Att G.13_LTCF Urinary Tract Infection

Urinary Tract Infection (UTI) Event for Long-term Care Facilities
Background: The urinary tract is one of the most common sites of healthcare-associated
infections, accounting for 20-30% of infections reported by long-term care facilities (LTCFs). In
the LTC resident, risk factors for developing bacteriuria and UTI include age-related changes to
the genitourinary tract, comorbid conditions resulting in neurogenic bladder, and instrumentation
required to manage bladder voiding. The point prevalence of asymptomatic bacteriuria in LTC
residents can range from 25-50%. Although the incidence of symptomatic UTI is lower, it still
comprises a significant proportion of infections manifesting in LTCFs and results in a large
amount of antibiotic use.
Though prevalence of indwelling urinary catheter use in LTCFs is lower than in the acute
care setting, catheter-associated UTI (CAUTI) can lead to such complications as cystitis,
pyelonephritis, bacteremia, and septic shock. These complications associated with CAUTI can
result in decline in resident function and mobility, acute care hospitalizations, and increased
mortality. Prevention of CAUTIs is discussed in the CDC/HICPAC document, Guideline for
Prevention of Catheter-associated Urinary Tract Infections1.
Efforts to examine antibiotic use practices for UTI have demonstrated a discrepancy
between the number UTI events identified through the application of evidence-based
surveillance criteria with the numbers of clinically identified and treated UTI2. Consistent
tracking and reporting symptomatic UTIs using surveillance criteria identify opportunities to
examine, understand and address larger differences between surveillance events and clinically
identified events.
1: Healthcare Infection Control Practices Advisory Committee (HICPAC) approved guidelines for the
Prevention of catheter-associated urinary tract infections, 2009. Available at www.cdc.gov/hicpac/pdf/CAUTI/
CAUTIguideline2009final.pdf
2: Juthani-Mehta M et al. JAGS 2007; 55: 1072-77 and Wang L. et al. Eur J Clin Microbiol Infect Dis. 2012. 31(8):1797-804).

Settings: UTI Event reporting is currently available for certified skilled nursing facilities/nursing
homes (LTC:SKILLNURS), and intermediate/chronic care facilities for the developmentally
disabled (LTC:DEVDIS). Infection surveillance for UTIs should be performed facility-wide
(FacWideIN).
Only UTI events presenting > 2 calendar days after admission (where date of admission= day 1)
are considered facility onset events.
Example: NHSN Classification of reportable LTCF UTI Events
Admission date
June 4th

June 5th

June 6th

June 7th

June 8th

day 1

day 2

day 3

day 4

day 5

Not a LTCF reportable UTI event

LTCF reportable UTI event

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NOTE: If a resident is transferred from an acute care facility and develops signs/symptoms of a
UTI within the first 2 calendar days of admission to the LTCF, it would be considered present at
the time of transfer to the LTCF. An event present at the time of transfer should be reported back
to the transferring facility and not reported to NHSN as a LTCF UTI event.
Requirements: Facilities must indicate their surveillance for UTI in the Monthly Reporting Plan
for LTCF (CDC 57.141). UTI surveillance must be reported for at least 6 consecutive months to
provide meaningful measures.
Definitions:
Date of Event is defined as the date when the first clinical evidence (signs/symptoms) of the UTI
appeared or the date the specimen was collected that was used to make or confirm the diagnosis,
whichever comes first.
Urinary tract infections (UTI) are defined using a combination of clinical signs and symptoms
and laboratory criteria (See Figure 1 and Table 1).
Symptomatic UTI (SUTI) events occur when the resident manifests signs and symptoms such as
acute dysuria, new and/or marked increase in urinary frequency, suprapubic tenderness, etc.
which localize the infection to the urinary tract. These events can occur in residents without
urinary devices or managed with urinary devices other than indwelling urinary catheters, such as
suprapubic catheters, straight in-and-out catheters and condom catheters. Events occurring in
residents with indwelling urinary catheters (defined below) are a sub-set of SUTIs referred to as
catheter-associated SUTI (CA-SUTI) events.
Catheter-associated SUTIs (CA-SUTI) events occur when a resident develops signs and
symptoms localizing to the urinary tract while having an indwelling urinary catheter in place or
removed within the 2 calendar days prior to the date of event (where day of catheter removal =
day 1).
NOTE: An indwelling urinary catheter should be in place for a minimum of 2 calendar days
before infection onset (where day of catheter insertion = day 1) in order for the SUTI to be
catheter-associated
NOTE: If a resident is transferred to your facility with an indwelling urinary catheter and you
replace that catheter with a new one while the resident is in your care, then the date of insertion
of the device corresponds to the date the new catheter was placed in your facility.
Indwelling urinary catheter: a drainage tube that is inserted into the urinary bladder through the
urethra, is left in place, and is connected to a closed collection system; also called a Foley
catheter. Indwelling urinary catheters do not include straight in-and-out catheters or suprapubic
catheters.
NOTE: UTIs in residents managed with suprapubic, in and out, or condom (males only)
catheters will be captured as SUTIs, not CA-SUTIs.

