Att D.1_Explanations & Justification for Proposed Revisions

National Healthcare Safety Network (NHSN)

OMB Control No. 0920-0666

Revision Request June 2014

Explanations and justifications for proposed revisions to OMB 0920-0666

Thirty-one collection tools previously approved under OMB No. 0920-0666 are being revised to some extent in this revision request. In addition, three forms are being removed from the package and one form is being added. Proposed program changes are explained below.

1. Addition of new NHSN Component: Antimicrobial Use and Resistance Component

Justification: A new component will be launched within NHSN that will specifically examine antimicrobial use (AU) and antimicrobial resistance (AR) within healthcare facilities: Antimicrobial Use and Resistance (AUR) Component. The goal of the AUR Component is to provide a mechanism for facilities to report and analyze antimicrobial use and/or resistance as part of local or regional efforts to reduce antimicrobial resistant infections through antimicrobial stewardship efforts or interruption of transmission of resistant pathogens at their facility. AU and AR functionalities currently exist within NHSN but participation is limited to inpatient healthcare facilities. Moving the AU and AR Modules to a separate NHSN Component will allow all healthcare facility types, such as outpatient dialysis facilities and long-term care facilities, to take advantage of these tools for antimicrobial stewardship.

With the new component, one new form was added to this ICR package:

• 57.154 – Antimicrobial Use & Resistance Component - Monthly Reporting Plan

2. Significant updates to annual facility surveys

Justification: After an internal review of the annual facility surveys it was determined by DHQP Division Leadership that the surveys should be revised and updated to accommodate the evolving needs of obtaining information from healthcare facilities throughout the US. For the Facility Microbiology Laboratory Practices section of the survey it was determined that some questions were no longer needed as the majority of laboratories are following similar practices to adhere to industry guidelines. Response options were also added to be inclusive of all laboratory types used by healthcare facilities. A few questions were added to obtain information regarding activities to prevent furthering of antimicrobial resistance within the individual healthcare facility.

Two new sections were added to the surveys. Questions about infection control practices are being added to the survey for the purpose of gaining a better understanding of current practices and to identify areas to target prevention efforts among facilities that have reported a multidrug-resistant organism. The information collected will inform future efforts to improve facility implementation of recommended prevention measures to control spread of multidrug-resistant organisms. Questions about antibiotic stewardship are being added to the survey for the purpose of gaining a better understanding of current efforts to improve antibiotic use in hospitals and to assess the quality of hospital antibiotic stewardship programs. The information collected will inform efforts to improve facility implementation of best practices to improve antibiotic stewardship programs and antibiotic use in hospitals.

3. Revision of susceptibility options for Cefepime.

Justification: Recently CLSI has updated the susceptibility options for Cefepime to replace Intermediate (I) with Susceptible-dose dependent (S-DD) for three organisms: Escherichia coli, Enterobacter, and Klebsiella. However, because not all laboratories will implement this change at the same time, the susceptibility options for Cefepime for those three organisms will include both I and S-DD on all NHSN event forms.

4. A total of three forms will be removed from NHSN as patient vaccination monitoring will be removed from NHSN due to low use. The removed forms are:

   • 57.130 – Vaccination Monthly Monitoring Form–Summary Method

   • 57.131 – Vaccination Monthly Monitoring Form–Patient-Level Method

   • 57.133 – Patient Vaccination

5. All other NHSN data collection form revisions.

Justification: A number of minor revisions, updates, and clarifications have been made to 31 NHSN data collection forms. See Attachment D-2 for itemized NHSN data collection forms revisions and justifications. Resulting burden revisions are itemized in Attachments D-3 and D-4.

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