Att D-4 _Rev of Est Annual Cost Burden

National Healthcare Safety Network (NHSN)

OMB Control No. 0920-0666

Revision Request May 2016

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	05/2016	06/2015	05/2016	06/2015	05/2016	06/2015
57.100	NHSN Registration Form	167	167	$39.66	$38.98	$6,610	$6,497	$113
57.101	Facility Contact Information	333	333	$39.66	$38.98	$13,220	$12,993	$227
57.103	Patient Safety Component--Annual Hospital Survey	4,583	4,167	$39.66	$38.98	$181,775	$162,417	$19,358
57.105	Group Contact Information	83	83	$39.66	$38.98	$3,305	$3,248	$57
57.106	Patient Safety Monthly Reporting Plan	18,000	18,000	$39.66	$38.98	$713,880	$701,640	$12,240
57.108	Primary Bloodstream Infection (BSI)	132,000	132,000	$39.66	$38.98	$5,235,120	$5,145,360	$89,760
57.111	Pneumonia (PNEU)	216,000	216,000	$39.66	$38.98	$8,566,560	$8,419,680	$146,880
57.112	Ventilator-Associated Event	360,000	360,000	$39.66	$38.98	$14,277,600	$14,032,800	$244,800
57.113	Pediatric Ventilator-Associated Event (PedVAE)	100,000	-	$39.66	-	$3,966,000	-	$3,966,000
57.114	Urinary Tract Infection (UTI)	80,000	80,000	$39.66	$38.98	$3,172,800	$3,118,400	$54,400
57.115	Custom Event	106,167	-	$39.66	-	$4,210,570	-	$4,210,570
57.116	Denominators for Neonatal Intensive Care Unit (NICU)	162,000	162,000	$32.45	$32.04	$5,256,900	$5,190,480	$66,420
57.117	Denominators for Specialty Care Area (SCA)/Oncology (ONC)	270,000	270,000	$32.45	$32.04	$8,761,500	$8,650,800	$110,700
57.118	Denominators for Intensive Care Unit (ICU)/Other locations (not NICU or SCA)	1,800,000	1,800,000	$32.45	$32.04	$58,410,000	$57,672,000	$738,000
57.120	Surgical Site Infection (SSI)	126,000	126,000	$39.66	$38.98	$4,997,160	$4,911,480	$85,680
57.121	Denominator for Procedure	540,000	270,000	$32.45	$32.04	$17,523,000	$8,650,800	$8,872,200
57.123	Antimicrobial Use and Resistance (AUR)-Microbiology Data Electronic Upload Specification Tables	6,000	6,000	$18.73	$18.45	$112,380	$110,700	$1,680
57.124	Antimicrobial Use and Resistance (AUR)-Pharmacy Data Electronic Upload Specification Tables	6,000	6,000	$58.41	$14.33	$350,460	$85,980	$264,480
57.125	Central Line Insertion Practices Adherence Monitoring	41,667	41,667	$39.66	$38.98	$1,652,500	$1,624,167	$28,333
57.126	MDRO or CDI Infection Form	216,000	216,000	$39.66	$38.98	$8,566,560	$8,419,680	$146,880
57.127	MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring	36,000	36,000	$39.66	$38.98	$1,427,760	$1,403,280	$24,480
57.128	Laboratory-identified MDRO or CDI Event	480,000	480,000	$39.66	$38.98	$19,036,800	$18,710,400	$326,400
57.129	Adult Sepsis	5,208	-	$39.66	-	$206,563	-	$206,563
57.137	Long-Term Care Facility Component – Annual Facility Survey	378	250	$39.66	$38.98	$14,991	$9,745	$5,246
57.138	Laboratory-identified MDRO or CDI Event for LTCF	1,050	500	$39.66	$38.98	$41,643	$19,490	$22,153
57.139	MDRO and CDI LabID Event Reporting Monthly Summary Data for LTCF	700	250	$39.66	$38.98	$27,762	$9,745	$18,017
57.140	Urinary Tract Infection (UTI) for LTCF	2,450	1,125	$39.66	$38.98	$97,167	$43,853	$53,315
57.141	Monthly Reporting Plan for LTCF	350	250	$39.66	$38.98	$13,881	$9,745	$4,136
57.142	Denominators for LTCF Locations	14,070	9,750	$39.66	$38.98	$558,016	$380,055	$177,961
57.143	Prevention Process Measures Monthly Monitoring for LTCF	300	250	$39.66	$38.98	$11,898	$9,745	$2,153
57.150	LTAC Annual Survey	367	333	$39.66	$38.98	$14,542	$12,993	$1,549
57.151	Rehab Annual Survey	917	833	$39.66	$38.98	$36,355	$32,483	$3,872
57.200	Healthcare Personnel Safety Component Annual Facility Survey	400	400	$33.75	$33.27	$13,500	$13,308	$192
57.203	Healthcare Personnel Safety Monthly Reporting Plan	1,417	1,417	$33.75	$33.27	$47,813	$47,133	$680
57.204	Healthcare Worker Demographic Data	3,333	3,333	$33.75	$33.27	$112,500	$110,900	$1,600
