NHSN healthcare Personnel Safety Component Protocol: Healthcare Personnel Exposure Module

The National Healthcare Safety
Network (NHSN) Manual
HEALTHCARE PERSONNEL SAFETY
COMPONENT PROTOCOL:
Healthcare Personnel Exposure Module

Division of Healthcare Quality Promotion
National Center for Emerging, Zoonotic and Infectious Diseases
Atlanta, GA, USA

Last Updated January 1, 2013

Table of Contents
Chapter

Title

1

Introduction to the Healthcare Personnel Safety Component

2

Healthcare Personnel Safety Reporting Plan

3

Blood/Body Fluid Exposure Options (With and Without
Exposure Management)

4

Influenza Exposure and Treatment Option

5

Tables of Instructions

6

Key Terms

7

CDC Codes (Occupations, Devices and PEP Drugs)

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i

Introduction to the HPS Component of NHSN

Introduction to Healthcare Personnel Safety Component of NHSN
In recent years, occupational hazards faced by healthcare personnel (HCP) in the United States
have received increasing attention. Although recommendations, guidelines, and regulations to
minimize HCP exposure to such hazards have been developed, additional information is needed
to improve HCP safety. In particular, existing surveillance systems are often inadequate to
describe the scope and magnitude of occupational exposures to infectious agents and noninfectious occupational hazards that HCP experience, the outcomes of these exposures and
injuries, and the impact of preventive measures. The lack of ongoing surveillance of
occupational exposures, injuries, and infections in a national network of healthcare facilities
using standardized methodology also compromises the ability of the Centers for Disease
Prevention and Control (CDC) and other public health agencies to identify emerging problems,
to monitor trends, and to evaluate preventive measures.
The Healthcare Personnel Safety (HPS) Component of the National Healthcare Safety Network
(NHSN) was launched in 2009. The component consists of two modules: 1) Healthcare
Personnel Exposure; and (2) Healthcare Personnel Vaccination. The Healthcare Personnel
Exposure module includes: Blood/Body Fluid Exposure Only; Blood/Body Fluid Exposure with
Exposure Management; and Influenza Exposure Management. The Healthcare Personnel
Vaccination module includes: Influenza Vaccination Summary.
Data collected in this component of NHSN will help healthcare facilities, HCP organizations,
and public health agencies to monitor and report trends in blood/body fluid exposures, to assess
the impact of preventive measures, to characterize antiviral medication use for exposures to
influenza, and to monitor influenza vaccination rates among HCP. In addition, this surveillance
component will allow CDC to monitor national trends, to identify newly emerging hazards for
HCP, to assess the risk of occupational infection, and to evaluate measures, including
engineering controls, work practices, protective equipment, and post-exposure prophylaxis
designed to prevent occupationally-acquired infections. Hospitals and other healthcare facilities
participating in this system will benefit by receiving technical support and standardized
methodologies, including a web-based application, for conducting surveillance activities on
occupational health. The NHSN reporting application will enable participating facilities to
analyze their own data and compare these data with a national standard.

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Healthcare Personnel Safety Reporting Plan

Healthcare Personnel Safety Reporting Plan
The Healthcare Personnel Safety Monthly Reporting Plan Form (CDC 57.203) is
used by an NHSN facility to inform CDC which healthcare personnel safety modules are
used during a given month. This guides NHSN on what data to expect from the user in a
given month and allows CDC to select the data that should be included into the aggregate
data pool for analysis. Each participating facility is to enter a monthly plan to indicate the
module to be used, if any, and the exposures and/or vaccinations that will be monitored.
A plan must be completed for every month that data are entered into NHSN,
although a facility may choose “No NHSN Healthcare Personnel Safety Modules
Followed this Month” as an option. The Instructions for Completion of Healthcare
Personnel Safety Monthly Reporting Plan Form includes brief instructions for collection
and entry of each data element on the form.

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Blood/Body Fluid Exposure Option

Blood/Body Fluid Exposure Option
Introduction:
Transmission of bloodborne pathogens [e.g., Hepatitis B virus (HBV), Hepatitis C virus (HBC),
Human Immunodeficiency Virus (HIV)] from patients to healthcare workers (HCW) is an
important occupational hazard faced by healthcare personnel (HCP). The risk of bloodborne
pathogen transmission following occupational exposure depends on a variety of factors that
include source patient factors (e.g., titer of virus in the source patient’s blood/body fluid), the
type of injury and quantity of blood/body fluid transferred to the HCW during the exposure, and
the HCW’s immune status. The greatest risk of infection transmission is through percutaneous
exposure to infected blood. Nevertheless, transmission of HBV, HCV, or HIV after mucous
membrane or non-intact skin exposure to blood has also been reported. The risk of transmission
of these pathogens through mucocutaneous exposure is considered lower than the risk associated
with a percutaneous exposure.
An estimated 385,000 percutaneous injuries (i.e., needlesticks, cuts, punctures and other injuries
with sharp objects) occur in U.S. hospitals each year. Prevention of occupational transmission of
bloodborne pathogens requires a diversified approach to reduce blood contact and percutaneous
injuries including improved engineering controls (e.g., safer medical devices), work practices
(e.g., technique changes to reduce handling of sharps), and the use of personal protective
equipment (e.g., impervious materials for barrier precautions). Since 1991, when the U.S.
Occupational Safety and Health Administration (OSHA) first issued its Bloodborne Pathogens
Standard, the focus of regulatory and legislative activity has been on implementing a hierarchy
of control measures. The federal Needlestick Safety and Prevention Act signed into law in
November 2000 authorized OSHA’s revision of its Bloodborne Pathogens Standard to more
explicitly require the use of safety-engineered sharp devices.
(http://www.osha.gov/SLTC/bloodbornepathogens/). Other strategies to prevent infection
include hepatitis B immunization and postexposure prophylaxis for HIV and HBV. Strategies for
prevention of percutaneous injuries are addressed in CDC’s Workbook for Designing,
Implementing, and Evaluating a Sharps Injury Prevention Program at
http://www.cdc.gov/sharpssafety/index.html.
Facilities are not required to collect data for exposures that involve intact skin or exposures to
body fluids that do not carry a risk of bloodborne pathogen transmission (e.g., feces, nasal
secretions, saliva, sputum, sweat, tears, urine and vomitus) unless these are visibly contaminated
with blood. However, facilities that routinely collect data on such exposures may enter this
information into the system.

(i) Methodology
Occupational exposures to blood and body fluids in healthcare settings have the potential to
transmit HBV, HCV, or HIV. Use of the Blood/Body Fluid Exposure Option permits a

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Blood/Body Fluid Exposure Option

healthcare facility to record information about the exposure and its management. This option can
be used in any healthcare setting where there is potential for occupational exposure to blood and
body fluids among HCP. This option requires that data be entered into NHSN when exposures
occur, as indicated in the Healthcare Personnel Safety Monthly Reporting Plan (CDC 57.203). In
general, these data may be provided by the occupational health department in the facility or may
be provided by the infection control/epidemiology department, as appropriate. NHSN forms
should be used to collect all required data, using the definitions included for each data field.
Blood/Body Fluid Exposure with or without Exposure Management
A facility may choose to report exposure events alone or exposure events and subsequent
management and follow-up of each event, including administration of postexposure prophylaxis
(PEP) to the HCW and any laboratory test results collected as part of exposure management.
Settings: Any healthcare setting with the potential for occupational exposure to blood and body
fluids.
Requirements: Blood and body fluid exposures are to be reported as they occur during the
calendar year.
Definitions:
• Bite: A human bite sustained by a HCW from a patient, other HCW, or visitor.
• Bloodborne pathogens: Pathogenic microorganisms that may be present in human blood and
can cause disease in humans. These pathogens include, but are not limited to hepatitis B virus
(HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV).
• HCW (Healthcare Worker): A person who works in the facility, whether paid or unpaid,
who has the potential for exposure to infectious materials, including body substances,
contaminated medical supplies and equipment, contaminated environmental surfaces, or
contaminated air. Healthcare worker is the singular form of healthcare personnel.
• HCP (Healthcare Personnel): A population of healthcare workers working in a healthcare
setting.
• Hollow-bore needle: Needle (e.g., hypodermic needle, phlebotomy needle) with a lumen
through which material (e.g., medication, blood) can flow.
• Mucous membrane exposure: Contact of mucous membrane (e.g., eyes, nose, or mouth)
with the fluids, tissues, or specimens listed below in "Occupational exposure."
• Non-intact skin: Areas of the skin that have been opened by cuts, abrasions, dermatitis,
chapped skin, etc.

