15

Table X. Instructions for Completion of State Health Department
Validation Record form (CDC 57.600)
Data Field
Facility ID #
Facility Type
Sampling Version
Data for Year
HAI(s) Validated
Reason Validated

Sampling Information for
Numerator Audit: ICU
CLABSI Sampling Frame
Sampling Information for
Numerator Audit: ICU
CAUTI Sampling Frame
Sampling Information for
Numerator Audit: COLO
SSI Sampling Frame
Sampling Information for
Numerator Audit: HYST
SSI Sampling Frame
Sampling Information for
Numerator Audit: MRSA
Bacteremia LabID Event
Sampling Frame
Sampling Information for
Numerator Audit: CDI
LabID Event Sampling
Frame
Reported Events:
ICU CLABSI
Reported Events:
ICU CAUTI
Reported Events:
COLO SSI
Reported Events:
HYST SSI
Reported Events:
MRSA Bacteremia LabID

Instructions for Data Collection
FACILITY VALIDATION OVERVIEW
Required. Enter the assigned NHSN facility ID (“orgID”).
Required. Check Acute Care Hospital, Long-term Care Hospital, Inpatient
Rehabilitation Facility, or Oncology Hospital to indicate the type of facility.
Required. Select CDC Version 1 (Targeted Sampling) to indicate that validation
has been conducted using CDC Version 1 sampling methods.
Required. Select year of data being validated.
Required. Select type of healthcare-associated infection validated at this facility for
the year in question.
Required. For type of healthcare-associated infection validated at this facility,
select reason for validation of specified HAI at this facility.
NUMERATOR VALIDATION
Conditionally Required. Complete if ICU CLABSI was validated at this facility.
Enter number of medical records with one or more positive ICU blood culture
Conditionally Required. Complete if ICU CAUTI was validated at this facility.
Enter number of medical records with one or more positive ICU urine culture, that
grows ≥103 CFU/ml of no more than 2 organisms.
Conditionally Required. Complete if COLO SSI was validated at this facility. Enter
number of colon (COLO) surgical procedures performed in this facility’s inpatient
operating rooms and meeting the NHSN procedure definition
Conditionally Required. Complete if HYST SSI was validated at this facility. Enter
number of abdominal hysterectomy (HYST) surgical procedures performed in this
facility’s inpatient operating rooms and meeting the NHSN procedure definition
Conditionally Required. Complete if MRSA Bacteremia LabID Event was validated
at this facility. Enter the number of blood cultures positive for methicillin-resistant
Staphylococcus aureus (MRSA) AND collected among inpatients or collected in
facility outpatient settings from patients who are admitted to the facility the same
day.
Conditionally Required. Complete if CDI LabID Event was validated at this facility.
Enter the number of positive laboratory assays for Clostridium difficile toxin A
and/or B and collected among facility inpatients or collected in facility outpatient
settings from patients who are admitted to the facility the same day.
Conditionally Required. Complete if ICU CLABSI was validated at this facility.
Enter the number of ICU CLABSIs reported to NHSN before external validation
Conditionally Required. Complete if ICU CAUTI was validated at this facility.
Enter the number of ICU CAUTIs reported to NHSN before external validation
Conditionally Required. Complete if COLO SSI was validated at this facility. Enter
the number of COLO SSIs reported to NHSN before external validation
Conditionally Required. Complete if HYST SSI was validated at this facility. Enter
the number of HYST SSIs reported to NHSN before external validation
Conditionally Required. Complete if MRSA Bacteremia LabID Event was validated
at this facility. Enter the number of MRSA Bacteremia LabID Events reported to
1