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Asymptomatic Bacteremic UTI (ABUTI) events occur when the resident has NO signs or
symptoms localizing to the urinary tract but has urine and blood cultures positive for at least one
common organism (See Table 1) regardless of whether a catheter is in place or not.

Table 1. Examples of ‘‘sameness’’ by organism speciation
Culture

Companion Culture
Coagulase-negative
staphylococci

Report as.

Klebsiella oxytoca

Klebsiella spp.

K oxytoca

S salivarius

Strep viridans

S salivarius

S epidermidis

S epidermidis

Numerator and Denominator Data:
Numerator Data: The Urinary Tract Infection (UTI) for LTCF form (CDC 57.140) is used to
collect and report each SUTI, CA-SUTI or ABUTI that is identified during the month selected
for surveillance. The Tables of Instructions includes information on how to complete this form.
The UTI form includes resident demographic information and information on whether or not a
catheter (or other urinary device) was present. Additional data include the specific clinical
criteria evidence (signs and symptoms) and laboratory and diagnostic testing that were used for
identifying the UTI; whether the resident developed a secondary bloodstream infection; whether
the resident was transferred to an acute care facility for any reason or died from any cause within
7 days of the UTI event; and the organisms isolated from cultures and their antimicrobial
susceptibilities.
NOTE: When a urine specimen is being collected from a resident with a chronic indwelling
urinary catheter (in place >14 days), it is recommended that the original catheter be changed
prior to specimen collection.
Denominator data: Catheter-days, resident-days, and new antibiotic starts for UTI indication
are used for denominators. Catheter-days, defined as the number of residents with an indwelling
urinary (Foley) catheter, are collected daily for all residents in the facility using the
Denominators for LTCF form (CDC 57.142).
NOTE: None of the following urinary management devices should be included when counting
indwelling catheter-days: suprapubic catheters, straight in-and-out catheters or condom catheters.

Page 3 of 21

NOTE: If a resident is transferred to an acute care facility for a suspected UTI, no additional
indwelling catheter-days are reported after the day of transfer.
Resident-days are calculated using the daily census of residents in the facility each day of the
month. These daily counts are summed and only the total for the month is entered into NHSN,
under Summary Data.
New antibiotic starts for UTI indication may be collected daily or summarized at the end of each
month. A “new antibiotic start” refers to a new prescription for an antibiotic ordered for a
resident who is suspected or diagnosed with having a urinary tract infection (both catheterassociated and not catheter associated) regardless of whether that UTI meets the NHSN event
definition. There is no minimum number of doses or days of therapy which define a new
antibiotic start—count all new orders.
Include only antibiotics which are started while the resident is receiving care in the facility,
either by clinical providers working in the facility or by outside physicians who see the resident
in an outpatient clinic or Emergency department. Do not include antibiotic courses started by
another healthcare facility prior to the resident’s admission or readmission back to your facility
even if the resident continues to take that antibiotic while in the facility.
Data Analyses:
Line lists of UTI events and UTI events by catheter status will be available as part of the UTI
event within the NHSN LTCF component. Below are measures and calculations which will be
incorporated into the analytics output that will be available for use in 2013.
Calculated UTI Rates and Metrics
Data will be stratified by time (e.g., month, quarter) and aggregated across the entire facility.
Total UTI incidence rate/1,000 resident-days = Number of UTI Events (i.e., SUTI+CASUTI+ABUTI) / Total resident-days x 1,000.
Percent that is SUTI = Number of SUTI Events / Total number of UTI Events x 100.
Percent that is CA-SUTI = Number of CA-SUTI Events / Total number of UTI Events x
100.
Percent that is ABUTI = Number of ABUTI Events / Total number of UTI Events x 100.
SUTI incidence rate/1,000 resident-days = Number of SUTI Events / (Total resident-days –
catheter-days) x 1,000.
NOTE: Only SUTIs which are NOT catheter-associated will be included in the SUTI incidence
rate.
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CA-SUTI incidence rate/1,000 catheter-days = Number of CA-SUTI events/ Catheter-days x
1,000
NOTE: Only symptomatic events which develop at the time an indwelling catheter is in place or
recently removed (within last 2 calendar days) will contribute to the CA-SUTI rate.
Urinary Catheter Utilization Ratio = Total urinary catheters-days / Total resident-days.
UTI treatment ratio = New antibiotic starts for UTI / Total UTI Count (SUTI + ABUTI +
CASUTI)
NOTE: When the UTI treatment ratio is <1, there are fewer reported antibiotic starts for UTI
than symptomatic UTI events submitted; when the UTI treatment ratio equals 1, there are the
same number of new antibiotic starts for UTI and symptomatic UTI events submitted; when the
UTI treatment ratio is >1, there are more reported antibiotic starts for UTI than symptomatic UTI
events submitted

