LTC TOI Prev Process Measures

NHSN Long Term Care Facility Component

Tables of Instructions

Table XX . Instructions for Completion of the MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring form (CDC 57.139) (Tables of Instructions List)

Data Field	Instructions for Form Completion
Facility ID #	The NHSN-assigned facility ID number will be auto-entered by the computer
Month	Required. Enter the 2-digit month during which surveillance was performed.
Year	Required. Enter the 4-digit year during which surveillance was performed.
Location Code	Required. Enter the code of the resident care location where the outcome measures monitoring was done.
Process Measures: Hand Hygiene
Performed	Conditionally required, if enrolled in hand hygiene adherence process measures. Enter the total number of observed contacts during which a healthcare worker touched either the resident or inanimate objects in the immediate vicinity of the resident and appropriate hand hygiene was performed (i.e., Hand Hygiene Performed).
Indicated	Conditionally required, if enrolled in hand hygiene adherence process measures. Enter the total number of observed contacts during which a healthcare worker touched either the resident or inanimate objects in the immediate vicinity of the resident and therefore, appropriate hand hygiene was indicated (i.e., Hand Hygiene Indicated).
Process Measures: Gown and Gloves
Used	Conditionally required, if enrolled in gown and gloves use adherence process measures. Among patients on Contact Precautions, enter the total number of observed contacts between a healthcare worker and a resident or inanimate objects in the immediate vicinity of the resident for which gloves and gowns had been donned prior to the contact (i.e., Gown and Gloves Used).
Indicated	Conditionally required, if enrolled in gown and gloves use adherence process measures. Among patients on Contact Precautions, enter the total number of observed contacts between a healthcare worker and a resident or inanimate objects in the immediate vicinity of the resident and therefore, gloves and gowns were indicated (i.e., Gown and Gloves Indicated).
Custom Fields
Labels Comments	Optional. Up to two date fields, 2 numeric and 10 alphanumeric fields that may be customized for local use. NOTE: Each Custom Field must be set up in the Facility/Custom Options section of the application before the field can be selected for use. Optional.

July, 2011