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Prevalence Survey of Healthcare Associated Infections (HAIs) and Antimicrobial Use in U.S. Acute Care Hospitals

Att F_2015 Operational Manual

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2015 OPERATIONAL
MANUAL
Emerging Infections Program Healthcare-Associated
Infections and Antimicrobial Use Prevalence Survey
Primary Team Instructions

Version 2015.04.30

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Phase 4 Prevalence Survey PT Instructions, 20150430

TABLE OF CONTENTS
*NOTE: This document contains only the sections of the complete Operational Manual that are relevant
to the Primary Team’s responsiblities in this survey. Some sections, appendices, and forms have been
removed as they are not relevant to the major activities of the Primary Team. If you have questions about
the complete Operational Manual, please contact your EIP Team.
Section
References
Introduction to the prevalence survey
Prevalence survey teams
Patient population
Overview of survey procedures
Overview of data collection
Instructions for completing Patient Information Form
What to do with completed forms
Appendix 1: CDC location mapping codes and process
Appendix 3: Antimicrobial drug list

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References used in preparing this manual:
1) The National Healthcare Safety Network (NHSN) acute care hospital healthcare-associated infection
(HAI) surveillance protocols, CDC locations, and other supporting materials, available at
http://www.cdc.gov/nhsn/acute-care-hospital/index.html. Whenever possible and appropriate,
language from the NHSN surveillance protocols and supporting materials appears verbatim (or with
minimal modification) in this manual.
2) Operational manual for the Four Country (England, Wales, Northern Ireland, Republic of Ireland)
Healthcare Associated Infection Prevalence Survey 2006, Hospital Infection Society and Infection
Control Nurses Association. Survey results presented in: Smyth ETM, McIlvenny G, Enstone JE, et
al. Four Country Healthcare Associated Infection Prevalence Survey 2006: overview of the results. J
Hosp Infect 2008;69:230-48.
3) Operational manual for the Jacksonville Healthcare-Associated Infections Prevalence Survey Pilot
2009, Jacksonville, FL, Version 6, June 29, 2009.
4) Operational manual for the Emerging Infections Program Phase 2 Limited Roll-Out HealthcareAssociated Infections and Antimicrobial Use Prevalence Survey, Version 4, June 17, 2010.
5) Emerging Infections Program Phase 3 Healthcare-Associated Infections and Antimicrobial Use
Prevalence Survey protocol, Version 4a, March 22, 2011.
6) European Centre for Disease Prevention and Control. Point prevalence survey of healthcareassociated infections and antimicrobial use in Eurooean acute care hospitals—protocol version 4.3.
Stockholm: ECDC; 2012.
INTRODUCTION: PREVALENCE SURVEY DESIGN OVERVIEW
This manual contains instructions for performing the Emerging Infections Program (EIP) HealthcareAssociated Infections (HAI) and Antimicrobial Use Prevalence Survey and completing the data collection
forms.
The project has been designed as a point prevalence survey, to be conducted on a single day in each
participating hospital. Hospital types included in the survey are general acute care hospitals, including
general acute care pediatric hospitals. Hospitals participating in the Phase 3 (2011) survey were
randomly selected and recruited for participation in each EIP site from 3 bed size strata: small, medium,
and large. The numbers of hospitals recruited in each of these strata attempted to approximate the
distribution of hospitals in these bed size categories across the entire EIP catchment area (combined
catchment areas of the 10 EIP sites). For the Phase 4 (2015) survey, EIP sites will attempt to engage all
hospitals that participated in Phase 3. EIP sites with fewer than 20 hospitals participating in the Phase 3
survey are encouraged to attempt to engage additional hospitals for the Phase 4 survey, as resources
permit, up to a maximum of 25 hospitals.
Each participating hospital will select its own survey date. Where possible, hospital survey dates will
occur during the period from May 1 through September 11, 2015. Because this is a point prevalence
survey, all data collection will remain restricted to information present (or cultures or other testing on
specimens collected) on or prior to the survey date. Medical record review will be performed on the
survey date by trained hospital staff (called the Primary Team or PT) to collect basic demographic, risk
factor, and antimicrobial use data for a random sample of acute care inpatients. Each EIP site will have a
trained team of survey personnel (the EIP Team, or EIPT) that may assist the PT with its data collection
or perform this data collection instead of the PT, where needed. Basic demographic, risk factor, and
antimicrobial use data collected on the survey date by the PT should be transmitted to EIPTs within 30
days following the survey date.
The EIPTs will identify patients needing additional medical record review (i.e. those patients identified by
the PTs as receiving or being scheduled to receive antimicrobial therapy on the survey date or the
calendar day prior to the survey date). EIPTs will request and review medical records of these patients to
make HAI determinations and collect antimicrobial use data, including data to use in evaluating the quality
and antimicrobial drug prescribing. EIPTs will enter all survey data into a web-based electronic data
management system developed by CDC. It is recommended that EIPTs begin requesting medical records