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Blood/Body Fluid Exposure Option

• Non-intact skin exposure: Contact of non-intact skin with the fluids, tissues, or specimens
listed below in "Occupational exposure."
• Non-Responder to Hepatitis B vaccine: A HCW who has received two series of hepatitis B
vaccine is serotested within 2 months after the last dose of vaccine and does not have antiHBs ≥10 mIU/mL.
• Occupational exposure: Contact with blood, visibly bloody fluids, and other body fluids
(i.e., semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal
fluid, pericardial fluid, and amniotic fluid, tissues, and laboratory specimens that contain
concentrated virus) to which Standard Precautions apply and during the performance of an
HCW’s duties. Modes of exposure include percutaneous injuries, mucous membrane
exposures, non-intact skin exposures, and bites.
• Percutaneous injury: An exposure event occurring when a needle or other sharp object
penetrates the skin. This term is interchangeable with “sharps injury.”
• Sharp: Any object that can penetrate the skin including, but not limited to, needles, scalpels,
broken glass, broken capillary tubes, and exposed ends of dental wires.
• Sharps Injury: An exposure event occurring when any sharp object penetrates the skin. This
term is interchangeable with “percutaneous injury.”
• Solid Sharp: A sharp object (e.g., suture needle, scalpel) that does not have a lumen through
which material can flow.
Reporting Instructions:
Forms Description and Purpose: (See also: Tables of Instructions for Completion of Healthcare
Personnel Safety Component forms)
All NHSN facilities following the Blood/Body Fluids Exposure Option:
For either exposure reporting or exposure and exposure management reporting, a site should
complete the following form:
 Healthcare Personnel Safety Component Facility Survey (CDC Form 57.200) – Used
to collect facility administrative data including total patient beds set up and staffed,
annual inpatient days, number of patient admissions per year, number of annual
outpatient encounters, number of annual employee hours worked. The survey also
collects annual data on the total number of HCP in selected occupational groups (fulltime equivalents and numbers of HCP, full or part-time).
 Healthcare Personnel Safety Monthly Reporting Plan (CDC Form 57.203) – Used to
collect data on which modules and which months a facility intends to participate in

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Blood/Body Fluid Exposure Option

the NHSN HPS Component. This form should be completed for every month that the
facility will participate in the HPS component.

Exposure-Only Reporting:
Those facilities participating in exposure-only reporting should complete the following forms:
 Healthcare Worker Demographic Data (CDC Form 57.204) – Used to collect data on
HCW demographics such as gender and occupation for a healthcare worker who has
reported a blood or body fluid exposure.
 Exposure to Blood/Body Fluids (CDC Form 57.205) – Used to collect information
about individual blood and body fluid exposure events. Sections I – IV should be
completed for all reported exposures. For percutaneous injuries with a needle or sharp
object that was not in contact with blood or other body fluids (as defined in
“occupational exposure”) prior to exposure, the completion of Sections V-IX is not
required.
Exposure and Exposure Management Reporting:
Facilities participating in exposure reporting and exposure management should complete the
forms:
 Healthcare Worker Demographic Data (CDC Form 57.204) – Used to collect data on
HCW demographics such as gender and occupation for a healthcare worker who has
reported a blood or body fluid exposure.
 Exposure to Blood/Body Fluids (CDC Form 57.205) – Used to collect information
about individual blood and body fluid exposure events. Sections I – IV should be
completed for all reported exposures. If a facility chooses to follow the protocol for
exposure management, Sections V – IX are also required.
 Healthcare Worker Prophylaxis/Treatment – BBF Postexposure Prophylaxis (PEP)
(CDC Form 57.206) – Used to collect details of medications administered to a
healthcare worker following blood or body fluid exposure to HIV or HBV.
 Follow-Up Laboratory Testing (CDC Form 57.207) – Used to collect additional
laboratory testing results obtained on an HCW following a blood or body fluid
exposure as part of exposure management. These serologic and other laboratory
results are not required for exposure management but provide details for facilities
opting for the long-term follow-up of exposures and evidence of seroconversion.
Data Analysis:
The use of the Blood/Body Fluid Exposure and Exposure Management Options will allow the
participating NHSN site to estimate the nature, frequency, circumstances, and sequelae of
occupational exposures to bloodborne pathogens (i.e., HBV, HCV, and/or HIV) through

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Blood/Body Fluid Exposure Option

percutaneous injuries, bites, mucous membrane exposures or non-intact skin exposures. In
addition, facilities can assess for changes in percutaneous injuries with the implementation of
safety devices and other prevention strategies, the timeliness of initiating HIV postexposure
prophylaxis (PEP) when indicated, assess the duration of HIV prophylaxis, and the proportion of
HCP experiencing adverse signs and symptoms after taking HIV PEP for occupational
exposures.
Denominator data from the annual Facility Survey (CDC 57.200) can be used to estimate
rates of exposures to blood/body fluids and to assess the effectiveness of engineering controls,
work practices, and protective equipment in reducing exposure.
References:
The following CDC/PHS publications provide recommendations for management and follow-up
of blood and body fluid exposures to HBV, HCV, and HIV:
•
•

•

Updated U.S. Public Health Service Guidelines for the Management of Occupational
Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis
(MMWR, June 29, 2001 / 50(RR11); 1-42)
Updated U.S. Public Health Service Guidelines for the Management of Occupational
Exposures to HIV and Recommendations for Postexposure Prophylaxis (MMWR,
September 30, 2005 / 54(RR09); 1-17). (PEP medications are updated in NHSN as
required)
A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus
Infection in the United States. (MMWR), December 8, 2006 / 55(RR16); 1-25)

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Influenza Exposure Management Option

Influenza Exposure Management Option
Introduction: The Advisory Committee on Immunization Practices (ACIP) recommends that all
healthcare personnel (HCP) and persons in training for healthcare professions should be
vaccinated annually against influenza.[1,2] Persons who are infected with influenza virus,
including those with subclinical infection, can transmit influenza virus to persons at higher risk
for complications from influenza. Vaccination of HCP has been associated with reduced work
absenteeism [3] and with fewer deaths among nursing home patients [4,5] and elderly
hospitalized patients.[5] Although annual vaccination is recommended for HCP and is a high
priority for reducing morbidity associated with influenza in healthcare settings, national survey
data have demonstrated vaccination coverage levels of <50% among HCP over several
vaccination seasons.[1]
Although annual vaccination with the seasonal influenza vaccine is the best way to prevent
infection, antiviral drugs can be effective for prevention and treatment of influenza. When HCP
have not been vaccinated or are exposed to an influenza strain with no vaccine coverage (i.e.,
non-seasonal), a plan for anti-viral chemoprophylaxis and treatment could be implemented.
Influenza Exposure Management Option
Use of the Influenza Exposure Management Option permits a healthcare facility to record
information on antiviral medication use for chemoprophylaxis or treatment without reporting
influenza vaccination. It can be used in any healthcare setting. This option includes reporting of
individual-level antiviral medication use for chemoprophylaxis or treatment after exposure to
influenza. The reason for antiviral medication use can be attributed to either seasonal or nonseasonal influenza. Use of this option will allow facilities and CDC to measure antiviral
medication use related to the prevention and treatment of influenza.
Settings: Any healthcare settings
Requirements: Surveillance for influenza in the healthcare facility is to be conducted during the
vaccination season.
Definitions:
• HCW (Healthcare Worker): A person who works in the facility, whether paid or unpaid,
who has the potential for exposure to infectious materials, including body substances,
contaminated medical supplies and equipment, contaminated environmental surfaces, or
contaminated air. Healthcare worker is the singular form of healthcare personnel.
• HCP (Healthcare Personnel): The entire population of healthcare workers working in a
healthcare setting.