Page 5 of 21

Figure 1: Criteria for Defining UTI Events in NHSN LTCF Component.

Resident without an indwelling catheter (Meets criteria 1a OR 2a OR 3a):
SUTI – Criteria 1a

SUTI – Criteria 2a

SUTI – Criteria 3a

Either of the following:
1. Fever a
2. Leukocytosis b
AND
ONE or more of the following:
 Costovertebral angle pain or
tenderness
 New or marked increase in
suprapubic tenderness
 Gross hematuria
 New or marked increase in
incontinence
 New or marked increase in urgency
 New or marked increase in frequency

Either of the following:
1. Acute dysuria
2. Acute pain, swelling
or tenderness of the
testes, epididymis or
prostate

TWO or more of the following:
 Costovertebral angle pain or
tenderness
 New or marked increase in
suprapubic tenderness
 Gross hematuria
 New or marked increase in
incontinence
 New or marked increase in urgency
 New or marked increase in frequency

AND
Either of the following:
1. Specimen collected from clean catch voided urine and positive culture with ≥ 105 CFU/ml of no more than 2 species of
microorganisms
2. Specimen collected from in/out straight catheter and positive culture with ≥ 102 CFU/ml of any microorganisms

SUTI
a
b

o

o

o

o

o

o

Fever: Single temperature ≥ 37.8 C (>100 F), or > 37.2 C (>99 F) on repeated occasions, or an increase of >1.1 C (>2 F) over baseline
3
3
Leukocytosis: >14,000 cells/mm , or Left shift (> 6% or 1,500 bands/mm

Page 6 of 21

Resident with an indwelling catheter:
CA-SUTI – Criteria
ONE or more of the following with no alternate source:
 Fever a
 Rigors
 New onset hypotension, with no alternate site of infection.
 New onset confusion/functional decline AND Leukocytosis b
 New costovertebral angle pain or tenderness
 New or marked increase in suprapubic tenderness
 Acute pain, swelling or tenderness of the testes, epididymis or prostate
 Purulent discharge from around the catheter

AND
Any of the following:
If urinary catheter removed within last 2 calendar days:
1. Specimen collected from clean catch voided urine and positive culture with ≥ 105 CFU/ml of no more than 2 species of
microorganisms
2. Specimen collected from in/out straight catheter and positive culture with ≥ 102 CFU/ml of any microorganisms
If urinary catheter in place:
3. Specimen collected from indwelling catheter and positive culture with ≥ 105 CFU/ml of any microorganisms c

CA-SUTI
a

o

o

o

o

o

o

Fever: Single temperature ≥ 37.8 C (>100 F), or > 37.2 C (>99 F) on repeated occasions, or an increase of >1.1 C (>2 F) over baseline
3
3
Leukocytosis: >14,000 cells/mm , or Left shift (> 6% or 1,500 bands/mm
c
Indwelling urinary catheters which have been in place for >14 days should be changed prior to specimen collection
b

Page 7 of 21

Resident with or without an indwelling catheter:
ABUTI –Criteria
Resident has no localizing urinary signs or symptoms (i.e., no urgency, frequency, acute dysuria, suprapubic
tenderness, or costovertebral angle pain or tenderness). If no catheter is in place, fever as only sign would
not exclude ABUTI if other positive culture criteria are met.