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and performing the antimicrobial use and HAI data collection as soon as possible, at a time point when it
can be anticipated that most patients will have been discharged from the hospital and medical records will
be available for review; for example, approximately 45 days following each hospital’s survey date. The
goal date for completion of all survey data collection and entry is June 30, 2016.
PREVALENCE SURVEY TEAMS
As noted above, primary data collection for the prevalence survey will be conducted by 2 teams: Primary
Teams (PTs) and EIP Teams (EIPTs).
The PT is the team that each participating hospital assembles for the purposes of conducting prevalence
survey activities. The number, experience, and expertise of team members will vary from hospital to
hospital, although it is recommended that the PT leader be an infection preventionist. Other team
members will be determined by the PT leader. These individuals may be Registered Nurses or other
hospital personnel without specific infection prevention experience, as long as these team members: 1)
possess appropriate credentials and permissions to review patient medical records as required by the
facility; 2) have participated in prevalence survey training conducted by EIP sites and/or CDC; and 3)
receive adequate supervision by the PT leader. The PT will collect basic demographic and limited clinical
data on patients selected for inclusion in the survey. The EIPT may assist the PT in these survey date
activities, to the extent determined upon by the PT and EIPT, by providing support or participating in data
collection.
The EIPT is the team composed of EIP epidemiologists/surveillance officers and led by the EIP survey
coordinator. In some EIP sites, this team may also include other designated, qualified individuals, as
deemed appropriate by the EIP survey coordinator. EIPT members will participate in prevalence survey
training conducted by CDC. The EIPT will assist the PT with hospital acute care unit mapping to NHSN
location codes, training, and patient selection activities, and may also assist the PT with its portion of the
survey data collection or collect these data instead of the PT. The EIPT will also perform retrospective
medical record review of surveyed patients to identify HAIs and to assess antimicrobial use and
prescribing quality.
PATIENT POPULATION
The prevalence survey will include patients of any age admitted to acute care areas of participating
hospitals. Acute care areas of participating hospitals include labor and delivery (LD) units, labor-deliveryrecovery-postpartum (LDRP) units, and newborn nurseries housing well newborns. Newborns rooming in
with mothers on LDRP or postpartum (PP) units are also included. There is no required duration of
hospitalization for a patient to be included in the study (except in the case of patients on observation
status, who are eligible for inclusion in the survey if they have been in the hospital for ≥ 24 hours at the
time of the survey).
Do not include patients in the following categories:
 Patients in non-acute care areas of the hospital.
 Patients in non-admission areas of the hospital.
 Patients in psychiatric units (units providing care for patients whose primary condition is
psychiatric).
 Patients in rehabilitation units (units for patients whose primary reason for hospitalization is to
receive physical therapy or rehabilitative therapy).
 Patients in skilled nursing care units.
 Patients undergoing same-day treatment or surgery.
 Patients seen as outpatients, whether for 23-hour observation, diagnosis, or therapy (e.g.
chemotherapy, dialysis, or cardiac catheterization).
 Patients in the Emergency Department.
 Patients in hospice units.