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Influenza Exposure Management Option

• Non-seasonal influenza vaccine: A vaccine for additional/novel influenza virus strains
(e.g., 2009 H1N1) not included in the seasonal influenza vaccine which may or may not be
offered on an annual basis.
• Seasonal influenza vaccine: A vaccine for seasonal influenza virus strains that is offered on
an annual basis.
• Severe adverse reaction to antiviral medication use for influenza chemoprophylaxis or
treatment: Adverse reactions severe enough to affect daily activities and/or result in the
discontinuation of the antiviral medication.
• Vaccination season: A 12-month period starting from July 1 of a year – June 30 of the
following year.
Reporting Instructions
Forms Description and Purpose: (See also: Tables of Instructions for Completion of Healthcare
Personnel Safety Component forms)
All NHSN facilities following the Influenza Exposure Management Option:
NHSN participants should complete the following forms:
 Healthcare Personnel Safety Component Facility Survey (CDC 57.200) – Used to collect
facility administrative data including total patient beds set up and staffed, annual
inpatient days, number of patient admissions per year, number of annual outpatient
encounters, number of annual employee hours worked. The survey also collects annual
data on the total number of HCP in selected occupational groups (full-time equivalents
and numbers of HCP, full or part-time). Numbers of HCWs for at least one nurse
occupation (e.g., registered nurse, nurse midwife) and one physician occupation (i.e.,
intern/resident, fellow, attending physician) are required. All other fields are optional for
the Selected HCW Occupational Groups; you may enter 0 for these optional fields.
 Healthcare Personnel Safety Monthly Reporting Plan (CDC 57.203) – Used to collect
data on which modules and which months a facility intends to participate in the NHSN
HPS Component. This form should be completed for every month that the facility will
participate in the HPS Component.
 Healthcare Worker Demographic Data (CDC 57.204) – Used to collect data on HCW
demographics such as gender and occupation for each individual HCW. This form also is
used optionally to collect information about immune status for certain vaccinepreventable diseases (e.g., measles, mumps, rubella).
Influenza Exposure Management Reporting:

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Influenza Exposure Management Option

Facilities participating in influenza exposure management reporting for antiviral medication use
should complete the following form:
 Healthcare Worker Prophylaxis/Treatment – Influenza (CDC 57.210) – Used to collect
data on which (if any) antiviral medications were administered to the HCW and any
severe adverse reactions associated with their use.

Data Analyses:
The use of the Influenza Exposure Management Option will allow facilities and CDC to measure
antiviral medication use related to the prevention and treatment of influenza. Antiviral
medication use for chemoprophylaxis or treatment after exposure to influenza can be evaluated
and monitored. Frequencies and trends of antiviral medication use as a result of potential or
confirmed exposures to influenza will be calculated and summarized. Also, frequency estimates
of the personnel types and clinical areas more likely to require chemoprophylaxis or treatment
may be analyzed as well as information on adverse effects associated with the receipt of antiviral
medications (as part of chemoprophylaxis or treatment).

References:
[1] Centers for Disease Control and Prevention, Prevention and control of seasonal influenza
with vaccines: Recommendations of the Advisory Committee on Immunization Practices
(ACIP), 2009, MMWR, 58 (2009) 1-52.
[2] Centers for Disease Control and Prevention, Influenza vaccination of health-care personnel,
MMWR, 55 (2006) 1-16.
[3] R. T. Lester, A. McGeer, G. Tomlinson, and A. S. Detsky, Use of, effectiveness of,
attitudes regarding influenza vaccine among house staff, Infection Control and Hospital
Epidemiology, 24 (2003) 839-844.
[4] J. Potter, D. J. Stott, M. A. Roberts, A. G. Elder, B. ODonnell, P. V. Knight, and W. F.
Carman, Influenza vaccination of health care workers in long-term-care hospitals reduces
the mortality of elderly patients, Journal of Infectious Diseases, 175 (1997) 1-6.
[5] R. E. Thomas, T. O. Jefferson, V. Demicheli, and D. Rivetti, Influenza vaccination for
health-care workers who work with elderly people in institutions: a systematic review,
Lancet Infectious Diseases, 6 (2006) 273-279.

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NHSN Healthcare Personnel Safety Component
Tables of Instructions

Tables of Instructions
TABLE

CDC
FORM

1

57.203

Instructions for completion of the Healthcare Personnel
Safety Monthly Reporting Plan form

2

2

57.204

Instructions for completion of the Healthcare Worker
Demographic Data form

3

3

57.205

Instructions for completion of the Exposure to Blood/Body
Fluids form

5

4

57.206

Instructions for completion of the Healthcare Worker
Prophylaxis/Treatment – BBF Postexposure Prophylaxis
(PEP) form

14

5

57.207

Instructions for completion of the Follow-up Laboratory
Testing form

16

6

57.210

Instructions for completion of the Healthcare Worker
Prophylaxis/Treatment – Influenza form

17

7

57.200

Instructions for completion of the Healthcare Personnel
Safety Component – Annual Facility Survey form

19

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TITLE

PAGE

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NHSN Healthcare Personnel Safety Component
Tables of Instructions

Table 1. Instructions for Completion of the Healthcare Personnel Safety
Monthly Reporting Plan Form (CDC 57.203)
This form collects data on which options and which months a facility intends to participate in NHSN
Healthcare Personnel Safety (HPS) Component. This form should be completed for every month that the
facility will participate in the HPS Component.
Data Field

Instructions for Data Collection
Required. The NHSN-assigned facility ID will be autoentered by the application.
Required. Enter the month and year for the surveillance
plan being recorded.
Conditionally required. Check this box if you do not plan
to follow any of the NHSN Healthcare Personnel Safety
Modules during the month and year selected.

Facility ID #
Month/Year
No NHSN Healthcare Personnel Safety
Modules Followed this Month

Healthcare Personnel Exposure Module
Conditionally required. Check this box if you plan to
follow blood/body fluid exposures only, without
following exposure management during the month and
year selected.
Conditionally required. Check this box if you plan to
follow blood/body fluid exposure with exposure
management during the month and year selected.
Conditionally required. Check this box if you plan to
follow influenza exposure management (i.e., antiviral
chemoprophylaxis and/or treatment)

Blood/Body Fluid Exposure Only

Blood/Body Fluid Exposure with Exposure
Management
Influenza Exposure Management

Healthcare Personnel Vaccination Module
Conditionally required. Check this box if you plan to
follow the influenza vaccination summary option. Once
the influenza vaccination summary is selected on the
reporting plan, it is automatically updated with this
information for the entire NHSN-defined influenza
season (July 1 to June 30).

Influenza Vaccination Summary

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NHSN Healthcare Personnel Safety Component
Tables of Instructions

Table 2. Instructions for Completion of the Healthcare Worker Demographic
Data Form (CDC 57.204)
This form must be completed for all HCP who have information recorded in HPS component of NHSN
(e.g., exposure to blood or body fluid or influenza vaccination.) Alternatively, data for all or selected
personnel can be imported from the facility’s personnel database at facility enrollment.

Data Field
Facility ID #
HCW ID #
Social Security #
Secondary ID #
HCW Name:
Last, First, Middle
Street Address
City
State
Zip Code
Home Phone
E-mail Address
Gender
Date of birth
Born in the U.S.?
Ethnicity
Race
Work Phone
Start Date
Work Status
Type of Employment
Work Location

Department

Instructions for Data Collection
Required. The NHSN-assigned facility ID will be auto-entered by the application.
Required. Enter the healthcare worker’s (HCW) alphanumeric identification
number. This identifier is unique to the healthcare facility.
Optional. Enter the HCW’s Social Security Number.
Optional. Enter the HCW’s secondary ID number. This could be the employee’s
medical record # or some other unique identifier.
Optional. Enter demographic information for the HCW.

Required. Indicate the gender of the HCW by checking F (Female) or M (Male).
Required. Enter the date of birth of the HCW using the format: mm/dd/yyyy.
Optional. Select Yes, No, or Unknown.
Optional. Select one ethnicity of the HCW.
Optional. Select the race of the HCW. Check all that apply.
Optional. Enter the work phone number of the HCW.
Required. Enter the date the HCW began employment or affiliation with the facility
(use format: mm/dd/yyyy).
Required. Select Active, Inactive, or No longer affiliated.
Required. Select from Full-time, Part-time, Contract, Volunteer, Other (please
specify).
Required. Select the code that best describes the HCW’s current permanent work
location. This refers to physical work location rather than to department
assignment. For example, a radiology technician who spends most of his/her time
performing portable x-rays throughout the facility works at multiple locations. In
general, most interns/residents are not considered to work at a single location
because they rotate every month or every few months. For HCP who do not work
at least 75% of the time at a single location, the work location code for ‘float’
should be entered. Location codes must be customized to the facility and set up
prior to entering HCW records. The work location must be mapped to a CDC
Location (http://www.cdc.gov/nhsn/PDFs/master-locations-descriptions.pdf).
Optional. Enter the department in which the HCW works (facility defined).

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NHSN Healthcare Personnel Safety Component
Tables of Instructions

Data Field
Supervisor
Occupation

Title

Clinical specialty
Performs direct
patient care

Custom Fields

Comments

Instructions for Data Collection
Optional. Enter the name of the HCW’s supervisor (facility defined).
Required. Select the occupation code that most appropriately describes the HCW’s
job. These must be customized to the facility and set up prior to entering HCW
records. The occupation must be mapped to a CDC Occupation Code.
Conditionally required. Required only for HCP designated as Influenza
Vaccinators if the facility intends on using NHSN to fulfill federal recordkeeping
requirements for administration of vaccine covered by the Vaccine Injury
Compensation Program. Enter the HCW’s job title.
Conditionally required. If Occupation is physician, fellow or intern/resident, select
the appropriate clinical specialty.
Conditionally required. Required only when the HCW has influenza vaccination
and/or influenza chemoprophylaxis/treatment records. Select Y (Yes) if the HCW
provides direct patient care (i.e., hands on, face-to-face contact with patients for the
purpose of diagnosis, treatment and monitoring); otherwise select N (No).
Optional. Up to two date fields, two numeric fields, 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. Enter any information about the HCW. This information cannot be
analyzed.