AND

Any of the following:

1. Specimen collected from clean catch voided urine and positive culture with ≥ 105 CFU/ml of no more than 2
species of microorganisms
2. Specimen collected from in/out straight catheter and positive culture with ≥ 102 CFU/ml of any
microorganisms
3. Specimen collected from indwelling catheter and positive culture with ≥ 105 CFU/ml of any microorganisms

AND

Positive blood culture with at least 1 matching organism in urine culture

ABUTI
Page 8 of 21

Table 1. Criteria for Defining UTI Events in NHSN LTCF Component.
Criterion Symptomatic Urinary Tract Infection (SUTI)
For residents without an indwelling catheter:
Either of the following (Signs & Symptoms):
1a
1. Acute dysuria
2. Acute pain, swelling, or tenderness of the testes, epididymis, or prostate
AND
Either of the following (Laboratory and Diagnostic Testing):
1. Specimen collected from clean catch voided urine and positive culture with ≥ 105
CFU/ml of no more than 2 species of microorganisms
2. Specimen collected from in/out straight catheter and positive culture with ≥ 102
CFU/ml of any microorganisms
2a

Either of the following:
1. Fever (Signs and Symptoms) [Single temperature  37.8C (>100F), or >37.2C (>
99F) on repeated occasions, or an increase of >1.1oC (>2oF) over baseline]
2. Leukocytosis (Laboratory and Diagnostic Testing) (>14,000 cells/mm3) or Left shift
(>6% or 1,500 bands/mm3)
AND
One or more of the following (New and/or marked increase):
3. Costovertebral angle pain or tenderness,
4. Suprapubic tenderness,
5. Visible (Gross) hematuria,
6. New or marked increase incontinence
7. New or marked increase urgency
8. New or marked increase frequency
AND
Either of the following (Laboratory and Diagnostic Testing):
1. Specimen collected from clean catch voided urine and positive culture with ≥ 105
CFU/ml of no more than 2 species of microorganisms
2. Specimen collected from in/out straight catheter and positive culture with ≥ 102
CFU/ml of any microorganisms

Page 9 of 21

3a

Two or more of the following (New and/or marked increase):
1. Costovertebral angle pain or tenderness,
2. New or marked increase incontinence
3. New or marked increase urgency
4. New or marked increase frequency
5. Suprapubic tenderness
6. Visible (gross) hematuria
AND

Either of the following (Laboratory and Diagnostic Testing):
1. Specimen collected from clean catch voided urine and positive culture with ≥ 105
CFU/ml of no more than 2 species of microorganisms
2. Specimen collected from in/out straight catheter and positive culture with ≥ 102
CFU/ml of any microorganisms
Criterion Cather-associated Symptomatic Urinary Tract Infection (SUTI) – CA-SUTI
For residents with an indwelling catheter in place or removed within 2 calendar days prior
to event onset
One or more of the following (Signs and Symptoms and Laboratory and Diagnostic
Testing):
a.
b.
c.
d.

Fever
Rigors
New onset hypotension, with no alternate site of infection.
New onset confusion/functional decline with no alternate diagnosis AND
leukocytosis
e. New onset suprapubic pain or costovertebral angle pain or tenderness
f. Acute pain, swelling, or tenderness of the testes, epididymis, or prostate.
g. Purulent discharge from around the catheter

AND
Any of the following:
If urinary catheter removed within last 2 calendar days:

1. Specimen collected from clean catch voided urine and positive culture with ≥ 105
CFU/ml of no more than 2 species of microorganisms
2. Specimen collected from in/out straight catheter and positive culture with ≥ 102 CFU/ml
of any microorganisms
If urinary catheter in place:
3. Specimen collected from indwelling catheter and positive culture with ≥ 105 CFU/ml of
any microorganisms

Page 10 of 21

Criterion Asymptomatic Bacteremic Urinary Tract Infection (ABUTI)
Resident with or without an indwelling urinary catheter
No signs or symptoms (i.e., no urgency, frequency, acute dysuria, suprapubic tenderness, or
1
costovertebral angle pain or tenderness). If no catheter is in place, fever alone would not
exclude ABUTI if other criteria are met.
AND
One of the following:

1. Specimen collected from clean catch voided urine and positive culture with ≥ 105
CFU/ml of no more than 2 species of microorganisms
2. Specimen collected from in/out straight catheter and positive culture with ≥ 102 CFU/ml
of any microorganisms
3. Specimen collected from indwelling catheter and positive culture with ≥ 105 CFU/ml of
any microorganisms .
AND
A positive blood culture with at least 1 matching organism in urine culture.

Page 11 of 21

NHSN Long-term Care Facility Component
Tables of Instructions

Table 2. Instructions for Completion of the Long-term Care Facility Component - Denominators for
LTCF (CDC 57.142)
Instructions for Form Completion
Data Field
Facility ID

Required. The NHSN-assigned facility ID will be auto-entered by the system.