57.205	Exposure to Blood/Body Fluids	2,500	2,500	$33.75	$33.27	$84,375	$83,175	$1,200
57.206	Healthcare Worker Prophylaxis/Treatment	375	375	$33.75	$33.27	$12,656	$12,476	$180
57.207	Follow-Up Laboratory Testing	625	625	$18.73	$18.45	$11,706	$11,531	$175
57.210	Healthcare Worker Prophylaxis/Treatment-Influenza	417	417	$33.75	$33.27	$14,063	$13,863	$200
57.300	Hemovigilance Module Annual Survey – Acute Care Facility	1,000	1,000	$34.99	$34.27	$34,990	$34,270	$720
57.301	Hemovigilance Module Monthly Reporting Plan	100	100	$34.99	$34.27	$3,499	$3,427	$72
57.303	Hemovigilance Module Monthly Reporting Denominators	7,020	6,000	$34.99	$34.27	$245,630	$205,620	$40,010
57.305	Hemovigilance Incident	833	833	$34.99	$34.27	$29,158	$28,558	$600
57.306	Hemovigilance Module Annual Survey - Non-Acute Care Facility	117	-	$34.99	-	$4,082	-	$4,082
57.307	Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction	833	-	$34.99	-	$29,158	-	$29,158
57.308	Hemovigilance Adverse Reaction - Allergic Transfusion Reaction	833	-	$34.99	-	$29,158	-	$29,158
57.309	Hemovigilance Adverse Reaction - Delayed Hemolytic Transfusion Reaction	208	-	$34.99	-	$7,290	-	$7,290
57.310	Hemovigilance Adverse Reaction - Delayed Serologic Transfusion Reaction	417	-	$34.99	-	$14,579	-	$14,579
57.311	Hemovigilance Adverse Reaction - Febrile Non-hemolytic Transfusion Reaction	833	-	$34.99	-	$29,158	-	$29,158
57.312	Hemovigilance Adverse Reaction - Hypotensive Transfusion Reaction	208	-	$34.99	-	$7,290	-	$7,290
57.313	Hemovigilance Adverse Reaction - Infection	208	-	$34.99	-	$7,290	-	$7,290
57.314	Hemovigilance Adverse Reaction - Post Transfusion Purpura	208	-	$34.99	-	$7,290	-	$7,290
57.315	Hemovigilance Adverse Reaction - Transfusion Associated Dyspnea	208	-	$34.99	-	$7,290	-	$7,290
57.316	Hemovigilance Adverse Reaction - Transfusion Associated Graft vs. Host Disease	208	-	$34.99	-	$7,290	-	$7,290
57.317	Hemovigilance Adverse Reaction - Transfusion Related Acute Lung Injury	208	-	$34.99	-	$7,290	-	$7,290
57.318	Hemovigilance Adverse Reaction - Transfusion Associated Circulatory Overload	417	-	$34.99	-	$14,579	-	$14,579
57.319	Hemovigilance Adverse Reaction - Unknown Transfusion Reaction	208	-	$34.99	-	$7,290	-	$7,290
57.320	Hemovigilance Adverse Reaction - Other Transfusion Reaction	208	-	$34.99	-	$7,290	-	$7,290
57.400	Patient Safety Component—Annual Facility Survey for Ambulatory Surgery Center (ASC)	417	417	$32.45	$32.04	$13,521	$13,350	$171
57.401	Outpatient Procedure Component - Monthly Reporting Plan	15,000	15,000	$32.45	$32.04	$486,750	$480,600	$6,150
57.402	Outpatient Procedure Component Event	83,333	83,333	$32.45	$32.04	$2,704,167	$2,670,000	$34,167
57.403	Outpatient Procedure Component - Monthly Denominators and Summary	40,000	40,000	$32.45	$32.04	$1,298,000	$1,281,600	$16,400
57.500	Outpatient Dialysis Center Practices Survey	13,000	13,000	$39.66	$38.98	$515,580	$506,740	$8,840
57.501	Dialysis Monthly Reporting Plan	6,500	6,500	$32.45	$32.04	$210,925	$208,260	$2,665
57.502	Dialysis Event	162,500	162,500	$32.45	$32.04	$5,273,125	$5,206,500	$66,625
57.503	Denominator for Outpatient Dialysis	13,000	13,000	$32.45	$32.04	$421,850	$416,520	$5,330
57.504	Prevention Process Measures Monthly Monitoring for Dialysis	22,500	22,500	$32.45	$32.04	$730,125	$720,900	$9,225
57.505	Dialysis Patient Influenza Vaccination	4,063	4,063	$32.45	$32.04	$131,828	$130,163	$1,666
57.506	Dialysis Patient Influenza Vaccination Denominator	271	271	$32.45	$32.04	$8,789	$8,678	$111
57.507	Home Dialysis Center Practices Survey	250	-	$39.66	-	$9,915	-	$9,915
Total Estimated Annual Cost Burden						$180,066,067	$169,329,048	$20,092,219

*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. 5