Att D-3 Revision of Estimated Annual Burden Hours

National Healthcare Safety Network (NHSN)

OMB Control No. 0920-0666

Revision Request May 2016

Revision of Estimated Annual Burden Hours

		Number of Respondents (Annual)		Responses per Respondent (Annual)		Burden per Response (Hours)		Total Annual Burden (Hours)*		Change in Burden (Hours)*
Form Number	Form Name	05/2016	06/2015	05/2016	06/2015	05/2016	06/2015	05/2016	06/2015
57.100	NHSN Registration Form	2,000	2,000	1	1	5/60	5/60	167	167	0
57.101	Facility Contact Information	2,000	2,000	1	1	10/60	10/60	333	333	0
57.103	Patient Safety Component--Annual Hospital Survey	5,000	5,000	1	1	55/60	50/60	4,583	4,167	417
57.105	Group Contact Information	1,000	1,000	1	1	5/60	5/60	83	83	0
57.106	Patient Safety Monthly Reporting Plan	6,000	6,000	12	12	15/60	15/60	18,000	18,000	0
57.108	Primary Bloodstream Infection (BSI)	6,000	6,000	44	44	30/60	30/60	132,000	132,000	0
57.111	Pneumonia (PNEU)	6,000	6,000	72	72	30/60	30/60	216,000	216,000	0
57.112	Ventilator-Associated Event	6,000	6,000	144	144	25/60	25/60	360,000	360,000	0
57.113	Pediatric Ventilator-Associated Event (PedVAE)	2,000	-	120	-	25/60	-	100,000	-	100,000
57.114	Urinary Tract Infection (UTI)	6,000	6,000	40	40	20/60	20/60	80,000	80,000	0
57.115	Custom Event	2,000	-	91	-	35/60	-	106,167	-	106,167
57.116	Denominators for Neonatal Intensive Care Unit (NICU)	6,000	6,000	9	9	3	3	162,000	162,000	0
57.117	Denominators for Specialty Care Area (SCA)/Oncology (ONC)	6,000	6,000	9	9	5	5	270,000	270,000	0
57.118	Denominators for Intensive Care Unit (ICU)/Other locations (not NICU or SCA)	6,000	6,000	60	60	5	5	1,800,000	1,800,000	0
57.120	Surgical Site Infection (SSI)	6,000	6,000	36	36	35/60	35/60	126,000	126,000	0
57.121	Denominator for Procedure	6,000	6,000	540	540	10/60	5/60	540,000	270,000	270,000
57.123	Antimicrobial Use and Resistance (AUR)-Microbiology Data Electronic Upload Specification Tables	6,000	6,000	12	12	5/60	5/60	6,000	6,000	0
57.124	Antimicrobial Use and Resistance (AUR)-Pharmacy Data Electronic Upload Specification Tables	6,000	6,000	12	12	5/60	5/60	6,000	6,000	0
57.125	Central Line Insertion Practices Adherence Monitoring	1,000	1,000	100	100	25/60	25/60	41,667	41,667	0
57.126	MDRO or CDI Infection Form	6,000	6,000	72	72	30/60	30/60	216,000	216,000	0
57.127	MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring	6,000	6,000	24	24	15/60	15/60	36,000	36,000	0
57.128	Laboratory-identified MDRO or CDI Event	6,000	6,000	240	240	20/60	20/60	480,000	480,000	0
57.129	Adult Sepsis	50	-	250	-	25/60	-	5,208	-	5,208
57.137	Long-Term Care Facility Component – Annual Facility Survey	350	250	1	1	1.08	1	378	250	128
57.138	Laboratory-identified MDRO or CDI Event for LTCF	350	250	12	8	15/60	15/60	1,050	500	550
57.139	MDRO and CDI LabID Event Reporting Monthly Summary Data for LTCF	350	250	12	12	10/60	5/60	700	250	450
57.140	Urinary Tract Infection (UTI) for LTCF	350	250	14	9	30/60	30/60	2,450	1,125	1,325
57.141	Monthly Reporting Plan for LTCF	350	250	12	12	5/60	5/60	350	250	100
57.142	Denominators for LTCF Locations	350	250	12	12	3.35	3.25	14,070	9,750	4,320
57.143	Prevention Process Measures Monthly Monitoring for LTCF	300	250	12	12	5/60	5/60	300	250	50
57.150	LTAC Annual Survey	400	400	1	1	55/60	50/60	367	333	33
57.151	Rehab Annual Survey	1,000	1,000	1	1	55/60	50/60	917	833	83
57.200	Healthcare Personnel Safety Component Annual Facility Survey	50	50	1	1	8	8	400	400	0
57.203	Healthcare Personnel Safety Monthly Reporting Plan	17,000	17,000	1	1	5/60	5/60	1,417	1,417	0