Location Code

Required: Enter the code for the location where surveillance was performed. For
Long-term Care Facilities this code will be FacWideIN (Facility-wide Inpatient).

Month

Required. Record the 2-digit month during which the data were collected.

Year

Required. Record the 4-digit year during which the data were collected.

Number of residents

Required. For each day of the month, record the number of residents in the
facility. Do not include residents for whom a bed is being held but are not
actually present in the facility.

Number of residents with a
urinary catheter

Conditionally required. Complete only if you are performing urinary tract
infection (UTI) surveillance for this month.

For each day of the month, count and record the number of residents in the
facility that have an indwelling urinary catheter.
Indwelling urinary catheter is a drainage tube that is inserted into the urinary
bladder through the urethra, is left in place, and is connected to a closed
collection system; also called a Foley catheter. Do not include straight in-and-out
catheters, suprapubic catheters , or condom catheters in your count.
New antibiotic starts for UTI
indication

Conditionally required. Complete only if you are performing urinary tract
infection (UTI) surveillance for this month.

For each day of the month, count and record the number of new prescriptions
for an antibiotic given for residents suspected or diagnosed with having a urinary
tract infection, (both catheter-associated and not catheter associated), in the
facility. Capture all new antibiotic starts, regardless of total duration of
treatment.

NHSN Patient Safety Component
Tables of Instructions

Instructions for Form Completion
Data Field

Include only antibiotics which are started while the resident is receiving care in
the facility, either by clinical providers working in the facility or by outside
physicians who see the resident in an outpatient clinic or Emergency
department.
Do not include antibiotic courses started by another healthcare facility prior to
the resident’s admission or readmission back to your facility.

Number of admissions

Required. For each day of the month, count and record the number of residents
admitted to the facility. Include both new admissions and re-admissions.

Number of admissions on C.diff Conditionally required. Complete only if you are performing LabID event for
treatment
C.difficile surveillance for this month.

For each day of the month, count and record the number of residents who are
receiving antibiotic therapy for C.difficile infection at the time of admission.
Include both new admissions and re-admissions.

Total (for Resident-days, Urinary Required. A total for each column should be calculated by summing the numbers
catheter-days, New antibiotic recorded for each individual day of the month.
starts for UTI indication,
Resident admissions)
Alternatively, if available, these monthly totals can be obtained from LTCF
administrate data sources in place of performing daily counts.

Only the monthly total will be entered into the NHSN application.

8 -2

NHSN Patient Safety Component
Tables of Instructions

Instructions for Form Completion
Data Field
Custom Fields

Optional. Up to 50 fields may be customized for local or group use in any
combination of the following formats: date (MMDDYYY), numeric, or
alphanumeric.
NOTE: Each Custom Field must be set up in the Facility/Custom Options section
of NHSN before the field can be selected for use.

8 -3

NHSN Long-term Care Facility Component
Form Instructions

Table 3. Instructions for Completion of the Long-term Care Facility
Component - Annual Facility Survey (CDC 57.137)
Data Field
Facility ID

Instructions for Form Completion
Required. The NHSN-assigned facility ID will be auto-entered by the system.

Survey Year

Required. Select the calendar year for which this survey was completed.
The survey year should represent the last full calendar year. For example, in 2011,
a facility would complete a 2010 survey.

National Provider ID

Required. Enter your facility National Provider ID (10-digit number).

State Provider ID

Optional. If available, enter your facility State Provider ID.

Ownership

Facility Characteristics
Required. Select the appropriate ownership of this facility (check one).
 For profit
 Not for profit, including church
 Government (Not VA)
 Veterans Affairs

Certification

Required. Select the appropriate certification of this facility (check one).
 Dual Medicare/Medicaid
 Medicare only
 Medicaid only
 State only

Affiliation

Required. Select the appropriate affiliation for this facility (check one):







February, 2013

Independent, free-standing - The facility does not share a building, staff, or
policies (such as infection control) with any other healthcare institution.
Independent, continuing care retirement community – This facility is not
affiliated with any other healthcare system, but is part of a campus containing
other levels of elder care services.
Multi-facility organization (chain) - The facility is part of a regional or
national network of specialty facilities. Facilities share policies (such as
infection control), corporate leadership, and a common business structure.
Hospital system, attached - The facility is affiliated with a local healthcare
system. Facility shares policies (such as infection control) with other
institutions within the hospital system. The facility is physically connected to
the hospital within the system.
Hospital system, free-standing - The facility is affiliated with a local
healthcare system. Facility shares policies (such as infection control) with
other institutions within the hospital system. The facility is not physically
connected to the hospital within the system.