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NHSN Healthcare Personnel Safety Component
Tables of Instructions

Table 3. Instructions for Completion of the Exposure to Blood/Body Fluids
Form (CDC 57.205)
Information for all blood/body fluid exposures should be recorded using this form. The variables to be
entered depend upon whether the facility selects the exposure event only reporting or exposure reporting
and management.
♦

Demographic data auto-entered by application if part of an existing HCW Demographic Data record (CDC 57.204).

Data Field
Facility ID #
Exposure Event #
HCW ID
♦

HCW Name:
Last, First, Middle
♦
Gender

Instructions for Data Collection
The NHSN-assigned facility ID will be autoentered by the application.
The exposure event number will be autogenerated by the application.
Enter the HCW’s alphanumeric identification
number. This identifier is unique to the
healthcare facility.
Enter the HCW’s name.

Indicate the gender of the HCW by checking F
(Female) or M (Male).
♦
Date of Birth
Enter the date of birth of the HCW using the
format: mm/dd/yyyy.
♦
Work Location
Required. Select the code that best describes the
HCW’s current permanent work location. This
refers to physical work location rather than to
department assignment. Location codes are
customized to the facility and set up prior to
entering HCW records. See Table 2 for more
details.
♦
Occupation
Required. Select the occupation code that most
appropriately describes the HCW’s job.
Occupation codes are customized to the facility
and set up prior to entering HCW records. See
Table 2 for more details.
Clinical Specialty
If Occupation is physician, fellow or
intern/resident, enter the appropriate clinical
specialty. The list of clinical specialties can be
found on Form CDC 57.204.
Exposure Type
The default setting is auto-entered by the
application as Blood/Body Fluids.
Section I – General Exposure Information
1. Did the exposure
Choose Y (Yes) or N (No).
occur at this facility

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Exposure
Event Only
Required

Exposure Event
and Exposure
Management
Required

Required

Required

Required

Required

Optional

Optional

Required

Required

Required

Required

Required

Required

Required

Required

Conditionally
required

Conditionally
required

Required

Required

Required

Required

NHSN Healthcare Personnel Safety Component
Tables of Instructions

Data Field
1a. If No, specify the
name of facility in
which exposure
occurred
2. Date of exposure
3. Time of exposure
4. Number of hours
on duty
5. Is exposed person
a temp/agency
employee?
6. Location where
exposure occurred
7. Type of Exposure
7a. Percutaneous:

Did the exposure
involve a clean,
unused needle or
sharp object?

7b. Mucous
membrane

7c. Skin:

Was skin intact?

Exposure
Event Only
Conditionally
required

Exposure Event
and Exposure
Management
Conditionally
required

Enter date of exposure in mm/dd/yyyy format.
Enter the time the exposure occurred and
whether it was AM or PM.
Enter the number of hours the HCW had been
on duty when the exposure occurred.
Choose Y (Yes) or N (No).

Required
Required

Required
Required

Optional

Optional

Optional

Optional

Choose the appropriate code for the physical
location where the event took place. (This is
customized to the facility).
Check the appropriate exposure type. Check all
that apply.
If Type of Exposure was Percutaneous, then
check this item.

Required

Required

Required

Required

Conditionally
required

Conditionally
required

If percutaneous is checked, then select Yes or
No to indicate whether the exposure involved a
clean, unused needle or sharp object. If the
incident involved a clean, unused needle or
sharp object you may not need to report this as
an exposure (see your protocol for more
information). If not, check No and complete Q8,
Q9 and Section II. If following the protocol for
exposure management also complete Sections
V-XI.
If Type of Exposure was Mucous Membrane,
then check this item and complete Q8, Q9 and
Section III. If following the protocol for
exposure management also complete Sections
V-XI.
If Type of Exposure was Skin, then check this
item.

Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

If Skin is checked, then indicate Y (Yes), N
(No) or (U) Unknown for whether the skin
remained intact during the exposure. If the
answer is No, complete Q8, Q9 and Section III.
If following the protocol for exposure
management also complete Sections V-XI.

Conditionally
required

Conditionally
required

Instructions for Data Collection
If the exposure did not occur at the reporting
facility, enter the name of the facility where the
event occurred.

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Data Field
7d. Bite

8. Type of
fluid/tissue involved
in exposure

9. Body site of
exposure

Exposure
Event Only
Conditionally
required

Exposure Event
and Exposure
Management
Conditionally
required

Required

Required

If Solutions or Body fluids are checked, indicate
whether visibly bloody or not visibly bloody.
For Body Fluids, indicate the primary body
fluid type implicated in the exposure from the
list.

Conditionally
required

Conditionally
required

If Other is selected for either the Type of
Fluid/Tissue involved in the exposure or the
Body Fluid Type, please specify the type.
(Make sure it is not a body fluid that is already
listed in the box on the right side of the form).
Check body site of exposure from the list.
Check all sites that were exposed.

Conditionally
required

Conditionally
required

Required

Required

Conditionally
required

Conditionally
required

Required

Required

Conditionally
required

Conditionally
required

Instructions for Data Collection
If Type of Exposure was Bite, then check this
item and complete Q9 and Section IV. If
following the protocol for exposure
management also complete Sections V-XI.
Select the Type of fluid/tissue from the list.

If the Body site of exposure was (Other), please
specify the site.
Section II – Percutaneous Injury
1. Was the needle or Choose Y (Yes) or N (No).
sharp object visibly
contaminated with
blood prior to
exposure?
2. Depth of the
Indicate the depth of the injury from the needle
injury (check one)
or sharp object using the list provided.
Exposures that are not obviously superficial
(e.g., scratch) or deep (e.g., “muscle contracted”
or “touched bone”), should be classified as
moderate.

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Data Field
3. What needle or
sharp object caused
the injury?

Exposure
Event Only
Conditionally
required

Exposure Event
and Exposure
Management
Conditionally
required

Conditionally
required

Conditionally
required

If Other known device is selected, please
specify.
Enter the brand name and model of the device
used. If the brand and model are unknown,
generic device descriptors can be entered.
Choose Y (Yes) or N (No).
If Yes, answer 5a and 5b. If No, skip to Q6.

Conditionally
required
Conditionally
required

Conditionally
required
Conditionally
required

Conditionally
required

Conditionally
required

If above is Y (Yes), choose one item from the
list of safety devices.

Conditionally
required

Conditionally
required

Choose the timing of the injury event with
relation to the use of the safety device. Check
one item from the list provided.

Conditionally
required

Conditionally
required

Instructions for Data Collection
Select one of the following categories: Device,
Non-Device Sharp Object, or Unknown Sharp
Object. If you select Device in the application
you will be provided with a Device button that
will take you to a screen to enter manufacturer,
model, etc. Once a device has been entered you
will be able to select it from the drop down list.
If a Non-Device Sharp is selected, please
describe the item or object.
Within Devices, there are six categories:
Hollow-bore needles, Suture needles, Other
solid sharps, Glass, Plastic, Non-sharp safety
devices, and Other devices.

4. Manufacturer and
model
5. Did the needle or
other sharp object
involved in the
injury have a safety
feature?
5a. If Yes, indicate
the type of safety
feature
5b. If the device had
a safety feature,
when did the injury
occur?

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Data Field
6. When did the
injury occur?
(check one)
Before use of the
item

Instructions for Data Collection
Choose the timing of the injury event from the
list provided.

During use of the
item

Injuries that occurred during the use of the
needle or sharp object. It also includes surgical
or other invasive procedures with many steps.

After use of item,
before disposal

Injuries that occurred while in transit to
disposal, cleaning instrument or recapping.

During or after
disposal

Injuries that occurred during or after the process
of disposal or because of improper disposal of a
needle or other sharp object.

Unknown

Time of injury relative to the use of the device
or object is unknown.
Choose from the lists provided. If Other specify
the purpose in the space provided.

7. For what purpose
or activity was the
sharp device being
used?

8. What was the
activity at the time
of injury?

Exposure
Event Only
Conditionally
required

Exposure Event
and Exposure
Management
Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

Injuries that occurred prior to intended use and
usually involve clean needles or sharp objects. It
may also include injuries that occurred with a
clean device that passed through bloody gloves.

