Att D-3

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. 2