NHSN Long-term Care Facility Component
Form Instructions

Average daily census

Required. Enter the average daily census for your facility during the last full
calendar year (12 months).

Total number of short-stay
residents

Required. Enter the total number of residents that stayed ≤ 100 days in the
previous calendar year.

Total number of long-stay
residents

Required. Enter the total number of residents that stayed > 100 days in the
previous calendar year.

Average length of stay for short- Optional. Enter the average length of stay for short-stay residents for your facility
stay residents
during the last full calendar year.
Average length of stay for long- Optional. Enter average length of stay for long-stay residents for your facility
stay residents
during the last full calendar year.
Number of new admissions

Required. Enter the total number new admissions to your facility during the last
full calendar year.

Number of Beds

Required. Enter the total number of beds (including any pediatric beds) for your
facility.

Number of Pediatric (age < 21) Required. Enter the number of pediatric beds for your facility. Pediatric beds are
Beds
defined as those beds dedicated to residents that are less than 21 years of age. If
you have no pediatric beds at your facility report zero.
Indicate which of the following Required. For each primary service type listed, check the box only if your facility
primary service types are
provides this primary service type. For the primary service types your facility
provided by your facility.
provides (those with boxes checked) indicate the number of residents primarily
receiving that service on the day this survey is completed.
For each service indicated:
On the day of this survey, how Only list one service type per resident and this should be the primary service (or
many residents are receiving
most specialized care) the resident is receiving. For example, a resident may be
care in your facility by the
admitted for skilled care while on a ventilator. That resident would be counted as
following primary service types “ventilator care”. A resident who is long-stay but on a specialized dementia unit
would be listed as “long-term dementia”.
The total of residents per service type reported should sum to the resident census
on the day the survey is completed.
 Long-term General Nursing:
 Long-term Dementia:
 Skilled nursing/short-term (sub-acute) rehab:
 Long-term psychiatric (non-dementia):
 Ventilator:
 Bariatric:
 Hospice/Palliative:
 Other:

February, 2013

NHSN Long-term Care Facility Component
Form Instructions

Facility Microbiology Laboratory Practices
Completion of this section may require the assistance from the microbiology laboratory.
1. Does your facility have its Required. Select Yes if your laboratory performs antimicrobial susceptibility
own laboratory that performs testing. Otherwise, select No.
antimicrobial susceptibility
testing?
If No, where is the facility's
antimicrobial susceptibility
testing performed? (check
one)
2. Indicate whether your
facility screens new
admissions for any of the
following multidrugresistant organisms (check
all that apply)

Conditionally Required. Select the location where your facility's antimicrobial
susceptibility testing is performed: Affiliated medical center or commercial
referral laboratory. If multiple laboratories are used include the laboratory which
performs the majority of the bacterial susceptibly testing.
Required. Indicate by checking the appropriate boxes if your facility obtains
screening cultures (Active Surveillance Testing) on newly admitted residents for
the following multidrug-resistant organisms (MDROs) (check all that apply).
If your facility does not obtain screening cultures on new admissions for any of
the MDROs listed, check the box indicating “We do not screen new admissions
for MDROs” only.






We do not screen new admissions for MDROs
Methicillin-resistant Staphylococcus aureus (MRSA)
Vancomycin-resistant Enterococcus (VRE)
Multidrug-resistant gram-negative rods (includes carbapenemase-resistant
Enterobacteriaceae; multidrug-resistant Acinetobacter, etc.)

For the MDROs checked,
MRSA: Conditionally required.
indicate the specimen types sent  Nasal swabs
for screening (check all that
 Wound swabs
apply)
 Sputum
 Other skin site
VRE: Conditionally required.
 Rectal swabs
 Wound swabs
 Urine
Multidrug-resistant gram-negative rods: Conditionally required.
 Rectal swabs
 Wound swabs
 Sputum
 Urine
3. What is the primary testing
method for C. difficile used
most often by your facility’s
laboratory or the outside
laboratory where your
facility’s testing is

February, 2013

Required. Select from the choices listed the testing methods used to perform C.
difficile testing by your facility’s laboratory or the outside laboratory where your
facility’s testing is done. If ‘Other’ is selected, please specify.
Note: “Other” should not be used to name specific laboratories, reference
laboratories, or the brand names of C. difficile tests; most methods can be