Select Unknown if injury was a result of contact
with discarded or uncontrolled sharps, or in
circumstances where the intent of device or
object use is unknown or cannot be ascertained.
Choose the activity being performed at the time
of injury involving the sharp object or needle. If
the activity being performed at the time of the
injury was different than the purpose indicated
in Q7, select the activity at the time the actual
injury event took place.
Select one answer.

9. Who was holding
the device at the
time the injury
occurred?
10. What happened
Choose one item from the list.
when the injury
If Other, please record details in the space
occurred?
provided.
Section III – Mucous Membrane and/or Skin Exposure
1. Estimate the
Select the estimated amount of blood or body
amount of
fluid involved in the mucous membrane or skin
blood/body fluid
exposure. Indicate Unknown if unable to
exposure
estimate the amount.

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Data Field
2. Activity/event
when exposure
occurred
3. Barriers used by
the worker at the
time of exposure
Section IV – Bite
1. Wound
description
2. Activity/event
when exposure
occurred

Exposure
Event Only
Conditionally
required

Exposure Event
and Exposure
Management
Conditionally
required

If Other is selected record details of the activity
or event in the space provided.
Check all that apply.

Conditionally
required
Conditionally
required

Conditionally
required
Conditionally
required

If Other is selected, list other barriers in the
space provided.

Conditionally
required

Conditionally
required

Select the description of the bite wound from
the list provided.
Choose the activity or event when the bite
occurred.

Conditionally
required
Conditionally
required

Conditionally
required
Conditionally
required

Instructions for Data Collection
Select the activity or event at the time mucous
membrane or skin exposure occurred.

If Other, specify the event in the space
Conditionally Conditionally
provided.
required
required
Sections V – IX are required when following the protocols for Exposure Management
Section V – Source Information
1. Was the source
Choose Y (Yes) if the source of the exposure
Optional
Required
patient known?
(patient) is known. Otherwise, select N (No).
2. Was HIV status
Indicate Y (Yes) if the source patient’s
Optional
Required
known at time of
serostatus was known at the time of exposure.
exposure?
3. Check the test
Use codes: P= positive, N= negative,
Optional
Required
results for the source I=Indeterminate, U=Unknown, R=Refused and
patient:
NT=Not tested.
Hepatitis B
HbsAg
HBeAg
Total anti-HBc
anti-HBs
Hepatitis C
anti-HCV EIA
anti-HCV suppl
PCR-HCV RNA
HIV
HIV EIA, ELISA
Rapid HIV
Confirmatory HIV

Indicate the results of any tests performed prior
to the exposure (as found in the medical record)
or performed immediately after the exposure. If
the source is not known, check U. If the source
refuses to be tested, check R. Not all tests listed
on the form need to be offered after all
exposures.

Section VI – For HIV Infected Source
1. Stage of Disease
Indicate the stage of HIV disease of the source
patient. Use CDC surveillance definitions. For
end stage AIDS and acute HIV illness, use
definitions as defined in the protocol.
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Optional

Conditionally
required

NHSN Healthcare Personnel Safety Component
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Data Field
2. Is the source
patient taking antiretroviral drugs?
2a. If Yes, indicate
drug(s)

3. Most recent CD4
count

Instructions for Data Collection
Indicate if the source patient is was taking antiretroviral drugs at the time of the exposure, Y
(Yes), N (No), or U (Unknown).
If the source patient was taking anti-retroviral
drugs at the time of the exposure, list them here.
Drug codes are listed in Chapter 7 and will be in
a drop down list in the application.
If available, indicate the most recent CD4 count
in mm3 for the source patient.

Exposure
Event Only
Optional

Exposure Event
and Exposure
Management
Conditionally
required

Optional

Conditionally
required

Optional

Conditionally
required

Optional

Conditionally
required

Optional

Required

Optional
Choose Y (Yes), N (No), or U (Unknown) if
antiretroviral drugs were taken by the HCW. If
Yes is selected, complete Post-Exposure
Prophylaxis/Treatment form (CDC form
57.206).
Choose Y (Yes), N (No), or U Unknown) for
Optional
whether Hepatitis B immunoglobulin was given.

Required

Date

Enter the month and year of the test for the
source patient.
4. Viral Load
If available, indicate the most recent HIV viral
load (# of copies per ml) or Undetectable for the
source patient.
Date
Enter the month and year of the test.
Section VII: Initial Care Given to Healthcare Worker
1. HIV postexposure
prophylaxis
Offered?

Taken?

2. HBIG given?

Date administered

3. Hepatitis B
vaccine given?
Date first dose
administered

Choose Y (Yes), N (No), or U (Unknown) if
antiretroviral drugs were offered to the HCW
following this exposure.

Enter date HBIG prophylaxis pertaining to this
exposure was administered. Use mm/dd/yyyy
format.
Choose Y (Yes), N (No), or U. (Unknown) for
whether Hepatitis B vaccine was given after
exposure.
Enter date of first dose of Hepatitis B vaccine
(mm/dd/yyyy format). This and subsequent
doses to complete the HBV series should be
recorded in the HCW’s file.

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Required

Optional

Conditionally
Required

Optional

Required

Optional

Conditionally
Required

NHSN Healthcare Personnel Safety Component
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Exposure
Event Only
Optional

Data Field
4. Is the HCW
pregnant?
4a. If yes, which
trimester?

Instructions for Data Collection
Indicate the pregnancy status of HCW. Choose
Y (Yes), N (No), or U (Unknown).
Check 1 (1st trimester), 2 (2nd trimester), or 3
Optional
(3rd trimester) at the time of exposure. If stage of
pregnancy is unknown, check U.
Section VIII – Baseline Lab Testing
Was baseline testing Choose Y (Yes) or N (No) or U (Unknown).
Optional
performed on the
Baseline lab tests should be performed within
HCW?
hours of the exposure .
HIV EIA
Enter the dates for each test performed and the
Optional
HIV confirmatory
result (Use codes: P= Positive, N= Negative,
HepC anti-HCV EIA
I=Indeterminate, U=Unknown, R=Refused).

Exposure Event
and Exposure
Management
Conditionally
required
Conditionally
required

Required

Conditionally
required

HepC anti-HCV-supp
HepC PCR HCV RNA
HepB HBsAg
HepB IgM anti-Hbc
HepB Total anti-Hbc
HepB Anti-HBs
ALT
Amylase
Blood glucose
Hematocrit
Hemoglobin
Platelets
Blood cells in urine
WBC
Creatinine
Other

Additional baseline laboratory tests may be
completed to document potential physiologic
changes associated with a blood/body fluid
exposure. Enter the date (in mm/dd/yyyy
format) and result, using the specified units.

Section IX – Follow-up
1. Is it recommended Choose Y (Yes) or N (No).
that the HCW return
for follow-up of this
exposure?
1a. If Yes, will
Choose Y (Yes) or N (No).
follow-up be
performed at this
facility?
Section X – Narrative
In the worker’s
Enter the narrative of the HCW’s description of
words, how did the
how the injury occurred.
injury occur?
Section XI – Prevention

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Optional

Optional

Optional

Required

Optional

Conditionally
Required

Optional

Optional

NHSN Healthcare Personnel Safety Component
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Data Field
In the worker’s
words, what could
have prevented the
injury?
Custom Fields

Comments

Instructions for Data Collection
Enter the narrative of the HCW’s assessment of
how the injury might have been prevented.

Up to two date fields, two numeric fields, 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.
Enter any additional information about the
HCW. CDC will not analyze this information.

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Exposure
Event Only
Optional

Exposure Event
and Exposure
Management
Optional

Optional

Optional

Optional

Optional

NHSN Healthcare Personnel Safety Component
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Table 4. Instructions for Completion of the Healthcare Worker
Prophylaxis/Treatment – BBF Postexposure Prophylaxis (PEP) Form (CDC
57.206)
Use this form if HIV postexposure prophylaxis (PEP) was administered to a healthcare worker following
a blood or body fluid exposure.
♦

Demographic data auto-entered by application if part of an existing HCW Demographic Data record (CDC 57.204).

