Att D.4_Revision of Estimated Annual Cost Burden

National Healthcare Safety Network (NHSN)

OMB Control No. 0920-0666

Revision Request June 2014

Revision of Estimated Annual Cost Burden*

		Total Estimated Burden (Hours)		Estimated Hourly Wage of Respondent		Total Estimated Annual Cost Burdena		Change in Estimated Annual Cost Burdena
Form Number	Form Name	06/2013	06/2014	06/2013	06/2014	06/2013	06/2014
57.100	NHSN Registration Form	167	167	$37.84	$38.55	$6,307	$6,425	$118
57.101	Facility Contact Information	333	333	$37.84	$38.55	$12,613	$12,850	$237
57.103	Patient Safety Component--Annual Hospital Survey	3,000	5,000	$37.84	$38.55	$113,520	$192,750	$79,230
57.105	Group Contact Information	500	83	$37.84	$38.55	$18,920	$3,213	($15,708)
57.106	Patient Safety Monthly Reporting Plan	42,000	18,000	$37.84	$38.55	$1,589,280	$693,900	($895,380)
57.108	Primary Bloodstream Infection (BSI)	115,200	132,000	$37.84	$38.55	$4,359,168	$5,088,600	$729,432
57.111	Pneumonia (PNEU)	208,800	216,000	$37.84	$38.55	$7,900,992	$8,326,800	$425,808
57.112	Ventilator-Associated Event	316,800	360,000	$37.84	$38.55	$11,987,712	$13,878,000	$1,890,288
57.114	Urinary Tract Infection (UTI)	78,300	120,000	$37.84	$38.55	$2,962,872	$4,626,000	$1,663,128
57.116	Denominators for Neonatal Intensive Care Unit (NICU)	162,000	162,000	$31.48	$31.84	$5,099,760	$5,158,080	$58,320
57.117	Denominators for Specialty Care Area (SCA)/Oncology (ONC)	270,000	270,000	$31.48	$31.84	$8,499,600	$8,596,800	$97,200
57.118	Denominators for Intensive Care Unit (ICU)/Other locations (not NICU or SCA)	1,620,000	1,620,000	$31.48	$31.84	$50,997,600	$51,580,800	$583,200
57.120	Surgical Site Infection (SSI)	104,400	126,000	$37.84	$38.55	$3,950,496	$4,857,300	$906,804
57.121	Denominator for Procedure	270,000	270,000	$31.48	$31.84	$8,499,600	$8,596,800	$97,200
57.123	Antimicrobial Use and Resistance (AUR)-Microbiology Data Electronic Upload Specification Tables	6,000	6,000	$17.90	$18.26	$107,400	$109,560	$2,160
57.124	Antimicrobial Use and Resistance (AUR)-Pharmacy Data Electronic Upload Specification Tables	6,000	6,000	$14.10	$14.25	$84,600	$85,500	$900
57.125	Central Line Insertion Practices Adherence Monitoring	8,333	8,333	$37.84	$38.55	$315,333	$321,250	$5,917
57.126	MDRO or CDI Infection Form	208,800	216,000	$37.84	$38.55	$7,900,992	$8,326,800	$425,808
57.127	MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring	28,800	36,000	$37.84	$38.55	$1,089,792	$1,387,800	$298,008
57.128	Laboratory-identified MDRO or CDI Event	360,000	360,000	$37.84	$38.55	$13,622,400	$13,878,000	$255,600
57.137	Long-Term Care Facility Component – Annual Facility Survey	188	250	$37.84	$38.55	$7,095	$9,638	$2,543
57.138	Laboratory-identified MDRO or CDI Event for LTCF	500	500	$37.84	$38.55	$18,920	$19,275	$355
57.139	MDRO and CDI Prevention Process Measures Monthly Monitoring for LTCF	250	250	$37.84	$38.55	$9,460	$9,638	$178
57.140	Urinary Tract Infection (UTI) for LTCF	1,013	1,125	$37.84	$38.55	$38,313	$43,369	$5,056
57.141	Monthly Reporting Plan for LTCF	250	250	$37.84	$38.55	$9,460	$9,638	$178
