Rev of Ext Annual Burden Hours

National Healthcare Safety Network (NHSN)

OMB Control No. 0920-0666

Revision Request September 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	05/2011	09/2011	05/2011	09/2011	05/2011	09/2011	05/2011	09/2011
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
57.103	Patient Safety Component--Annual Facility Survey	6,000	6,000	1	1	40/60	30/60	4,000	3,000	(1,000)
57.104	Patient Safety Component--Outpatient Dialysis Center Practices Survey	5,500	5,500	1	1	1	1	5,500	5,500	0
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	32/60	33/60	115,200	118,800	3,600
57.109	Dialysis Event	500	5,500	75	75	15/60	16/60	9,375	110,000	100,625
57.111	Pneumonia (PNEU)	6,000	6,000	72	72	32/60	32/60	230,400	230,400	0
57.112†	Streamlined Ventilator-Associated Pneumonia	-	6000	-	144	-	25/60	-	360,000	360,000
57.114	Urinary Tract Infection (UTI)	6,000	6,000	27	27	32/60	32/60	86,400	86,400	0
57.116	Denominators for Neonatal Intensive Care Unit (NICU)	6,000	6,000	9	9	4	3	216,000	162,000	(54,000)
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	500	5,500	12	12	5/60	6/60	500	6,600	6,100
57.120	Surgical Site Infection (SSI)	6,000	6,000	27	36	32/60	32/60	86,400	115,200	28,800
57.121	Denominator for Procedure	6,000	6,000	540	540	10/60	8/60	540,000	432,000	(108,000)
57.123	Antimicrobial Use and Resistance (AUR)-Microbiology Data Electronic Upload Specification Tables	6,000	6,000	12	12	5/60	5/60	6,000	6,000	0
57.124	Antimicrobial Use and Resistance (AUR)-Pharmacy Data Electronic Upload Specification Tables	6,000	6,000	12	12	5/60	5/60	6,000	6,000	0
57.125	Central Line Insertion Practices Adherence Monitoring	6,000	1,000	100	100	5/60	5/60	50,000	8,333	(41,667)
57.126	MDRO or CDI Infection Form	6,000	6,000	72	72	32/60	32/60	230,400	230,400	0
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	25/60	15/60	600,000	360,000	(240,000)
57.130	Vaccination Monthly Monitoring Form–Summary Method	6,000	6,000	5	5	14	14	420,000	420,000	0
57.131	Vaccination Monthly Monitoring Form–Patient-Level Method	2,000	2,000	5	5	2	2	20,000	20,000	0
57.133	Patient Vaccination	2,000	2,000	250	250	10/60	10/60	83,333	83,333	0
57.137	Patient Safety Component--Annual Facility Survey for LTCF	250	250	1	1	25/60	25/60	104	104	0
57.138	Laboratory-identified MDRO or CDI Event for LTCF	250	250	8	8	30/60	15/60	1,000	500	(500)
57.139	MDRO and CDI Prevention Process Measures Monthly Monitoring for LTCF	250	250	3	3	7/60	5/60	88	63	(26)
57.140	Urinary Tract Infection (UTI) for LTCF	250	250	9	9	30/60	30/60	1,125	1,125	0
57.141†	Monthly Reporting Plan for LTCF	-	250	-	12	-	5/60	-	250	250
57.142†	Denominators for LTCF Locations	-	250	-	12	-	3	-	9,000	9,000
57.143†	Prevention Process Measures Monthly Monitoring for LTCF	-	250	-	12	-	5/60	-	250	250
57.150†	Patient Safety Component-Annual Facility Survey for LTAC	-	400	-	1	-	30/60	-	200	200
57.151†	Patient Safety Component-Annual Facility Survey for IRF	-	1,000	-	1	-	25/60	-	417	417
57.200	Healthcare Personnel Safety Component Annual Facility Survey	6,000	6,000	1	1	8	8	48,000	48,000	0
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	6,000	6	6	2	2	72,000	72,000	0
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)								3,914,125	3,978,175	64,050

^†This is a new form.

Revision of estimated annual burden, in number of hours, by NHSN data collection form. 2