Data Field
Facility ID #
MedAdmin ID#
HCW ID #
♦

HCW Name:
Last, First, Middle
♦
Gender
♦
Date of Birth
Infectious Agent
Exposure Event #

Initial PEP
Time between
exposure and 1st dose
Drug
Drug
Drug
Drug
Date Started

Date Stopped

Instructions for Data Collection
Required. The NHSN-assigned facility ID will be auto-entered by the application.
Required. Medical administration number. Data will be auto-entered by the
application.
Required. Enter the HCW’s alphanumeric identification number. This identifier is
unique to the healthcare facility.
Optional. Enter the HCW’s name.
Required. Indicate the gender of the HCW by checking F (Female) or M (Male).
Required. Enter the date of birth of the HCW using the format: mm/dd/yyyy.
Required. Enter HIV on form. Select HIV in the application.
Required. The Exposure event number will be auto-entered by the system. Use the
Link/Unlink button to find any exposures for the entered HCW, select, and link
the exposure for which PEP is being administered. PEP records cannot be saved
unless they are linked to an exposure. PEP records entered from the Blood and
Body Fluid Exposure Form will automatically be linked to that exposure.
Indication: Prophylaxis
Required. Enter the number of hours between the exposure and when the 1st dose
of PEP was administered.
Required. Enter any drugs prescribed for prophylaxis. See Chapter 7 in the
protocol for a list of individual drug codes.
Conditionally required. Enter any additional drugs prescribed for initial
prophylaxis.
Conditionally required. Enter any additional drugs prescribed for prophylaxis.
Conditionally required. Enter any additional drugs prescribed for prophylaxis.
Required. Enter the date the initial PEP regimen commenced (mm/dd/yyyy
format). The start date will apply to all drugs selected as the initial PEP regimen.
The date started must be on or after the exposure date.
Required. Enter the date the initial PEP regimen was stopped (mm/dd/yyyy
format).
Note: If any drug(s) of a drug regimen are discontinued, the entire regimen is
considered ‘stopped.’ If select drugs in the regimen continue to be used as
prophylaxis (and if other drugs are added) enter them as drugs under a PEP
change with a new start date.

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Data Field
Reason for Stopping

Instructions for Data Collection
Required. Indicate the primary reason for stopping the initial PEP regimen by
selecting the appropriate choice.

PEP Change 1
Drug

Indication: Prophylaxis
Required. Enter drugs prescribed for a second prophylaxis regimen. Note that the
second PEP regimen may contain drugs that were included in the first regimen.
Conditionally required. Enter any additional drugs prescribed for prophylaxis.
Conditionally required. Enter any additional drugs prescribed for prophylaxis.
Conditionally required. Enter any additional drugs prescribed for prophylaxis.
Conditionally required. Enter the date the second PEP regimen was started using
mm/dd/yyyy format.
Conditionally required. Enter the date the second PEP regimen was stopped using
mm/dd/yyyy format.

Drug
Drug
Drug
Date Started
Date Stopped

Reason for Stopping
PEP Change 2
Drug

Drug
Drug
Drug
Date Started
Date Stopped

Reason for Stopping
Adverse Reactions
Signs or symptoms of
adverse reactions to
post-exposure
prophylaxis

Note: If any drug(s) of a drug regimen are discontinued, the regimen is
considered ‘stopped.’ Whatever drugs in the regimen are continued (and if other
drugs are added) will constitute a new regimen and should be recorded as part of a
new PEP regimen(s) with dates that resume from the last stop date. .
Conditionally required. Indicate the primary reason for stopping this PEP regimen
by selecting the appropriate choice.
Indication: Prophylaxis
Conditionally required. Enter drugs prescribed for a third prophylaxis regimen.
Note that the third PEP regimen may contain drugs that were included in previous
regimens.
Conditionally required. Enter any additional drugs prescribed for prophylaxis.
Conditionally required. Enter any additional drugs prescribed for prophylaxis.
Conditionally required. Enter any additional drugs prescribed for prophylaxis.
Conditionally required. Enter the date the new PEP regimen was started using
mm/dd/yyyy format.
Conditionally required. Enter the date the new PEP regimen was stopped using
mm/dd/yyyy format.
Note: If any drug(s) of a drug regimen are discontinued, the regimen is
considered ‘stopped.’ Whatever drugs in the regimen are continued (and if other
drugs are added) will constitute a new regimen and should be entered as such.
Conditionally required. Indicate the primary reason for stopping this PEP regimen
by selecting the appropriate choice.
Optional. Indicate any adverse signs/symptoms the HCW experienced while
receiving postexposure prophylaxis. You may select up to six.
If Other is selected, briefly specify details of adverse reaction.

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NHSN Healthcare Personnel Safety Component
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Data Field
Custom Fields

Comments

Instructions for Data Collection
Optional. Up to two date fields, two numeric fields, 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. Enter any additional information about the HCW. CDC will not analyze
this information.

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Table 5: Instructions for Completion of Follow-Up Laboratory Testing Form
(CDC 57.207)
This form should be completed for HCP who have additional laboratory testing done as a result of blood
or body fluid exposures. These tests would occur after baseline laboratory testing had been completed.
♦

Demographic data auto-entered by application if part of an existing HCW Demographic Data record (CDC 57.204).

Data Field
Facility ID #
Lab #
HCW ID #
♦

HCW Name:
Last, First, Middle
♦
Gender
♦
Date of birth
Exposure Event #

Lab Results
Lab Test

Instructions for Data Collection
Required. The NHSN-assigned facility ID will be auto-entered by the application.
Required. The lab testing ID number will be auto-generated by the application.
Required. Enter the HCW’s alphanumeric identification number. This identifier is
unique to the healthcare facility.
Optional. Enter the HCW’s name.
Required. Indicate the gender of the HCW by checking F (Female) or M (Male).
Required. Enter the date of birth of the HCW using the format: mm/dd/yyyy.
Required. The user is required to link the laboratory follow-up record to a blood and
body fluid exposure record using the Link feature within the application. Once the
exposure is selected and submitted, the form will display the message “Lab is
Linked.” Laboratory records must be linked to an exposure.
Required (At least one laboratory test and date are required). Multiple test results
may be recorded on this form. Select lab test from dropdown menu:
HIV EIA
HIV confirmatory
HepC anti-HCV EIA
HepC anti-HCV-supp
HepC PCR HCV RNA
HepB HBsAg
HepB IgM anti-Hbc
HepB Total anti-Hbc
HepB Anti-HBs

Date
Result
Custom Fields

Comments

ALT
Amylase
Blood glucose
Hematocrit
Hemoglobin
Platelets
Blood cells in urine
WBC
Creatinine
Other

Required. Indicate date of test using mm/dd/yyyy format.
Conditionally required. Select one of the result codes:
Use codes: P= positive, N= negative, I=Indeterminate, U=Unknown, R=Refused)
Optional. Up to two date fields, two numeric fields, 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. Enter any additional information about the HCW. CDC will not analyze
this information.

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Table 6. Instructions for Completion of the Healthcare Worker
Prophylaxis/Treatment – Influenza Form (CDC 57.210)
This form should be completed when an HCW receives antiviral medications as influenza treatment or as
chemoprophylaxis against influenza infection. It is used to collect information on which antiviral
medications were administered, when, and what (if any) adverse reactions were experienced by the HCW.
♦

Demographic data auto-entered by application if part of an existing HCW Demographic Data record (CDC 57.204).

Data Field
Facility ID #
Med Admin ID #
HCW ID #
♦

HCW Name:
Last, First, Middle
♦
Gender
♦
Date of Birth
♦
Work Location

♦

♦

Occupation

Clinical Specialty

♦

Performs direct
patient care
Infectious agent
For season

#
Indication
Influenza subtype

Antiviral
medication
Start date
Stop date

Instructions for Data Collection
Required. The NHSN-assigned facility ID will be auto-entered by the application.
Required. The medication administration ID number will be auto-generated by the
application.
Required. Enter the HCW’s alphanumeric identification number. This identifier is
unique to the healthcare facility.
Optional. Enter the HCW’s name.
Required. Indicate the gender of the HCW by checking F (Female) or M (Male).
Required. Enter the date of birth of the HCW using the format: mm/dd/yyyy.
Required. Select the code that best describes the HCW’s current permanent work
location. This refers to physical work location rather than to department assignment.
Location codes are customized to the facility and set up prior to entering HCW
records. See Table 2 for more details.
Required. Select the occupation code that most appropriately describes the HCW’s
job. Occupation codes are customized to the facility and set up prior to entering
HCW records. See Table 2 for more details.
Conditionally required. If Occupation is physician, fellow or intern/resident, enter the
appropriate clinical specialty. The list of clinical specialties can be found on Form
CDC 57.204.
Required. Select Yes if the HCW provides direct patient care (i.e., hands on, face-toface contact with patients for the purpose of diagnosis, treatment and monitoring);
otherwise select No.
Required. Auto-filled on hard copy form. Select Influenza in application.
Required. Select the vaccination season. Specify the year(s) during which this
chemoprophylaxis or treatment date falls. For NHSN purposes, the vaccination
“season” is 7/1 of the first year to 6/30 of the next calendar year.
Required. Indicate up to 10 antiviral medications given using sequential numbers
starting with 1.
Required. Select Prophylaxis or Treatment as appropriate.
Required. Select the influenza subtype for which the HCW is receiving antiviral
medications (for post-exposure chemoprophylaxis or for treatment). Select Unknown,
if you do not know the specific subtype necessitating antiviral medication use.
Required. Enter the code of the antiviral medication that was administered to the
HCW using the codes listed at the bottom of the form.
Required. Enter the start date of the antiviral using mm/dd/yyyy format.
Conditionally required. Enter the stop date of the antiviral using mm/dd/yyyy format.

