Att D-4 _Rev of Est Annual Cost Burden

National Healthcare Safety Network (NHSN)

OMB Control No. 0920-0666

Revision Request June 2015

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	06/2015	06/2014	06/2015	06/2014	06/2015	06/2014
57.100	NHSN Registration Form	167	167	$38.98	$38.55	$6,497	$6,425	$72
57.101	Facility Contact Information	333	333	$38.98	$38.55	$12,993	$12,850	$143
57.103	Patient Safety Component--Annual Hospital Survey	4,167	5,000	$38.98	$38.55	$162,417	$192,750	($30,333)
57.105	Group Contact Information	83	83	$38.98	$38.55	$3,248	$3,213	$36
57.106	Patient Safety Monthly Reporting Plan	18,000	18,000	$38.98	$38.55	$701,640	$693,900	$7,740
57.108	Primary Bloodstream Infection (BSI)	132,000	132,000	$38.98	$38.55	$5,145,360	$5,088,600	$56,760
57.111	Pneumonia (PNEU)	216,000	216,000	$38.98	$38.55	$8,419,680	$8,326,800	$92,880
57.112	Ventilator-Associated Event	360,000	360,000	$38.98	$38.55	$14,032,800	$13,878,000	$154,800
57.114	Urinary Tract Infection (UTI)	80,000	120,000	$38.98	$38.55	$3,118,400	$4,626,000	($1,507,600)
57.116	Denominators for Neonatal Intensive Care Unit (NICU)	162,000	162,000	$32.04	$31.84	$5,190,480	$5,158,080	$32,400
57.117	Denominators for Specialty Care Area (SCA)/Oncology (ONC)	270,000	270,000	$32.04	$31.84	$8,650,800	$8,596,800	$54,000
57.118	Denominators for Intensive Care Unit (ICU)/Other locations (not NICU or SCA)	1,800,000	1,620,000	$32.04	$31.84	$57,672,000	$51,580,800	$6,091,200
57.120	Surgical Site Infection (SSI)	126,000	126,000	$38.98	$38.55	$4,911,480	$4,857,300	$54,180
57.121	Denominator for Procedure	270,000	270,000	$32.04	$31.84	$8,650,800	$8,596,800	$54,000
57.123	Antimicrobial Use and Resistance (AUR)-Microbiology Data Electronic Upload Specification Tables	6,000	6,000	$18.45	$18.26	$110,700	$109,560	$1,140
57.124	Antimicrobial Use and Resistance (AUR)-Pharmacy Data Electronic Upload Specification Tables	6,000	6,000	$14.33	$14.25	$85,980	$85,500	$480
57.125	Central Line Insertion Practices Adherence Monitoring	41,667	8,333	$38.98	$38.55	$1,624,167	$321,250	$1,302,917
57.126	MDRO or CDI Infection Form	216,000	216,000	$38.98	$38.55	$8,419,680	$8,326,800	$92,880
57.127	MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring	36,000	36,000	$38.98	$38.55	$1,403,280	$1,387,800	$15,480
57.128	Laboratory-identified MDRO or CDI Event	480,000	360,000	$38.98	$38.55	$18,710,400	$13,878,000	$4,832,400
57.137	Long-Term Care Facility Component – Annual Facility Survey	250	250	$38.98	$38.55	$9,745	$9,638	$108
57.138	Laboratory-identified MDRO or CDI Event for LTCF	500	500	$38.98	$38.55	$19,490	$19,275	$215
57.139	MDRO and CDI Prevention Process Measures Monthly Monitoring for LTCF	250	250	$38.98	$38.55	$9,745	$9,638	$108
57.140	Urinary Tract Infection (UTI) for LTCF	1,125	1,125	$38.98	$38.55	$43,853	$43,369	$484
57.141	Monthly Reporting Plan for LTCF	250	250	$38.98	$38.55	$9,745	$9,638	$108
57.142	Denominators for LTCF Locations	9,750	9,750	$38.98	$38.55	$380,055	$375,863	$4,192
57.143	Prevention Process Measures Monthly Monitoring for LTCF	250	250	$38.98	$38.55	$9,745	$9,638	$108
57.150	LTAC Annual Survey	333	333	$38.98	$38.55	$12,993	$12,850	$143
57.151	Rehab Annual Survey	833	833	$38.98	$38.55	$32,483	$32,125	$358
57.200	Healthcare Personnel Safety Component Annual Facility Survey	400	400	$33.27	$32.15	$13,308	$12,860	$448
57.203	Healthcare Personnel Safety Monthly Reporting Plan	1,417	917	$33.27	$32.15	$47,133	$29,471	$17,662
57.204	Healthcare Worker Demographic Data	3,333	3,333	$33.27	$32.15	$110,900	$107,167	$3,733
57.205	Exposure to Blood/Body Fluids	2,500	2,500	$33.27	$32.15	$83,175	$80,375	$2,800
57.206	Healthcare Worker Prophylaxis/Treatment	375	375	$33.27	$32.15	$12,476	$12,056	$420
57.207	Follow-Up Laboratory Testing	625	625	$18.45	$18.26	$11,531	$11,413	$119
57.210	Healthcare Worker Prophylaxis/Treatment-Influenza	417	417	$33.27	$32.15	$13,863	$13,396	$467
57.300	Hemovigilance Module Annual Survey	1,000	1,000	$34.27	$33.61	$34,270	$33,610	$660
57.301	Hemovigilance Module Monthly Reporting Plan	100	100	$34.27	$33.61	$3,427	$3,361	$66
57.303	Hemovigilance Module Monthly Reporting Denominators	6,000	6,000	$34.27	$33.61	$205,620	$201,660	$3,960
57.304	Hemovigilance Adverse Reaction	6,000	6,000	$34.27	$33.61	$205,620	$201,660	$3,960
57.305	Hemovigilance Incident	833	833	$34.27	$33.61	$28,558	$28,008	$550
57.400	Patient Safety Component—Annual Facility Survey for Ambulatory Surgery Center (ASC)	417	417	$32.04	$31.84	$13,350	$13,267	$83
57.401	Outpatient Procedure Component - Monthly Reporting Plan	15,000	15,000	$32.04	$31.84	$480,600	$477,600	$3,000
57.402	Outpatient Procedure Component Event	83,333	83,333	$32.04	$31.84	$2,670,000	$2,653,333	$16,667
57.403	Outpatient Procedure Component - Monthly Denominators and Summary	40,000	40,000	$32.04	$31.84	$1,281,600	$1,273,600	$8,000
57.500	Outpatient Dialysis Center Practices Survey	13,000	11,375	$38.98	$38.55	$506,740	$438,506	$68,234
57.501	Dialysis Monthly Reporting Plan	6,500	6,500	$32.04	$31.84	$208,260	$206,960	$1,300
57.502	Dialysis Event	162,500	130,000	$32.04	$31.84	$5,206,500	$4,139,200	$1,067,300
57.503	Denominator for Outpatient Dialysis	13,000	7,800	$32.04	$31.84	$416,520	$248,352	$168,168
57.504	Prevention Process Measures Monthly Monitoring for Dialysis	22,500	9,000	$32.04	$31.84	$720,900	$286,560	$434,340
57.505	Dialysis Patient Influenza Vaccination	4,063	4,063	$32.04	$31.84	$130,163	$129,350	$813
57.506	Dialysis Patient Influenza Vaccination Denominator	271	271	$32.04	$31.84	$8,678	$8,623	$54
Total Estimated Annual Cost Burden						$169,329,048	$146,941,956	$22,387,097

*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