NHSN Long-term Care Facility Component
Form Instructions

performed? (check one)

categorized accurately by selecting from the options provided. Please ask your
laboratory or conduct a search for further guidance on selecting the correct option
to report.
4. Does your laboratory
Required. Select Yes if your laboratory provides your facility with a report which
provide a report
summarizes the percent susceptibility to a list of common antibiotics for the
summarizing the percent of bacterial organisms most frequently identified by cultures sent to the
antibiotic resistance seen in microbiology lab. This summary is NOT the same as antibiotic susceptibility
common organisms
testing provided on culture reports for individual residents. Otherwise, select No.
identified in cultures sent
from your facility (often
called an antibiogram)?
Conditionally Required. If ‘Yes’, indicate whether the antibiogram is provided
If yes, indicate how often
once a year, every 2 years, or Other and specify the frequency.
this summary reported is
received
Infection Control Practices
5. Number of staff hours
dedicated to infection
control activities in the
facility
a. Total hours per week
performing surveillance

Required. Enter average total hours per week that are dedicated to ALL infection
control activities in your facility. If multiple staff members are responsible for
parts of the infection control program, include the hours spent per week by each
person.
Required. Enter the number of hours per week engaged in activities designed to
find and report healthcare-associated infections and the appropriate denominators.

b. Total hours per week for
infection prevention
activities other than
surveillance
6. Does the facility routinely
require use of gowns/gloves
for care of residents infected
or colonized with MRSA?

Required. Enter the number of hours per week spent on infection prevention and
control activities other than surveillance. These activities include, but are not
limited to, education, prevention, meetings, etc.

7. Does the facility routinely
require use of gowns/gloves
for care of residents infected
or colonized with VRE?
8. Does the facility routinely
require use of gowns/gloves
for care of residents infected
or colonized with CRE

Required. Select the single best choice from the choices listed that most
accurately describes the primary approach to using gowns/gloves for care of
residents with methicillin resistant Staphylococcus aureus (MRSA) at your
facility.
Select ‘No’ if your facility does not routinely use gowns/gloves during care of
residents infected or colonized with MRSA
Required. Select the single best choice from the choices listed that most
accurately describes the primary approach to using gowns/gloves for care of
residents with vancomycin resistant Eterococcus (VRE) at your facility.
Select ‘No’ if your facility does not routinely use gowns/gloves during care of
residents infected or colonized with VRE
Required. Select the single best choice from the choices listed that most
accurately describes the primary approach to using gowns/gloves for care of
residents with carbapenem resistant Enterobacteriaceae (CRE) at your facility.
Select ‘No’ if your facility does not routinely use gowns/gloves during care of
residents infected or colonized with CRE
NOTE: The term “Enterobacteriaceae” refers to a family of common gram
negative bacteria which can colonize the GI or urinary tract of frail and/or older
adults. Examples of these bacteria include E. coli, Klebsiella and Enterobacter

February, 2013

NHSN Long-term Care Facility Component
Form Instructions

9. Does the facility routinely
require use of gowns/gloves
for care of residents infected
or colonized with ESBLproducing or extended
spectrum cephalosporin
resistant Enterobacteriaceae
in contact precautions?

Required. Select the single best choice from the choices listed that most
accurately describes the primary approach to using gowns/gloves for care of
residents with extended-spectrum beta-lactamase producing (ESBL) or extendedspectrum cephalosporin resistant Enterobacteriaceae at your facility.
Select ‘No’ if your facility does not routinely use gowns/gloves during care of
residents infected or colonized with ESBL producing or extended cephalosporin
resistant Enterobacteriaceae.

NOTE: The term “Enterobacteriaceae” refers to a family of common gram
negative bacteria which can colonize the GI or urinary tract of frail and/or older
adults. Examples of these bacteria include E. coli, Klebsiella and Enterobacter
10. When a resident colonized or Required. Select ‘Yes’ if your facility routinely communicates the status of a
infected with an MDRO is patient known to be colonized or infected with a multidrug-resistant organism
transferred to another
(MDRO) to the receiving facility at the time of patient transfer; otherwise, select
facility, does your facility
‘No’.
communicate the resident’s
MDRO status to the
receiving facility at the time
of transfer?
11. Among residents with an
Required. Enter the estimated percentage of the time that your facility receives
MDRO admitted to your
information from a transferring facility about the status of a resident known to be
facility from other healthcare colonized or infected with a multidrug-resistant organism (MDRO)
facilities, what percentage of
the time does your facility
receive information from the
transferring facility about the
resident’s MDRO status?
Antibiotic Stewardship Practices. Completion of this by section may require assistance from the consultant
pharmacist, director of nursing and/or medical director who focus on efforts to improve antibiotic use and
monitoring (known as Stewardship) for your facility
12. Is there a leader responsible Required Select 'Yes' if any individual has been identified as a lead for antibiotic
for the impact of activities to stewardship activities as evidenced by responsibility for improving antibiotic use
improve use of antibiotics at in the job description or performance review, authority to coordinate activities of
your facility?
staff from multiple departments (e.g. laboratory, pharmacy, information
technology), and/or responsibility to report to facility administration/senior
leaders on the antibiotic stewardship program planning and outcomes.
Select ‘No’ if the facility leadership has not specifically given a person the
responsibility, support and authority to oversee antibiotic use and stewardship
efforts in the facility.
If Yes, what is the position
of this leader?
13. Does your facility have a
policy that requires
prescribers to document in
the medical record or during
order entry, a dose, duration,

