does not change the previously estimated burden of 2 hours for this annual survey. |
57.301 |
Hemovigilance Module Monthly Reporting Plan |
No change |
Formatting changes only. |
Improved usability. No change in burden. |
57.302 |
Hemovigilance Module Monthly Incident Summary |
Hemovigilance Module Monthly Incident Summary |
|
No change in burden. |
57.303 |
Hemovigilance Module Monthly Reporting Denominators |
No change |
Formatting changes only. |
Improved usability. No change in burden. |
57.304 |
Hemovigilance Adverse Reaction |
No change |
|
The addition of defined options does not change the previously estimated burden of 10 minutes for this event form. |
57.305 |
Hemovigilance Incident |
No change |
Formatting changes only. |
Improved usability. No change in burden. |
NHSN
Data Collection Forms: Itemized Revisions and Justifications
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | fom7 |
File Modified | 0000-00-00 |
File Created | 2021-02-01 |