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Ideally, all acute care patients in participating hospitals would be included in the survey. However, in
many instances this is not practical. Therefore, a random sample of acute care patients from each
participating hospital will be included. The process for selecting the random sample of patients is
described below. The size of the random sample will depend on the staffed bed size of the hospital:




Small hospitals will have a target sample size of 75 patients.
Medium hospitals will have a target sample size of 75 patients.
Large hospitals will have a target sample size of 100 patients.

OVERVIEW OF SURVEY PROCEDURES FOR PRIMARY TEAMS
Primary Teams
1) Each hospital should designate a PT leader in advance of the survey date. The PT leader is
responsible for coordinating all prevalence survey activities at that facility and for supervising and
organizing the efforts of the PT.
2) The PT leader and EIPT will work together to establish the hospital’s survey date and training
date(s).
3) The PT leader, with assistance from the EIPT and other hospital staff as needed, will coordinate
completion of the “Healthcare Facility Assessment” (HFA, a hospital questionnaire pertaining to
hospital characteristics and infection control and antimicrobial stewardship policies and practices)
during the month prior to the survey date. The HFA is completed once by each hospital
participating in the survey. The completed HFA is submitted to the EIPT, ensuring that
precautions are taken (in accordance with local and state regulations) to protect the confidentiality
of the information recorded on the HFA.
4) In advance of the survey date, the PT leader will send a list of the participating facility’s acute
care inpatient units to the EIPT along with the corresponding NHSN location codes to which the
units are mapped. In those uncommon situations in which a hospital’s inpatient units are not
already mapped to NHSN location codes, or are mapped to codes that were not used in the
Phase 3 (2011) survey, the EIPT will work with CDC staff to map each acute care inpatient unit to
the correct NHSN location code (see Appendix 1).
5) The PT leader will submit a list of acute care bed numbers to the EIPT approximately 2-3 weeks
in advance of the survey date. This bed number list should, whenever possible, be formatted in
Microsoft Excel, with columns for acute care unit name, CDC location code, and bed number.
Bed numbers should represent unique hospital beds (and, therefore, in most cases unique
patients).
6) Approximately one week prior to the survey, the PT leader will receive a randomly-sorted acute
care bed number list from the EIPT. This list should include the following information for each
acute care bed number: the hospital unit on which the bed is located, the CDC location code for
that unit, and the CDC ID code assigned to that bed number. The list should also make note of
the target sample size for that hospital, based on the hospital’s bed size category.
Note for small hospitals: If the number of staffed beds in a small hospital is less than 75, then the
goal will be for the PT to survey all patients in that hospital on the survey date. For example, if
Hospital CC has 50 staffed beds, Hospital CC would have a sample size goal of 50 patients on
the survey date. If 45 eligible acute care patients were in Hospital CC on the morning of the
survey date (i.e. 5 beds were empty), the PT should attempt to survey all 45 patients. Also, in
hospitals where the number of staffed beds may be greater than 75 but the number of eligible
patients on the survey date turns out to be less than 75, the PT should attempt to survey all
eligible patients.

