Rev pf Est Annual Cost Burden

National Healthcare Safety Network (NHSN)

OMB Control No. 0920-0666

Revision Request September 2011

Revision of Estimated Annual Cost Burden*

		Total Estimated Burden (Hours)		Estimated Hourly Wage of Respondent		Total Estimated Annual Cost Burden		Change in Estimated Annual Cost Burden
Form Number	Form Name	05/2011	09/2011	05/2011	09/2011	05/2011	09/2011
57.100	NHSN Registration Form	500	500	$37.49	$37.99	$18,745	$18,995	$250
57.101	Facility Contact Information	1,000	1,000	$37.49	$37.99	$37,490	$37,990	$500
57.103	Patient Safety Component--Annual Facility Survey	4,000	3,000	$37.49	$37.99	$149,960	$113,970	($35,990)
57.104	Patient Safety Component--Outpatient Dialysis Center Practices Survey	5,500	5,500	$37.49	$37.99	$206,195	$208,945	$2,750
57.105	Group Contact Information	500	500	$37.49	$37.99	$18,745	$18,995	$250
57.106	Patient Safety Monthly Reporting Plan	31,500	31,500	$37.49	$37.99	$1,180,935	$1,196,685	$15,750
57.108	Primary Bloodstream Infection (BSI)	115,200	118,800	$37.49	$37.99	$4,318,848	$4,513,212	$194,364
57.109	Dialysis Event	9,375	110,000	$30.65	$31.10	$287,344	$3,421,000	$3,133,656
57.111	Pneumonia (PNEU)	230,400	230,400	$37.49	$37.99	$8,637,696	$8,752,896	$115,200
57.112†	Streamlined Ventilator-Associated Pneumonia	-	360,000	-	$37.99	-	$13,676,400	$13,676,400
57.114	Urinary Tract Infection (UTI)	86,400	86,400	$37.49	$37.99	$3,239,136	$3,282,336	$43,200
57.116	Denominators for Neonatal Intensive Care Unit (NICU)	216,000	162,000	$30.65	$31.10	$6,620,400	$5,038,200	($1,582,200)
57.117	Denominators for Specialty Care Area (SCA)	270,000	270,000	$30.65	$31.10	$8,275,500	$8,397,000	$121,500
57.118	Denominators for Intensive Care Unit (ICU)/Other locations (not NICU or SCA)	540,000	540,000	$30.65	$31.10	$16,551,000	$16,794,000	$243,000
57.119	Denominator for Outpatient Dialysis	500	6,600	$30.65	$31.10	$15,325	$205,260	$189,935
57.120	Surgical Site Infection (SSI)	86,400	115,200	$37.49	$37.99	$3,239,136	$4,376,448	$1,137,312
57.121	Denominator for Procedure	540,000	432,000	$30.65	$31.10	$16,551,000	$13,435,200	($3,115,800)
57.123	Antimicrobial Use and Resistance (AUR)-Microbiology Data Electronic Upload Specification Tables	6,000	6,000	$17.32	$17.44	$103,920	$104,640	$720
57.124	Antimicrobial Use and Resistance (AUR)-Pharmacy Data Electronic Upload Specification Tables	6,000	6,000	$13.49	$13.65	$80,940	$81,900	$960
57.125	Central Line Insertion Practices Adherence Monitoring	50,000	8,333	$37.49	$37.99	$1,874,500	$316,583	($1,557,917)
57.126	MDRO or CDI Infection Form	230,400	230,400	$37.49	$37.99	$8,637,696	$8,752,896	$115,200
57.127	MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring	24,000	24,000	$37.49	$37.99	$899,760	$911,760	$12,000
57.128	Laboratory-identified MDRO or CDI Event	600,000	360,000	$37.49	$37.99	$22,494,000	$13,676,400	($8,817,600)
57.130	Vaccination Monthly Monitoring Form–Summary Method	420,000	420,000	$37.49	$37.99	$15,745,800	$15,955,800	$210,000
57.131	Vaccination Monthly Monitoring Form–Patient-Level Method	20,000	20,000	$37.49	$37.99	$749,800	$759,800	$10,000
57.133	Patient Vaccination	83,333	83,333	$37.49	$37.99	$3,124,167	$3,165,833	$41,666