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NHSN Healthcare Personnel Safety Component
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Data Field
Adverse reactions?

Adverse reactions
to antiviral
medication
#1…#10

Custom Fields

Comments

Instructions for Data Collection
Required. Check Yes if the HCW had a severe adverse reaction attributable to the
influenza antiviral medication; otherwise check No. If it is unknown whether or not
the HCW experienced any adverse reactions, check Don’t Know.
Conditionally required. If the HCW had a severe adverse reaction, check all reactions
that apply for each medication administered. Please correlate the antiviral medication
# with the antiviral medication on page 1. If an adverse reaction is not listed, check
Other and specify the adverse reaction in the space provided. All Other adverse
reactions should be included if the reactions were severe enough to affect daily
activities and/or resulted in the discontinuation of the antiviral medication.
Optional. Up to two date fields, two numeric fields, 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. Enter any additional information about the HCW. CDC will not analyze
this information.

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NHSN Healthcare Personnel Safety Component
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Table 7. Instructions for Completion of Healthcare Personnel Safety
Component – Annual Facility Survey (CDC 57.200)
This form must be completed once a year by any facility using the Healthcare Personnel Safety
Component.
Data Field
Tracking #
Facility ID #
Survey year
Total beds set up and staffed
Patient admissions
Inpatient days
Outpatient encounters
Number of hours worked by
all employees

Number of HCWs

Number of FTEs

Last Updated January 1, 2013

Instructions for Data Collection/Entry
Required. The NHSN-assigned Tracking # will be auto-entered by the
application.
Required. The NHSN-assigned facility ID will be auto-entered by the
application.
Required. Enter the year of the survey using the format: yyyy.
Required. Enter the number of all active beds across specialties and
intensive care units.
Required. Enter the number of patients, excluding newborns, admitted for
inpatient service.
Required. Enter the number of adult and pediatric days of care, excluding
newborn days of care, rendered during a specified reporting period.
Required. Enter the number of visits by patients who are not admitted as
inpatients to the hospital while receiving medical, dental, or other services.
Optional. Number of hours worked is available from OSHA300 reporting
logs. The value can also be calculated by identifying the number of full
time employees working in your facility within a year, multiply by the
number of work hours for one full time employee in a year (typically
ranges from 2000-2100 hours per year). Add in overtime hours and total
hours worked by part-time, temporary, and contracted staff.
Required. HCWs are all persons who work in the hospital. Calculate the
number of attending physicians by including only those who are active or
associate staff (e.g. similar methodology to the American Hospital
Association annual survey, if applicable). Do not include courtesy,
consulting, honorary, provisional, or other attending physicians in this
number. If you cannot determine the exact number for a particular category,
please estimate it. If the facility does not have any HCP in a specific
occupation, the user may enter 0. This is the denominator when used to
calculate rates of particular exposure events per HCW.
Required. A subset of total number of HCP. FTEs are all HCP whose
regularly scheduled workweek is 35 hours or more. To calculate the
number of FTE’s add the number of FTEs to ½ the number of part-time
HCP (e.g., 2 part-time HCP = 1 FTE). If you cannot determine the exact
number for a particular category, please estimate it. If the facility does not
have any FTEs in a specific occupation, the user may enter 0. This is the
denominator used to calculate rates of particular exposure events per FTE.

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NHSN Healthcare Personnel Safety Component
Tables of Instructions

REFERENCES
The following CDC/PHS publications provide recommendations for management and follow-up of blood and body
fluid exposures to HBV, HCV, and HIV:
• Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV,
HCV, and HIV and Recommendations for Postexposure Prophylaxis. (MMWR, June 29, 2001 / 50(RR11); 142)
• Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and
Recommendations for Postexposure Prophylaxis (PEP regimens have been changed). (MMWR, September
30, 2005 / 54(RR09); 1-17)

The following CDC/PHS publication provides recommendations for the immunization of HCP:
• A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the
United States. (MMWR, December 8, 2006 / 55(RR16); 1-25)
• Influenza Vaccination of Health-care Personnel. (MMWR, February 24, 2006 / 55(RR02); 1-16)
• Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee
on Immunization Practices (ACIP). (MMWR, July 29, 2009 / 58(Early Release); 1-52)

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NHSN Healthcare Personnel Safety Component
Key Terms

Key Terms
Key term

Definition

Antiviral
medications for
influenza

Drugs used to treat or to prevent influenza infections, not necessarily to treat the
symptoms of influenza (e.g., analgesics)

Adverse reaction to
influenza vaccine

A reaction experienced by the HCW that is attributable to the influenza vaccine.
The Vaccine Information Statement defines a reaction as “Any unusual condition,
such as high fever or behavior changes.” Typically, adverse reactions to vaccines
are only known when the HCW notifies you (i.e., passive surveillance) rather than
you following up after the vaccination (i.e., active surveillance).

Bite

A human bite sustained by a HCW from a patient, other HCW, or visitor.

Bloodborne
pathogens

Pathogenic microorganisms that may be present in human blood and can cause
disease in humans. These pathogens include, but are not limited to hepatitis B
virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV).

CDC Location

A CDC-defined designation given to a patient care area housing patients who have
similar disease conditions or who are receiving care for similar medical or surgical
specialties. Each facility location that is monitored is “mapped” to one CDC
Location. The specific CDC Location code is determined by the type of patients
cared for in that area according to the 80% Rule. That is, if 80% of patients are of a
certain type (e.g., pediatric patients with orthopedic problems) then that area is
designated as that type of location (in this case, an Inpatient Pediatric Orthopedic
Ward). Work locations must be mapped to a CDC location. For CDC locations, see
http://www.cdc.gov/nhsn/PDFs/pscManual/15LocationsDescriptions_current.pdf

CDC (occupation) A CDC-defined designation for each occupation type in a facility. A facility
occupation is “mapped” to one CDC Code. See Chapter 7 of protocol for list of
Code
occupations.

Contractor

Individual facilities may have differing classifications of work status. According to
the Bureau of Labor Statistics, workers with no explicit or implicit contract for a
long-term employment arrangement, such as temporary or term positions, are
considered contingent or contract workers. Facilities should use their own
definition of a contractor.

Device

Any of the following devices (hollow-bore needle, suture needle, glass, plastic,
other solid sharps, and non-sharp safety devices) used at the healthcare facility.

Direct patient care Hands on, face-to-face contact with patients for the purpose of diagnosis, treatment
and monitoring.

Float

A work location for HCP who do not work at least 75% of the time in a single
location. For example, a radiology technician who spends most of his/her time
performing portable x-rays throughout the facility.

Last Updated January 1, 2013

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NHSN Healthcare Personnel Safety Component
Key Terms

Key term

Definition

Full Time
Equivalent (FTE)

HCP whose regularly scheduled workweek is 35 hours or more. To calculate the
number of FTE’s add the number of FTEs to ½ the number of part-time HCP (e.g.,
2 part-time HCWs = 1 FTE).

Healthcare
personnel (HCP)

A population of healthcare workers working in a healthcare setting. HCP might
include (but are not limited to) physicians, nurses, nursing assistants, therapists,
technicians, emergency medical service personnel, dental personnel, pharmacists,
laboratory personnel, autopsy personnel, students and trainees, contractual staff not
employed by the healthcare facility, and persons (e.g., clerical, dietary,
housekeeping, maintenance, and volunteers) not directly involved in patient care
but potentially exposed to infectious agents that can be transmitted to and from
HCP. It includes students, trainees, and volunteers.

Healthcare worker
(HCW)

A person who works in the facility, whether paid or unpaid, who has the potential
for exposure to infectious materials, including body substances, contaminated
medical supplies and equipment, contaminated environmental surfaces, or
contaminated air. Healthcare worker is the singular form of healthcare personnel.

Hollow-bore needle

Needle (e.g., hypodermic needle, phlebotomy needle) with a lumen through which
material (e.g., medication, blood) can flow.

