National Healthcare Safety Network (NHSN)
OMB Control No. 0920-0666
Revision Request February 2011
Revision of Estimated Annual Burden Hours
|
|
Number of Respondents (Annual) |
Responses per Respondent (Annual) |
Burden per Response (Hours) |
Total Annual Burden (Hours) |
Change in Burden (Hours) |
||||
Form Number |
Form Name |
2009 |
2010 |
2009 |
2010 |
2009 |
2010 |
2009 |
2010 |
|
57.100 |
NHSN Registration Form |
6,000 |
6,000 |
1 |
1 |
5/60 |
5/60 |
500 |
500 |
0 |
57.101 |
Facility Contact Information |
6,000 |
6,000 |
1 |
1 |
10/60 |
10/60 |
1,000 |
1,000 |
0 |
57.102 |
N/A-Remove from ICR |
6,000 |
0 |
1 |
0 |
15/60 |
0 |
1,500 |
0 |
(1,500) |
57.103 |
Patient Safety Component--Annual Facility Survey |
6,000 |
6,000 |
1 |
1 |
30/60 |
40/60 |
3,000 |
4,000 |
1,000 |
57.104 |
Patient Safety Component--Outpatient Dialysis Center Practices Survey |
225 |
5,500 |
1 |
1 |
1 |
1 |
225 |
5,500 |
5,275 |
57.105 |
Group Contact Information |
6,000 |
6,000 |
1 |
1 |
5/60 |
5/60 |
500 |
500 |
0 |
57.106 |
Patient Safety Monthly Reporting Plan |
6,000 |
6,000 |
9 |
9 |
35/60 |
35/60 |
31,500 |
31,500 |
0 |
57.108 |
Primary Bloodstream Infection (BSI) |
6,000 |
6,000 |
36 |
36 |
30/60 |
32/60 |
108,000 |
115,200 |
7,200 |
57.109 |
Dialysis Event |
225 |
500 |
200 |
75 |
5/60 |
15/60 |
11,250 |
9,375 |
(1,875) |
57.111 |
Pneumonia (PNEU) |
6,000 |
6,000 |
72 |
72 |
30/60 |
32/60 |
216,000 |
230,400 |
14,400 |
57.112 |
N/A-Remove from ICR |
- |
- |
- |
- |
- |
- |
- |
- |
- |
57.113 |
N/A-Remove from ICR |
- |
- |
- |
- |
- |
- |
- |
- |
- |
57.114 |
Urinary Tract Infection (UTI) |
6,000 |
6,000 |
27 |
27 |
30/60 |
32/60 |
81,000 |
86,400 |
5,400 |
57.116 |
Denominators for Neonatal Intensive Care Unit (NICU) |
6,000 |
6,000 |
9 |
9 |
4 |
4 |
216,000 |
216,000 |
0 |
57.117 |
Denominators for Specialty Care Area (SCA) |
6,000 |
6,000 |
9 |
9 |
5 |
5 |
270,000 |
270,000 |
0 |
57.118 |
Denominators for Intensive Care Unit (ICU)/Other locations (not NICU or SCA) |
6,000 |
6,000 |
18 |
18 |
5 |
5 |
540,000 |
540,000 |
0 |
57.119 |
Denominator for Outpatient Dialysis |
225 |
500 |
9 |
12 |
5/60 |
5/60 |
169 |
500 |
331 |
57.120 |
Surgical Site Infection (SSI) |
6,000 |
6,000 |
27 |
27 |
30/60 |
32/60 |
81,000 |
86,400 |
5,400 |
57.121 |
Denominator for Procedure |
6,000 |
6,000 |
540 |
540 |
8/60 |
10/60 |
432,000 |
540,000 |
108,000 |
57.123 |
Antimicrobial Use and Resistance (AUR)-Microbiology Data Electronic Upload Specification Tables |
6,000 |
6,000 |
45 |
12 |
3 |
5/60 |
810,000 |
6,000 |
(804,000) |
57.124 |
Antimicrobial Use and Resistance (AUR)-Pharmacy Data Electronic Upload Specification Tables |
6,000 |
6,000 |
36 |
12 |
2 |
5/60 |
432,000 |
6,000 |
(426,000) |
57.125 |
Central Line Insertion Practices Adherence Monitoring |
6,000 |
6,000 |
100 |
100 |
10/60 |
5/60 |
100,000 |
50,000 |
(50,000) |
57.126 |
MDRO or CDI Infection Form |
6,000 |
6,000 |
72 |
72 |
30/60 |
32/60 |
216,000 |
230,400 |
14,400 |
57.127 |
MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring |
6,000 |
6,000 |
24 |
24 |
10/60 |
10/60 |
24,000 |
24,000 |
0 |
57.128 |
Laboratory-identified MDRO or CDI Event |
6,000 |
6,000 |
240 |
240 |
30/60 |
25/60 |
720,000 |
600,000 |
(120,000) |
57.130 |
Vaccination Monthly Monitoring Form–Summary Method |
6,000 |
6,000 |
5 |
5 |
16 |
14 |
480,000 |
420,000 |
(60,000) |
57.131 |