February, 2013

Conditionally Required. If ‘Yes’, specify the qualification or job title of the
leader(s). More than choice one may be selected. If ‘Other’ is selected, please
specify the position.
Required. Select 'Yes' if your facility has a policy requiring documentation of
dose, duration and indication for all antibiotics in the medical record or during
order entry; otherwise, select 'No'.

NHSN Long-term Care Facility Component
Form Instructions

and indication for all
antibiotics?
If Yes, has adherence to this
documentation policy (dose,
duration, and indication)
been monitored?
14. Does your facility provide
facility-specific treatment
recommendations, based on
national guidelines and local
susceptibility, to assist with
antibiotic decision making
for common clinical
conditions?

15.

16.

17.

18.

Conditionally Required. If ‘Yes’ to question 13, select ‘Yes’ if charts are
routinely being been reviewed to confirm documentation of dose, duration, and
indication in patient medical records; otherwise, select ‘No’.

Required. Select 'Yes' if there are facility-specific recommendations for
antibiotic treatment selection based on evidence-based guidelines and/or local
susceptibility reports for ANY common clinical infections diagnosed and treated
(e.g., community required pneumonia, urinary tract infections, or skin and soft
tissue infections); otherwise, select 'No'.
Conditionally Required. If ‘Yes’ to question 14,
a. Select ‘Yes’ charts have been audited to confirm adherence to facility-specific
treatment guidelines for ANY of the common clinical conditions listed above;
otherwise, select ‘No’.

If Yes, has adherence to
facility-specific treatment
recommendations been
monitored?
Is there a formal procedure Required. Select 'Yes' if your facility has developed a standardized way for
for perform a follow-up
clinicians or nurses caring for a resident to reassess the continuing need and
assessment 2-3 days after a choice of antibiotics between 2-3 days after a new antibiotic start in order to
new antibiotic start to
determine the following: confirm indication, review microbiology results, and
determine whether the
review antibiotic choice, dose, and duration; Otherwise, select 'No'.
antibiotic is still indicated
and appropriate (e.g.
antibiotic time out)?
Does a physician, nurse or Required. Select 'Yes' if your facility has a physician, nurse or pharmacist
pharmacist review courses of knowledgeable in antibiotic use, and not part of the treating team, review courses
therapy for specified
of therapy for specified antibiotic agents and communicate the results to the
antibiotic agents and
providers caring for the resident; otherwise, select 'No'.
communicate results with
prescribers (i.e., audit with
feedback) at your facility?
Does the pharmacy service Required. Select Yes if your pharmacy service provides your facility with a
provide a monthly report of report which summarizes the antibiotic use in your facility on a monthly basis.
antibiotic use (e.g., new
This report could include a list of all antibiotics started each month or number of
orders, number of days of
days of antibiotics used each month; Select No if no report specifically
antibiotic treatment) for the describing on antibiotic use is provided to the facility every month.
facility?
Has your facility provided Required. Select 'Yes' if your facility has provided specific education on ways to
education to clinicians and improve antibiotic use to providers, nurses, and other relevant staff (e.g. inother relevant staff on
service training, direct instruction, etc.); Otherwise, select 'No'.
improving antibiotic use in
the past 12 months?
Electronic Health Record Utilization

February, 2013

NHSN Long-term Care Facility Component
Form Instructions

Indicate whether any of the Required. Indicate by checking the appropriate boxes whether any of the
following are available in an following are available in an electronic health record at your facility (check all
electronic health record
that apply).
(check all that apply)
 Microbiology lab culture and antimicrobial susceptibility results
 Medication orders
 Medication administration record
 Resident vital signs
 Resident admission notes
 Resident progress notes
 Resident transfer or discharge notes
 None of the above

February, 2013