Event
Reported Events:
CDI LabID Event
Facility Audit Numerators:
ICU CLABSI

Facility Audit Numerators:
ICU CAUTI

Facility Audit Numerators:
COLO SSI

Facility Audit Numerators:
HYST SSI

NHSN before external validation
Conditionally Required. Complete if CDI LabID Event was validated at this facility.
Enter the number of CDI LabID Events reported to NHSN before external
validation
Conditionally Required. Complete if ICU CLABSI was validated at this facility. In
cell a, enter the number of audited medical records where at least one ICU CLABSI
was found and a date-matched ICU CLABSI was reported to NHSN. If an ICU
CLABSI was reported to NHSN but the date of the event does not match the date of
ICU CLABSI found on audit, report this event in cell c.
In cell b, enter the number of audited medical records where no ICU CLABSI was
found but an ICU CLABSI was reported to NHSN.
In cell c, enter the number of audited medical records where at least one ICU
CLABSI was found and a date-matched ICU CLABSI was NOT reported to NHSN.
In cell d, enter the number of audited medical records where no ICU CLABSI was
found and no ICU CLABSI was reported to NHSN.
Conditionally Required. Complete if ICU CAUTI was validated at this facility. In
cell a, enter the number of audited medical records where at least one ICU CAUTI
was found and a date-matched ICU CAUTI was reported to NHSN. If an ICU
CAUTI was reported to NHSN but the date of the event does not match the date of
ICU CAUTI found on audit, report this event in cell c.
In cell b, enter the number of audited medical records where no ICU CAUTI was
found but an ICU CAUTI was reported to NHSN.
In cell c, enter the number of audited medical records where at least one ICU
CAUTI was found and a date-matched ICU CAUTI was NOT reported to NHSN.
In cell d, enter the number of audited medical records where no ICU CAUTI was
found and no ICU CAUTI was reported to NHSN.
Conditionally Required. Complete if COLO SSI was validated at this facility. In
cell a, enter the number of audited COLO medical records where a deep incisional
or organ/space (DI/OS) SSI was found within the appropriate NHSN timeframe and
a (DI/OS) SSI was reported to NHSN.
In cell b, enter the number of audited medical records where no (DI/OS) SSI was
found within the appropriate NHSN timeframe but a (DI/OS) SSI was reported to
NHSN.
In cell c, enter the number of audited medical records where at least one (DI/OS)
SSI was found within the appropriate NHSN timeframe and a (DI/OS) SSI was
NOT reported to NHSN.
In cell d, enter the number of audited medical records where no (DI/OS) SSI was
found within the appropriate NHSN timeframe and no (DI/OS) SSI was reported to
NHSN.
Conditionally Required. Complete if HYST SSI was validated at this facility. In
cell a, enter the number of audited HYST medical records where a deep incisional
or organ/space (DI/OS) SSI was found within the appropriate NHSN timeframe and
a (DI/OS) SSI was reported to NHSN.
In cell b, enter the number of audited medical records where no (DI/OS) SSI was
found within the appropriate NHSN timeframe but a (DI/OS) SSI was reported to
NHSN.
In cell c, enter the number of audited medical records where at least one (DI/OS)
SSI was found within the appropriate NHSN timeframe and a (DI/OS) SSI was
NOT reported to NHSN.
2

Facility Audit Numerators:
MRSA Bacteremia LabID
Event

Facility Audit Numerators:
CDI LabID Event

Facility Audit
Denominators: ICU
CLABSI: Counting
Methods
Facility Audit
Denominators: ICU
CLABSI: Internal
Validation
Facility Audit
Denominators: ICU
CLABSI: Internal
Validation Documentation

In cell d, enter the number of audited medical records where no (DI/OS) SSI was
found within the appropriate NHSN timeframe and no (DI/OS) SSI was reported to
NHSN
Conditionally Required. Complete if MRSA Bacteremia LabID Event was validated
at this facility. In cell a, enter the number of audited positive MRSA blood cultures
where a reportable MRSA Bacteremia LabID Event was found and a date-matched
MRSA Bacteremia LabID Event was reported to NHSN, including the correct
admission date. If a labID Event was reported to NHSN but the date of specimen
collection OR the date of hospital admission does not match the reportable positive
MRSA Bacteremia culture event, report this event in cell c.
In cell b, enter the number of audited positive MRSA blood cultures where no
reportable MRSA Bacteremia LabID Event was found and a MRSA Bacteremia
LabID Event was reported to NHSN.
In cell c, enter the number of audited positive MRSA blood cultures where a
reportable MRSA Bacteremia LabID Event was found and a date-matched MRSA
Bacteremia LabID Event was NOT reported to NHSN.
In cell d, enter the number of audited medical records where no MRSA Bacteremia
LabID Event was found and no MRSA Bacteremia LabID Event was reported to
NHSN.
Conditionally Required. Complete if CDI LabID Event was validated at this facility.
In cell a, enter the number of audited positive CDI toxin assays where a reportable
CDI LabID Event was found and a date-matched CDI LabID Event was reported to
NHSN, including the correct admission date. If a labID Event was reported to
NHSN but the date of specimen collection OR the date of hospital admission does
not match the reportable positive CDI culture event, report this event in cell c.
In cell b, enter the number of audited positive CDI cultures where no reportable CDI
LabID Event was found and a CDI LabID Event was reported to NHSN.
In cell c, enter the number of audited positive CDI cultures where a reportable CDI
LabID Event was found and a date-matched CDI LabID Event was NOT reported to
NHSN.
In cell d, enter the number of audited medical records where no CDI LabID Event
was found and no CDI LabID Event was reported to NHSN.
DENOMINATOR VALIDATION: CLABSI
Conditionally Required. Complete if ICU CLABSI was validated at this facility.
Select manual counting, electronic counting, or both manual and electronic
counting, to indicate methods for central line and patient day counting.
Conditionally Required. Complete if ICU CLABSI was validated at this facility.
Select No or Yes to indicate whether any internal validation of ICU CLABSI
denominator data was conducted using a recommended method.
Conditionally Required. Complete if ICU CLABSI was validated at this facility and
Internal validation was conducted in one or more ICUs using a recommended
method.
For each ICU where internal validation was conducted, the following cells should
be completed:
Column 1: name of ICU
Column 2: select month of validation
Column 3: select method A (concurrent dual manual counting by two observers),
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Facility Audit
Denominators: ICU
CAUTI: Counting
Methods
Facility Audit
Denominators: ICU
CAUTI: Internal
Validation
Facility Audit
Denominators: ICU
CAUTI: Internal
Validation Documentation