Vaccination Monthly Monitoring Form–Patient-Level Method |
2,000 |
2,000 |
5 |
5 |
4 |
2 |
40,000 |
20,000 |
(20,000) |
57.132 |
N/A-Remove from ICR |
2,000 |
0 |
250 |
0 |
5/60 |
0 |
41,667 |
0 |
(41,667) |
57.133 |
Patient Vaccination |
2,000 |
2,000 |
250 |
250 |
10/60 |
10/60 |
83,333 |
83,333 |
0 |
57.135 |
N/A-Remove from ICR |
6,000 |
0 |
1 |
0 |
1 |
0 |
6,000 |
0 |
(6,000) |
57.136 |
N/A-Remove from ICR |
6,000 |
0 |
1 |
0 |
1 |
0 |
6,000 |
0 |
(6,000) |
57.137† |
Patient Safety Component--Annual Facility Survey for LTCF |
- |
250 |
- |
1 |
- |
25/60 |
- |
104 |
104 |
57.138† |
Laboratory-identified MDRO or CDI Event for LTCF |
- |
250 |
- |
8 |
- |
30/60 |
- |
1,000 |
1,000 |
57.139† |
MDRO and CDI Prevention Process Measures Monthly Monitoring for LTCF |
- |
250 |
- |
3 |
- |
7/60 |
- |
88 |
88 |
57.140† |
Urinary Tract Infection (UTI) for LTCF |
- |
250 |
- |
9 |
- |
30/60 |
- |
1,125 |
1,125 |
57.200 |
Healthcare Personnel Safety Component Annual Facility Survey |
600 |
6,000 |
1 |
1 |
8 |
8 |
4,800 |
48,000 |
43,200 |
57.202 |
Healthcare Worker Survey |
600 |
600 |
100 |
100 |
10/60 |
10/60 |
10,000 |
10,000 |
0 |
57.203 |
Healthcare Personnel Safety Monthly Reporting Plan |
600 |
600 |
9 |
9 |
10/60 |
10/60 |
900 |
900 |
0 |
57.204 |
Healthcare Worker Demographic Data |
600 |
600 |
200 |
200 |
20/60 |
20/60 |
40,000 |
40,000 |
0 |
57.205 |
Exposure to Blood/Body Fluids |
600 |
600 |
50 |
50 |
1 |
1 |
30,000 |
30,000 |
0 |
57.206 |
Healthcare Worker Prophylaxis/Treatment |
600 |
600 |
10 |
10 |
15/60 |
15/60 |
1,500 |
1,500 |
0 |
57.207 |
Follow-Up Laboratory Testing |
600 |
600 |
100 |
100 |
15/60 |
15/60 |
15,000 |
15,000 |
0 |
57.208 |
Healthcare Worker Vaccination History |
600 |
600 |
300 |
300 |
10/60 |
10/60 |
30,000 |
30,000 |
0 |
57.209 |
Healthcare Worker Influenza Vaccination |
600 |
600 |
500 |
500 |
10/60 |
10/60 |
50,000 |
50,000 |
0 |
57.210 |
Healthcare Worker Prophylaxis/Treatment-Influenza |
600 |
600 |
50 |
50 |
10/60 |
10/60 |
5,000 |
5,000 |
0 |
57.211 |
Pre-season Survey on Influenza Vaccination Programs for Healthcare Personnel |
600 |
600 |
1 |
1 |
10/60 |
10/60 |
100 |
100 |
0 |
57.212 |
Post-season Survey on Influenza Vaccination Programs for Healthcare Personnel |
600 |
600 |
1 |
1 |
10/60 |
10/60 |
100 |
100 |
0 |
57.213† |
Healthcare Personnel Influenza Vaccination Monthly Summary |
- |
6,000 |
- |
6 |
- |
2 |
- |
72,000 |
72,000 |
57.300 |
Hemovigilance Module Annual Survey |
500 |
500 |
1 |
1 |
2 |
2 |
1,000 |
1,000 |
0 |
57.301 |
Hemovigilance Module Monthly Reporting Plan |
500 |
500 |
12 |
12 |
2/60 |
2/60 |
200 |
200 |
0 |
57.302 |
Hemovigilance Module Monthly Incident Summary |
500 |
500 |
12 |
12 |
2 |
2 |
12,000 |
12,000 |
0 |
57.303 |
Hemovigilance Module Monthly Reporting Denominators |
500 |
500 |
12 |
12 |
30/60 |
30/60 |
3,000 |
3,000 |
0 |
57.304 |
Hemovigilance Adverse Reaction |
500 |
500 |
120 |
120 |
10/60 |
10/60 |
10,000 |
10,000 |
0 |
57.305 |
Hemovigilance Incident |
500 |
500 |
72 |
72 |
10/60 |
10/60 |
6,000 |
6,000 |
0 |
Total Estimated Annual Burden (Hours) |
5,172,244 |
3,914,125 |
(1,258,119) |
†This is a new form.
Revision
of estimated annual burden, in number of hours, by NHSN data
collection form.
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | fom7 |
File Modified | 0000-00-00 |
File Created | 2021-02-01 |