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7) CDC ID codes should be pre-assigned to bed numbers prior to the survey by the EIPT or the PT.
Each code will be a 7-digit, alpha-numeric code starting with the state’s two-letter abbreviation,
followed by a two-letter facility identifier and 3 numbers (example, CA-AA001). The two-letter
facility identifier will be assigned by the EIPT.
Example of CDC ID code assignment: Hospital AA in CA is a small hospital with a target sample
size of 75 patients. The CA EIPT member assigned to Hospital AA provides the PT leader with
the hospital two-letter code (AA), and patient numbers from 1 to 150 (depending on the size of
the hospital, it may be prudent to provide more patient numbers to accommodate empty beds,
ineligible patients, etc.). Therefore, CDC ID codes in Hospital AA will be CA-AA001 through CAAA150. Hospital BB, also in CA, is a large hospital and therefore has a target sample size of 100.
The CA EIPT member gives the Hospital BB PT leader the hospital two-letter code (BB) and
patient numbers from 1 to 200 (to accommodate situations where there are empty beds,
ineligible patients, etc.). Therefore, Hospital BB’s CDC ID codes will be CA-BB001 through CABB200.
8) On the morning of the survey, the PT leader will print out the hospital census for that day. The
census should be generated between 12:00 am (2400 or 0000 hours) and 08:00 am (0800 hours)
on the survey date. The PT will match the randomly-sorted acute care bed number list with the
morning census to identify the patients to be surveyed. For example, if the first bed number on
the randomly-sorted bed number list is bed 100 on the 2 North patient care unit, then the PT will
use the morning census to identify the patient occupying bed 100 on the 2 North unit. That patient
will be included in the survey, unless initial review of the patient’s record reveals that the patient is
not an acute care patient eligible for inclusion in the survey. Once the randomly-sorted bed
numbers are matched to the morning census, the CDC ID codes are used as unique identifiers
for the patients occupying those acute care bed numbers randomly selected for inclusion in the
survey.
9) The PT (or the EIPT) must complete page 1 of the Patient Information Form (PIF) for each patient
included in the minimum sample size goal. In the Hospital AA example, a small hospital, the PT
needs to complete page 1 of the PIF for each patient occupying one of the first 75 bed numbers
on the randomly-sorted acute care bed number list on the morning of the survey, assuming that
each of the patients occupying those 75 bed numbers is eligible for the survey (i.e. are eligible
acute care inpatients) and their medical records are available. Page 2 of the PIF consists of
discharge and outcome information, and will be completed by the PT (or EIPT) at a later date.
10) Special circumstances that may arise include the following: (1) a patient occupying a bed
selected for inclusion in the survey is not eligible for the survey; (2) the patient’s medical record is
unavailable at the time of the survey; and (3) a bed selected for inclusion in the survey is empty at
the time of the survey. Circumstance (2) is likely to be a problem primarily in facilities where PTs
need to review paper medical records to complete PIFs. Several special circumstances are
addressed below:
a) What if I go to review the medical record of a patient occupying a bed selected for inclusion in
the survey, and I discover that the patient is actually a patient on observation status?
Answer: If the patient is an observation-status patient who has been in the hospital for at
least 24 hours, include that patient in the survey. If the patient is an observation-status patient
who has been in the hospital for < 24 hours, exclude that patient and move on to the next
patient/bed number on your list.


NOTE: If you are completing the PIF retrospectively, the patient must have been in the
hospital for at least 24 hours as of 5 pm (1700 hrs) on the survey date to be eligible for
inclusion.

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b) What should I do if I travel to a unit to review a patient selected for inclusion in the survey, but
the patient is off the floor and the medical record is not available?
Answer: This situation is probably only applicable to situations where paper medical records
are being reviewed on the survey date. In these cases, the PT (or EIPT) should make a
second attempt to review that patient’s chart at a later time on the survey date. If the patient
record is still not available on the second attempt, then the PT (or EIPT) can skip that patient
and not include that patient in the survey.


NOTE: For hospitals with electronic health records, this will not affect your ability to
review the electronic record and complete the PIF.

c) What should I do if a patient selected for inclusion in the survey dies or is discharged from the
hospital between the time the morning census was generated and the time I travel to the unit
to review the medical record?
Answer: This situation is primarily applicable to situations where paper medical records are
being reviewed on the survey date. If a patient selected for inclusion in the survey has been
discharged or has died between the time the morning census list is generated and the time
the PT (or EIPT) reviews that patient’s medical record on the survey date, the PT may skip
that patient and not include that patient in the survey if the medical record is not available.
If, however, the patient’s record is still available, and it can be confirmed that the patient was
in the hospital, was an eligible acute care inpatient, and occupied the selected acute care bed
number for some period of time on the survey date, the patient should be included in the
survey and page 1 of the PIF should be completed.