57.142	Denominators for LTCF Locations	9,000	9,750	$37.84	$38.55	$340,560	$375,863	$35,302
57.143	Prevention Process Measures Monthly Monitoring for LTCF	250	250	$37.84	$38.55	$9,460	$9,638	$178
57.150	LTAC Annual Survey	200	333	$37.84	$38.55	$7,568	$12,850	$5,282
57.151	Rehab Annual Survey	417	833	$37.84	$38.55	$15,767	$32,125	$16,358
57.154	Antimicrobial Use & Resistance Component - Monthly Reporting Plan	-	100	-	$38.55	-	$3,855	$3,855
57.200	Healthcare Personnel Safety Component Annual Facility Survey	400	400	$39.85	$32.15	$15,940	$12,860	($3,080)
57.203	Healthcare Personnel Safety Monthly Reporting Plan	75	917	$39.85	$32.15	$2,989	$29,471	$26,482
57.204	Healthcare Worker Demographic Data	3,333	3,333	$39.85	$32.15	$132,833	$107,167	($25,667)
57.205	Exposure to Blood/Body Fluids	2,500	2,500	$39.85	$32.15	$99,625	$80,375	($19,250)
57.206	Healthcare Worker Prophylaxis/Treatment	375	375	$39.85	$32.15	$14,944	$12,056	($2,888)
57.207	Follow-Up Laboratory Testing	625	625	$17.90	$18.26	$11,188	$11,413	$225
57.210	Healthcare Worker Prophylaxis/Treatment-Influenza	417	417	$39.85	$32.15	$16,604	$13,396	($3,208)
57.300	Hemovigilance Module Annual Survey	1,000	1,000	$33.14	$33.61	$33,140	$33,610	$470
57.301	Hemovigilance Module Monthly Reporting Plan	100	100	$33.14	$33.61	$3,314	$3,361	$47
57.303	Hemovigilance Module Monthly Reporting Denominators	6,000	6,000	$33.14	$33.61	$198,840	$201,660	$2,820
57.304	Hemovigilance Adverse Reaction	6,000	6,000	$33.14	$33.61	$198,840	$201,660	$2,820
57.305	Hemovigilance Incident	1,000	833	$33.14	$33.61	$33,140	$28,008	($5,132)
57.400	Outpatient Procedure Component—Annual Facility Survey	417	417	$31.48	$31.84	$13,117	$13,267	$150
57.401	Outpatient Procedure Component - Monthly Reporting Plan	15,000	15,000	$31.48	$31.84	$472,200	$477,600	$5,400
57.402	Outpatient Procedure Component Event	83,333	83,333	$31.48	$31.84	$2,623,333	$2,653,333	$30,000
57.403	Outpatient Procedure Component - Monthly Denominators and Summary	40,000	40,000	$31.48	$31.84	$1,259,200	$1,273,600	$14,400
57.500	Outpatient Dialysis Center Practices Survey	10,500	11,375	$37.84	$38.55	$397,320	$438,506	$41,186
57.501	Dialysis Monthly Reporting Plan	6,000	6,500	$31.48	$31.84	$188,880	$206,960	$18,080
57.502	Dialysis Event	78,000	130,000	$31.48	$31.84	$2,455,440	$4,139,200	$1,683,760
57.503	Denominator for Outpatient Dialysis	7,200	7,800	$31.48	$31.84	$226,656	$248,352	$21,696
57.504	Prevention Process Measures Monthly Monitoring for Dialysis	3,600	9,000	$31.48	$31.84	$113,328	$286,560	$173,232
57.505	Dialysis Patient Influenza Vaccination	3,125	4,063	$31.48	$31.84	$98,375	$129,350	$30,975
57.506	Dialysis Patient Influenza Vaccination Denominator	208	271	$31.48	$31.84	$6,558	$8,623	$2,065
57.600	State Health Department Validation Record	1,900	1,900	$31.38	$41.29	$59,622	$78,451	$18,829
Total Estimated Annual Cost Burden						$138,711,373	$146,941,956	$8,230,580

*Despite no change in the estimated burden hours, cost for some forms increased or decreased due to increase or decrease in annual wages.

^aValues were rounded prior to summation.

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