Facility Audit
Denominators: COLO :
Internal Validation
Documentation

Facility Audit
Denominators: HYST :
Internal Validation

method B (concurrent dual manual counting by two observers, with one observer
collecting specific patient-level data), or method C (concurrent manual counting and
electronic counting)
Columns 4 and 5: If method A was used, Count 1 should be the usual manual count,
and Count 2 should be the referent count by an expert counter. If method B was
used, Count 1 should be the usual manual count and Count 2 should be the referent
count by specific patient-level counting. If method C is used, Count 1 should be the
manual count and Count 2 should be the electronic count.
Additional rows should be added as needed.
DENOMINATOR VALIDATION: CAUTI
Conditionally Required. Complete if ICU CAUTI was validated at this facility.
Select manual counting, electronic counting, or both manual and electronic
counting, to indicate methods for indwelling (Foley) catheter and patient day
counting.
Conditionally Required. Complete if ICU CAUTI was validated at this facility.
Select No or Yes to indicate whether any internal validation of ICU CAUTI
denominator data was conducted using a recommended method.
Conditionally Required. Complete if ICU CAUTI was validated at this facility and
Internal validation was conducted in one or more ICUs using a recommended
method.
For each ICU where internal validation was conducted, the following cells should
be completed:
Column 1: name of ICU
Column 2: select month of validation
Column 3: select method A (concurrent dual manual counting by two observers),
method B (concurrent dual manual counting by two observers, with one observer
collecting specific patient-level data), or method C (concurrent manual counting and
electronic counting)
Columns 4 and 5: If method A was used, Count 1 should be the usual manual count,
and Count 2 should be the referent count by an expert counter. If method B was
used, Count 1 should be the usual manual count and Count 2 should be the referent
count by specific patient-level counting. If method C is used, Count 1 should be the
manual count and Count 2 should be the electronic count.
Additional rows should be added as needed.
DENOMINATOR VALIDATION: COLO
Conditionally Required: Complete if COLO SSI was validated at this facility.
Column 1: Month – enter month validated
Column 2: List the monthly count of COLO procedures in NHSN before external
validation
Column 3: Request that facility generate list of surgical procedures with any of the
ICD-9-CM Codes for COLO, as listed in the NHSN Manual Chapter 9, for specified
month(s) in the year. The list should include only patients undergoing COLO
procedures in the hospital inpatient operating room.
DENOMINATOR VALIDATION: HYST
Conditionally Required: Complete if HYST SSI was validated at this facility.
Column 1: Month – enter month validated
Column 2: List the monthly count of HYST procedures in NHSN before external
4