NOTE: For hospitals with electronic health records, if you can confirm that the patient
was an eligible acute care inpatient and occupied the selected bed number for some
period of time on the survey date during usual working hours, the patient is included in
the survey and a PIF is completed.

d) What should I do if a patient selected for inclusion in the survey is transferred to another bed
in my hospital between the time the morning census was generated and the time I travel to
the unit to review the medical record?
Answer: This situation is primarily applicable to situations where paper medical records are
being reviewed on the survey date. In this circumstance, you will need to skip that patient. Do
not “follow” the patient to their new location in the hospital. Also, if the patient’s original bed
number (the bed number selected for inclusion in the survey) is now occupied by a different
patient than the patient on the morning census list, DO NOT review the record of the patient
who is now occupying the bed. You should move to the next acute care bed number and
patient on your randomly-sorted bed number list.


NOTE: For hospitals with electronic health records, if you can confirm that the patient
was an eligible acute care inpatient and occupied the selected bed number for some
period of time on the survey date during usual working hours the patient is included in the
survey and a PIF is completed.

e) What should I do if I discover that a bed number selected for inclusion in the survey is empty
at the time of the survey?
Answer: You should simply skip that bed number and move on to the next bed number on
your list. Of course, you will need to replace that empty bed number with another bed number
on your randomly-sorted list, and the process for doing this is described in the answer to the
next question.

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f)

What should I do if I get to my minimum goal sample size on my list, but I realize that I have
had to skip a few patients for the reasons noted above (e.g., medical records were not
available, beds were empty, etc.), and so I haven’t actually completed my minimum goal
number of PIFs?
Answer: Let’s consider an example. You are a PT member in Hospital BB, considered a large
hospital for the purposes of the prevalence survey. You know that your minimum sample size
goal for the prevalence survey is 100 patients. You have reached the 100th acute care bed
number on your randomly-sorted bed number list, and you realize that you have only been
able to complete page 1 of 95 PIFs, since 3 patients’ medical records were not available and
2 bed numbers were empty. In this case, you should simply continue in order down your
randomly-sorted acute care bed number list until you are able to complete 5 more PIFs (page
1). That will give you your minimum goal sample size of 100. It is very important to continue
down your randomly-sorted list in order—do not skip around on your list to select the
replacement bed numbers.

11) The PT leader (or EIPT) should ensure that all PIFs (page 1) are filled out completely. It is
strongly recommended that page 1 of the PIFs be completed on the survey date. Page 2 of the
PIF will need to be completed retrospectively because it consists of discharge and outcome
information. The PT leader should maintain the linkages between CDC ID codes and patient
identifiers until the EIPT notifies the PT leader that project activities are complete and the
linkages can be destroyed (as long as this is in accordance with local and state rules and
regulations). The PT leader can maintain the linkages by making sure to fill out the top portion of
the PIF (the “Identifiers” section), making a copy of each PIF, and storing these forms in a secure
location at the participating facility, according to local institutional review board (IRB) and/or
hospital regulations.
12) The PT leader should submit all original, completed PIFs to the EIPT within 30 days after the
survey date, keeping in mind that these forms contain patient identifiers. All necessary
precautions, according to each participating facility’s and/or state’s requirements, should be taken
to ensure patient privacy and confidentiality.
13) EIPTs should review all PIFs for completeness, including page 2 (discharge and outcome
information). EIPTs should ensure that any incomplete fields on the PIF are completed in a timely
manner, either through EIPT retrospective medical record review or through follow-up with the
PT.
DATA COLLECTION OVERVIEW
NOTE regarding sources of data: This project includes hospital-specific forms and patientspecific forms. The hospital-specific forms are completed by PTs and EIPTs, and may involve
consultation with hospital staff other than PT members to gather information on basic hospital
characteristics and infection control and antimicrobial stewardship policies and practices. The
patient-specific forms rely only on existing data sources (e.g., medical records, nursing records,
and laboratory reports). There is no direct interaction with patients. Patients are not interviewed.
Acceptable sources of data include: electronic or paper medical records, radiology or laboratory
reports, census lists, lists of patients with selected medical devices, etc.
There are multiple survey forms that are completed by the Primary Teams and/or the EIP Teams.
There is one hospital-level form that is completed by the Primary Team and/or other hospital staff:
1) Healthcare Facility Assessment (HFA), completed by each hospital’s PT (and/or other hospital
staff where appropriate) one time during the month before each hospital’s survey date.
There is one patient-level form that is completed by the Primary Team and/or the EIP Team:

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1) Patient Information Form (PIF), 2-page form completed by PTs and/or EIPTs for all surveyed
patients. Page 2 (discharge and outcome information) is usually completed by the EIP Team.
There are additional forms completed by the EIP Team:
1) EIP Healthcare Facility Assessment (EIP HFA), 1-page form completed by EIPTs one time during
the month before each hospital’s survey date.
2) Antimicrobial Use Form (AUF), 2-page form completed by EIPTs for patients identified on page 1
of the PIF as receiving or being scheduled to receive antimicrobial drugs on the survey date or
the day prior to the survey date (or for whom antimicrobial data are unknown).
3) Antimicrobial Quality Assessment (AQUA) Forms:
a. Case Eligibility Form (AQUA Form 1), 2-page form completed by EIPTs for patients who
meet certain criteria based on data recorded on the AUF.
b. General Patient Assessment Form (AQUA Form 2), 2-page form completed by EIPTs for
patients who are deemed eligible for one or more AQUA events, based on information
recorded on the Case Eligibility Form.
c. Vancomycin Form (AQUA Form 3a), 2-page form completed by EIPTs for patients
deemed eligible for this AQUA event based on information recorded on the Case
Eligibility Form.
d. Fluoroquinolone Form (AQUA Form 3b), 3-page form completed by EIPTs for patients
deemed eligible for this AQUA event based on information recorded on the Case
Eligibility Form.
e. Community-Acquired Pneumonia (CAP) Form (AQUA Form 3c), 4-page form completed
by EIPTs for patients deemed eligible for this AQUA event based on information recorded
on the Case Eligibility Form.
f. Urinary Tract Infection (UTI) Form (AQUA Form 3d), 3-page form completed by EIPTs for
patients deemed eligible for this AQUA event based on information recorded on the Case
Eligibility Form.
4) HAI Form (HAIF), 2-page form completed by EIPTs for patients identified on the AUF as receiving
antimicrobial drug(s) for treatment of active infection or for unknown rationale.
The PT role in survey data collection is described in more detail below.
Primary Team Data Collection
Data Collection Tools
Data collection should be completed using the HFA and the PIF. The HFA can be completed manually,
using black or blue ink, or can be completed electronically as a fillable PDF. The PIF should be completed
manually using black or blue ink. Record dates, identification numbers, and codes where indicated. When
making a selection(s) among answer choices, place “X” in the appropriate box or boxes.
Timeline for Completing Data Collection
Each hospital will work with their EIPT to select a single survey date between May 1 and September 11,
2015. The HFA should be completed and submitted to the EIPT during the month prior to the survey date.
Surveys should be conducted on a weekday, Monday through Friday, during normal working hours. The
PT is strongly encouraged to complete its data collection activities on the survey date, with the exception
of page 2 of the PIF (discharge and outcome information). Data collection on page 1 of the PIF must
remain restricted to information present on or prior to the survey date. PTs should provide their completed
forms to the EIPT within 30 days of the survey date.
Data Collected
The PTs will complete the PIF for every patient included in the survey. In some cases the EIPT will assist
or will complete the PIF in lieu of the PT. The PIF is a 2-page form. Page 1 of the form is divided into 5
sections: Identifiers, Demographic information, Weight and height, Devices, and Antimicrobials. This page
of the form should ideally be completed on the survey date itself, using information in the medical record
from the survey date or the day prior to the survey date (as noted above). Page 2 of the form has one
section: Follow-up information (hospital discharge date and patient outcome). This page of the form must