Location

The patient care area to which an HCW is assigned while working in the
healthcare facility. See also CDC Location for how locations are defined. CDC
location codes may be accessed: at http://www.cdc.gov/nhsn/PDFs/masterlocations-descriptions.pdf

Mucous membrane
exposure

Contact of mucous membrane (e.g.., eyes, nose, or mouth) with the fluids, tissues,
or specimens listed on the blood and body fluids exposure form.

Non-intact skin

Areas of the skin that have been opened by cuts, abrasions, dermatitis, chapped
skin, etc.

Non-intact skinexposure

Contact of non-intact skin with the fluids, tissues, or specimens listed under
Occupational Exposure

Non-Responder to
Hepatitis B vaccine

An HCW, who has received two series of hepatitis B vaccine, is serotested within
2 months after the last dose of vaccine and does not have anti-HBs ≥10 mIU/mL.

Non-seasonal
influenza vaccine

A vaccine for additional/novel influenza virus strains (e.g., 2009 H1N1) not
included in the seasonal influenza vaccine which may or may not be available on
an annual basis.

Occupational
exposure

Contact with blood, visibly bloody fluids, and other body fluids (i.e., semen,
vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal
fluid, pericardial fluid, and amniotic fluid, tissues, and laboratory specimens that
contain concentrated virus) to which Standard Precautions apply and during the
performance of a healthcare worker’s duties. Modes of exposure include
percutaneous injuries, mucous membrane exposures, non-intact skin exposures,
and bites.

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NHSN Healthcare Personnel Safety Component
Key Terms

Key term

Definition

Part Time
Equivalent (PTE)

HCP whose regularly scheduled workweek is less than 35 hours. Two PTEs equal
1 FTE.

Percutaneous injury

An exposure event occurring when a needle or other sharp object penetrates the
skin.
For percutaneous injuries with a needle or sharp object that was not in contact with
blood or other body fluids prior to exposure, collection of data is optional.
Facilities are not required to collect data that involve intact skin or exposures to
body fluids to which contact precautions do not apply unless they are visibly
bloody. However, facilities that routinely collect data on such exposures may enter
this information into the system.

Safety device

Includes any safety device (e.g., needless IV systems, blunted surgical needles,
self-sheathing needles) used at the healthcare facility.

Seasonal influenza
vaccine

A vaccine for seasonal influenza virus strains that is offered on an annual basis.

Severe adverse
reaction to antiviral
medication use for
influenza
chemoprophylaxis
or treatment

Adverse reactions severe enough to affect daily activities and/or result in the
discontinuation of the antiviral medication.

Sharp

Any object that can penetrate the skin including, but not limited to, needles,
scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires.

Sharps Injury

An exposure event occurring when any sharp object penetrates the skin

Solid Sharp

A sharp object (e.g., suture needle, scalpel) that does not have a lumen through
which material can flow.

Vaccination season

A 12-month period starting from July 1 of a year to June 30 of the following year.

Work location

A HCW’s current permanent work location. This refers to physical work location
rather than to department assignment.

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NHSN Healthcare Personnel Safety Component
CDC Codes

CDC occupation Codes used to code (“map”) facility locations

CDC (occupation) Code

BLS SOC
(2000)*

CDC (occupation) Code

ATT-Attendant/orderly

31-1012

ICP-Infection Control Professional

BLS SOC
(2000)*

CLA-Clerical/administrative

IVT-IVT Team Staff

CNA-Nurse Anesthetist

LAU-Laundry Staff

CNM-Nurse Midwife

LPN-Licensed Practical Nurse

29-2061

MLT -Medical Laboratory
Technician

29-2012

CSS-Central Supply

33-7012

CSW-Counselor/Social Worker

21-1020

DIT-Dietician

29-1030

DNA-Dental Assistant/Tech

31-9091

DNH-Dental Hygienist

29-2021

29-1020

29-2041

35-0000

HEM-Hemodialysis Technician
HSK-Housekeeper

Last Updated January 1, 2013

29-2090

NUA-Nursing Assistant

OAS-Other Ancillary Staff
OFR-Other First Responder

FEL-Fellow
FOS-Food Service

MST-Medical Student

NUP-Nurse Practitioner

DST-Dental Student
EMT-EMT/Paramedic

MOR-Morgue Technician

MTE-Medical Technologist

DNO-Other Dental Worker
DNT-Dentist

MNT-Maintenance/Engineering

OH-Occupational Health
Professional

29-9010

OMS-Other Medical Staff
37-2010

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ORS-OR/Surgery Technician

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NHSN Healthcare Personnel Safety Component
CDC Codes

CDC (occupation) Code

BLS SOC
(2000)*

OTH-Other
OTT-Other Technician/Therapist

29-2099

PAS-Physician Assistant

29-1071

PCT-Patient Care Technician
PHA-Pharmacist

29-1051

PHL-Phlebotomist/IV Team
PHW-Public Health Worker
PHY-Physician

29-1060

PLT-Physical Therapist

29-1123

PSY-Psychiatric Technician

29-2053

RCH-Researcher

19-1040

RDT-Radiologic Technologist

29-2034

RES-Intern/Resident
RNU-Registered Nurse

29-1111

RTT-Respiratory Therapist/Tech

29-1126

STU-Other Student
TRA-Transport/Messenger/Porter
VOL-Volunteer

Last Updated January 1, 2013

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* Bureau of Labor Statistics (BLS) Standard
Occupational Codes (SOC), available online at the
United States Department of Labor, Bureau of
Labor Statistics at http://www.bls.gov/soc/

NHSN Healthcare Personnel Safety Component
CDC Codes

CDC Device description used to code (“map”) medical devices used in the facility
CDC Device Description

CDC Device Description

IVPER - IV catheter - peripheral

BCUT - Bone cutter

IVCATH - IV catheter – central line

BOVIE - Electrocautery device

HYPO - Hypodermic needle, attached syringe

BUR - Bur

UNATT - Unattached hypodermic needle

ELEV - Elevator

PREFILL - Prefilled cartridge syringe

EXPL - Explorer

STYLET - I.V. Stylet

FILE - File

VHOLD - Vacuum tube holder/needle

FORCEPS - Extraction Forceps

SPINAL - Spinal or epidural needle

LANCET - Lancet

BMARROW - Bone marrow needle

MICRO - Microtome blade

BIOPSY - Biopsy needle

PIN - Pin

OTH-HOL - Other hollow-bore needle

RAZOR - Razor

UNK-HOL - Hollow-bore needle, type unknown

RETRACT - Retractor

HUBER - Huber needle

ROD - Rod (orthopaedic)

WINGED - Winged-steel (Butterfly™-type) needle

SCALE - Scaler/curette

HEMODIAL - Hemodialysis needle

SCALPEL - Scalpel blade

HYPO-TUB - Hypodermic, attached to IV tubing

SCIS - Scissors

DENTASP -Dental aspirating syringe with needle

TENAC - Tenaculum

ABCD - Arterial Blood Collection Device

TROCAR - Trocar

SUTR - Suture needle

WIRE - Wire

Last Updated January 1, 2013

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NHSN Healthcare Personnel Safety Component
CDC Codes

CDC Device Description
COLLTUBE - Blood collection tubes
CAPILL - Capillary tube
MED - Medication ampule/vial/IV bottle
PIPE - Pipette (glass)
SLIDE - Slide
TUBE - Specimen/test/vacuum tube
BCADAP - Blood culture adapter
IVDEL - IV Delivery System
CATHSECD - Catheter Securement Device
PCOLLTUBE - Blood collection tubes - plastic
PCAPILL - Capillary tube - plastic
PTUBE - Specimen/test/vacuum tube - plastic
UNK - Unknown type of sharp object
OTHER - Other sharp

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NHSN Healthcare Personnel Safety Component
CDC Codes

Antiretroviral and Associated Drug Codes for Use on Healthcare Worker BBF
Postexposure Prophylaxis form (CDC 57.206)
CDC Drug Code
3TC - lamivudine
ABC - abacavir
ATV - atazanavir
CD4 - CD4 therapies
D4T - stavudine
ddI - didanosine
DLV - delavirdine
DRV - darunavir
EFV - efavirenz
ENF - enfuvirtide (T-20)
ETR - etravirine
fAPV - fosamprenavir
FTC - emtricitabine
HU - hydroxyurea
IDV - indinavir
IL2 - interleukin2
INT - interferon
LPV - lopinavir

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NHSN Healthcare Personnel Safety Component
CDC Codes

NFV - nelfinavir
NVP - nevirapine
OTH - other
RLT - raltegravir
RIL - Rilpivirine
RTV - ritonavir
SQV - saquinavir
TDF - tenofovir
TIP - tipranavir (PNU-140690)
ZDV - zidovudine (AZT)

Last Updated January 1, 2013

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