Documentation

validation
Column 3: Request that facility generate list of surgical procedures with any of the
ICD-9-CM Codes for HYST, as listed in the NHSN Manual Chapter 9, for the
specified month(s) in the year. The list should include only patients undergoing
HYST procedures in the hospital inpatient operating room.
DENOMINATOR VALIDATION: MRSA Bacteremia LabID Event & CDI LabID Event
Facility Audit
Conditionally Required: Complete if LabID Event validation for MRSA Bacteremia
Denominators: LabID
or CDI was validated at this facility and any inpatient location(s) was identified that
Event for MRSA
required mapping or re-mapping. For each inpatient location requiring changes to
Bacteremia and CDI:
mapping information:
Inpatient locations that
Column 1: Enter the facility inpatient location name
require mapping or reColumn 2: If location is currently mapped, specify location type. If location is
mapping in NHSN
currently not mapped, enter “not mapped”
Column 3: Enter current bed count
Column 4: Enter recommended mapping location type
Column 5: Enter recommended bed count
Add rows as needed
Facility Audit
Conditionally Required: Select Billing System, Admissions/Discharges/Transfers
Denominators: LabID
(ADT) System, Vendor System, or Other (explain). If Other is selected, provide
Event for MRSA
detail about how admissions are counted.
Bacteremia and CDI:
Admissions source
Facility Audit
Conditionally Required: Select Billing System, Admissions/Discharges/Transfers
Denominators: LabID
(ADT) System, Vendor System, or Other (explain). If Other is selected, provide
Event for MRSA
detail about how patient days are counted.
Bacteremia and CDI:
Patient Days source
Facility Audit
Conditionally Required: Select No or Yes to indicate whether any internal
Denominators: LabID
validation of LabID Event denominator data for the specified year was conducted
Event for MRSA
using the recommended method.
Bacteremia and CDI:
Internal Validation
Facility Audit
Conditionally Required: Complete if LabID Event validation for MRSA Bacteremia
Denominators: LabID
and/or CDI was validated at this facility. Internal validation guidelines for labID
Event for MRSA
event denominators recommend concurrent manual counting for at least one month,
Bacteremia and CDI:
along with normal “system” counting, in three different settings where errors are
Internal Validation
common; ICUs, labor/delivery/recovery/postpartum (LDRP) locations, and inpatient
Documentation
wards where “observation” or “obs” patients are commonly housed.
MRSA Bacteremia LabID event
Column 1: Enter location name and type
Additional rows can be added if needed.
Column 2: Select the month(s) when validation was conducted in this location
Column 3: Enter admissions to this location for the month as determined by the
usual system that counts for MRSA Bacteremia denominators
Column 4: Enter admissions to this location for the month as determined by manual
counting for MRSA Bacteremia denominators
Column 5: Enter patient days in this location for the month as determined by the
usual system that counts for MRSA Bacteremia denominators
5

Column 6: Enter patient days in this location for the month as determined by
manual counting for MRSA Bacteremia denominators
CDI LabID event
Column 1: Enter location name and type
Additional rows can be added if needed.
Column 2: Select the month(s) when validation was conducted in this location
Column 3: Enter admissions to this location for the month as determined by the
usual system that counts for CDI denominators
Column 4: Enter admissions to this location for the month as determined by manual
counting for CDI denominators
Column 5: Enter patient days in this location for the month as determined by the
usual system that counts for CDI denominators
Column 6: Enter patient days in this location for the month as determined by
manual counting for CDI denominators
RISK ADJUSTMENT VARIABLE VALIDATION
Correctly mapped ICUs #
Conditionally Required: Complete if ICU CLABSI or ICU CAUTI was validated
at this facility. Enter number of locations correctly mapped as ICUs (including
NICUs)
Non-ICUs mapped as ICUs # Conditionally Required: Complete if ICU CLABSI or ICU CAUTI was validated
at this facility. Enter number of non-ICU locations mapped as ICUs or NICUs
ICUs mapped as non-ICUs #
Conditionally Required: Complete if ICU CLABSI or ICU CAUTI was validated
at this facility. Enter number of ICU (or NICU) locations not mapped as ICUs or
NICUs
ICU mapping errors
(Autofill from above)
Reported Teaching Hospital
Conditionally Required: Complete if ICU CLABSI, ICU CAUTI, LabID Event
Affiliation (before validation) for MRSA Bacteremia or CDI was validated at this facility. Enter from NHSN
Annual Survey before audit; Major, Graduate, Undergraduate, or N/A (if IRF or
LTAC facility)
Correct teaching hospital
Conditionally Required: Complete if Complete if ICU CLABSI, ICU CAUTI,
affiliation
LabID Event for MRSA Bacteremia or CDI was validated at this facility. Select
Major, Graduate, or Undergraduate
Correct COLO ASA #
Conditionally Required: Complete if COLO was validated at this facility. Enter
number of times ASA score was correctly reported into NHSN as determined
during COLO validation
Correct HYST ASA #
Conditionally Required: Complete if HYST was validated at this facility. Enter
number of times ASA score was correctly reported into NHSN as determined
during HYST validation
Correct COLO Patient Age #
Conditionally Required: Complete if COLO was validated at this facility. Enter
number of times patient age was correctly reported into NHSN as determined
during COLO validation
Correct HYST Patient Age #
Conditionally Required: Complete if HYST was validated at this facility. Enter
number of times patient age was correctly reported into NHSN as determined
during HYST validation
Reported Facility Bed Size
Conditionally Required: Complete if LabID Event validation for MRSA
(before validation)
Bacteremia or CDI was validated at this facility. Enter from NHSN Annual
Survey before audit
Validated Facility Bed Size
Conditionally Required: Complete if LabID Event for MRSA Bacteremia or CDI
6

Facility Validation Comments

was validated at this facility. Enter number of staffed inpatient beds from all
inpatient locations, including “baby” locations. This number should exclude
outpatient locations such as ED, and “observation”.
(Optional): Consider additional comments regarding this facility’s validation

7