57.137	Patient Safety Component--Annual Facility Survey for LTCF	104	104	$37.49	$37.99	$3,905	$3,957	$52
57.138	Laboratory-identified MDRO or CDI Event for LTCF	1,000	500	$37.49	$37.99	$37,490	$18,995	($18,495)
57.139	MDRO and CDI Prevention Process Measures Monthly Monitoring for LTCF	88	63	$37.49	$37.99	$3,280	$2,374	($906)
57.140	Urinary Tract Infection (UTI) for LTCF	1,125	1,125	$37.49	$37.99	$42,176	$42,739	$563
57.141†	Monthly Reporting Plan for LTCF	-	250	-	$37.99	-	$9,498	$9,498
57.142†	Denominators for LTCF Locations	-	9,000	-	$37.99	-	$341,910	$341,910
57.143†	Prevention Process Measures Monthly Monitoring for LTCF	-	250	-	$37.99	-	$9,498	$9,498
57.150†	Patient Safety Component-Annual Facility Survey for LTAC	-	200	-	$37.99	-	$7,598	$7,598
57.151†	Patient Safety Component-Annual Facility Survey for IRF	-	417	-	$37.99	-	$15,829	$15,829
57.200	Healthcare Personnel Safety Component Annual Facility Survey	48,000	48,000	$37.84	$38.67	$1,816,320	$1,856,160	$39,840
57.202	Healthcare Worker Survey	10,000	10,000	$37.84	$38.67	$378,400	$386,700	$8,300
57.203	Healthcare Personnel Safety Monthly Reporting Plan	900	900	$37.84	$38.67	$34,056	$34,803	$747
57.204	Healthcare Worker Demographic Data	40,000	40,000	$37.84	$38.67	$1,513,600	$1,546,800	$33,200
57.205	Exposure to Blood/Body Fluids	30,000	30,000	$37.84	$38.67	$1,135,200	$1,160,100	$24,900
57.206	Healthcare Worker Prophylaxis/Treatment	1,500	1,500	$37.84	$38.67	$56,760	$58,005	$1,245
57.207	Follow-Up Laboratory Testing	15,000	15,000	$17.32	$17.44	$259,800	$261,600	$1,800
57.208	Healthcare Worker Vaccination History	30,000	30,000	$37.84	$38.67	$1,135,200	$1,160,100	$24,900
57.209	Healthcare Worker Influenza Vaccination	50,000	50,000	$37.84	$38.67	$1,892,000	$1,933,500	$41,500
57.210	Healthcare Worker Prophylaxis/Treatment-Influenza	5,000	5,000	$37.84	$38.67	$189,200	$193,350	$4,150
57.211	Pre-season Survey on Influenza Vaccination Programs for Healthcare Personnel	100	100	$37.84	$38.67	$3,784	$3,867	$83
57.212	Post-season Survey on Influenza Vaccination Programs for Healthcare Personnel	100	100	$37.84	$38.67	$3,784	$3,867	$83
57.213	Healthcare Personnel Influenza Vaccination Monthly Summary	72,000	72,000	$37.84	$38.67	$2,724,480	$2,784,240	$59,760
57.300	Hemovigilance Module Annual Survey	1,000	1,000	$31.27	$31.91	$31,270	$31,910	$640
57.301	Hemovigilance Module Monthly Reporting Plan	200	200	$31.27	$31.91	$6,254	$6,382	$128
57.302	Hemovigilance Module Monthly Incident Summary	12,000	12,000	$31.27	$31.91	$375,240	$382,920	$7,680
57.303	Hemovigilance Module Monthly Reporting Denominators	3,000	3,000	$31.27	$31.91	$93,810	$95,730	$1,920
57.304	Hemovigilance Adverse Reaction	10,000	10,000	$31.27	$31.91	$312,700	$319,100	$6,400
57.305	Hemovigilance Incident	6,000	6,000	$31.27	$31.91	$187,620	$191,460	$3,840
Total Estimated Annual Cost Burden						$135,294,367	$140,076,136	$4,781,769

*Despite no change in the estimated burden hours, cost increased on all forms due to a cost of living increase in average wages.

^†This is a new form.

Revision of estimated national annual cost burden of data collection by NHSN data collection form. 2