57.204	Healthcare Worker Demographic Data	50	50	200	200	20/60	20/60	3,333	3,333	0
57.205	Exposure to Blood/Body Fluids	50	50	50	50	1	1	2,500	2,500	0
57.206	Healthcare Worker Prophylaxis/Treatment	50	50	30	30	15/60	15/60	375	375	0
57.207	Follow-Up Laboratory Testing	50	50	50	50	15/60	15/60	625	625	0
57.210	Healthcare Worker Prophylaxis/Treatment-Influenza	50	50	50	50	10/60	10/60	417	417	0
57.300	Hemovigilance Module Annual Survey – Acute Care Facility	500	500	1	1	2	2	1,000	1,000	0
57.301	Hemovigilance Module Monthly Reporting Plan	500	500	12	12	1/60	1/60	100	100	0
57.303	Hemovigilance Module Monthly Reporting Denominators	500	500	12	12	1.17	1	7,020	6,000	1,020
57.305	Hemovigilance Incident	500	500	10	10	10/60	10/60	833	833	0
57.306	Hemovigilance Module Annual Survey - Non-Acute Care Facility	200	-	1	-	35/60	-	117	-	117
57.307	Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction	500	-	4	-	25/60	-	833	-	833
57.308	Hemovigilance Adverse Reaction - Allergic Transfusion Reaction	500	-	4	-	25/60	-	833	-	833
57.309	Hemovigilance Adverse Reaction - Delayed Hemolytic Transfusion Reaction	500	-	1	-	25/60	-	208	-	208
57.310	Hemovigilance Adverse Reaction - Delayed Serologic Transfusion Reaction	500	-	2	-	25/60	-	417	-	417
57.311	Hemovigilance Adverse Reaction - Febrile Non-hemolytic Transfusion Reaction	500	-	4	-	25/60	-	833	-	833
57.312	Hemovigilance Adverse Reaction - Hypotensive Transfusion Reaction	500	-	1	-	25/60	-	208	-	208
57.313	Hemovigilance Adverse Reaction - Infection	500	-	1	-	25/60	-	208	-	208
57.314	Hemovigilance Adverse Reaction - Post Transfusion Purpura	500	-	1	-	25/60	-	208	-	208
57.315	Hemovigilance Adverse Reaction - Transfusion Associated Dyspnea	500	-	1	-	25/60	-	208	-	208
57.316	Hemovigilance Adverse Reaction - Transfusion Associated Graft vs. Host Disease	500	-	1	-	25/60	-	208	-	208
57.317	Hemovigilance Adverse Reaction - Transfusion Related Acute Lung Injury	500	-	1	-	25/60	-	208	-	208
57.318	Hemovigilance Adverse Reaction - Transfusion Associated Circulatory Overload	500	-	2	-	25/60	-	417	-	417
57.319	Hemovigilance Adverse Reaction - Unknown Transfusion Reaction	500	-	1	-	25/60	-	208	-	208
57.320	Hemovigilance Adverse Reaction - Other Transfusion Reaction	500	-	1	-	25/60	-	208	-	208
57.400	Patient Safety Component—Annual Facility Survey for Ambulatory Surgery Center (ASC)	5,000	5,000	1	1	5/60	5/60	417	417	0
57.401	Outpatient Procedure Component - Monthly Reporting Plan	5,000	5,000	12	12	15/60	15/60	15,000	15,000	0
57.402	Outpatient Procedure Component Event	5,000	5,000	25	25	40/60	40/60	83,333	83,333	0
57.403	Outpatient Procedure Component - Monthly Denominators and Summary	5,000	5,000	12	12	40/60	40/60	40,000	40,000	0
57.500	Outpatient Dialysis Center Practices Survey	6,500	6,500	1	1	2.0	2.0	13,000	13,000	0
57.501	Dialysis Monthly Reporting Plan	6,500	6,500	12	12	5/60	5/60	6,500	6,500	0
57.502	Dialysis Event	6,500	6,500	60	60	25/60	25/60	162,500	162,500	0
57.503	Denominator for Outpatient Dialysis	6,500	6,500	12	12	10/60	10/60	13,000	13,000	0
57.504	Prevention Process Measures Monthly Monitoring for Dialysis	1,500	1,500	12	12	1.25	1.25	22,500	22,500	0
57.505	Dialysis Patient Influenza Vaccination	325	325	75	75	10/60	10/60	4,063	4,063	0
57.506	Dialysis Patient Influenza Vaccination Denominator	325	325	5	5	10/60	10/60	271	271	0
57.507	Home Dialysis Center Practices Survey	600	-	1	-	25/60	-	250	-	250
Total Estimated Annual Burden (Hours)								5,110,966	4,621,542	489,424

*Values were rounded prior to summation.

Revision of estimated annual burden, in number of hours, by NHSN data collection form. 2