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be completed retrospectively for all surveyed patients. PTs and EIPTs should decide how to ensure
completion of Page 2 for all surveyed patients. PIF Identifiers are collected and kept at the local hospital.
Identifiers are also provided to the EIPT so that the EIPT can complete its data collection activities.
Patient identifiers such as name, date of birth, and medical record number are not transmitted to CDC.
Dates such as admission date and survey date are transmitted to CDC. Detailed instructions about how
to answer each item in the PIF are provided below.
Patient Confidentiality Protection
All eligible patients will be assigned a unique identification code (called the “CDC ID”). This code does not
incorporate personally identifying information. Each code will be a 7-digit, alpha-numeric code starting
with the state’s two-letter abbreviation, followed by a two-letter facility identifier and 3 numbers (example,
CA-AA001). The two-letter facility identifier will be assigned by the EIPT. CDC ID codes will be assigned
prior to review of medical records. If bed numbers included in the random sample are not occupied, or
patients are subsequently found to be ineligible for inclusion in the study, CDC ID codes will not be reused or re-assigned to other patients.
The linkages between patient identifiers and CDC ID codes will be maintained at the participating hospital
and EIP site until the conclusion of project activities, at which time the linkages should be destroyed. Data
collected during the course of the project, whether identifiable or de-identified, must be stored in secure
locations according to local and state regulations. Where necessary, participating hospitals and EIP sites
will obtain institutional review board (IRB) approval and/or other appropriate approvals to perform the
prevalence survey.
INSTRUCTIONS FOR COMPLETING DATA COLLECTION FORMS
Patient Information Form (PIF, completed by PTs and/or EIPTs)
Data Field
CDC ID
Survey Date
Data collector initials
If data collected on survey
date, enter data collection
time
OR Data collected
retrospectively

Instructions
Record CDC identification code.
Enter the date in mm/dd/yyyy format.
Enter data collector’s initials.
Self-explanatory. Indicate the time at which data collection began for
that particular PIF, and check “am” or “pm.”
If data collection was not done on the survey date but rather was done
after the survey date, check this box. When data are collected
retrospectively, use only information present, specimens collected, and
tests performed up until 1700 hours (5:00 pm) on the survey date.

Section I. Identifiers – information in Section I is not submitted to CDC
Data Field
Instructions
Patient name
Enter last name, first name, middle initial.
Date of birth
Enter in mm/dd/yyyy format.
Hospital name
Enter the name of the hospital.
Hospital unit name
Enter the name of the hospital unit on which the patient is housed at the
time of the survey.
Room no.
Enter the number of the room occupied by the patient at the time of the
survey.
Medical record no.
Enter the medical record number.
Section II. Demographic information
Data Field
Instructions
Age
Record the patient’s age on the survey date. Age may be noted on the
medical record “face sheet.” If patient’s age is less than 30 days,
indicate age in days and check the “dys” box. If patient’s age is 30 days

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Data Field

Admission date

Gender

CDC location code

Race

Instructions
to 11 months, indicate age in months. If patient is 12 months or older,
indicate age in years. Examples: 34 days of age should be coded as
Age=1 and the box for “mos” should be checked. 14 months of age
should be coded as Age=1 and the box for “yrs” should be checked.
Enter the date the patient was admitted to the hospital. Use
mm/dd/yyyy format. Admission date may be noted on the medical
record “face sheet.” You should enter the actual hospital admission
date, even in circumstances where the patient has stayed overnight in
the Emergency Department waiting for admission. Note that in other
data fields on the survey forms, special instructions are provided for
how to handle data collected in the Emergency Department on the day
prior to inpatient admission.
On occasion you may encounter a patient who is on “observation”
status and not officially a hospital inpatient. These patients qualiify for
inclusion in the survey if they are in an acute care unit inpatient bed and
they have been in the hospital for ≥24 hours at the time of the survey.
Because they are not considered hospital inpatients, there may not be
a hospital admission date. In these cases, enter the date that the
patient was brought to the acute care inpatient bed as the admission
date for the purposes of the prevalence survey.
Check the appropriate box: M=male, F=female, as noted on the
medical record “face sheet.” Enter the biological sex of the patient at
the time of birth.
The CDC location code identifies the type of inpatient unit on which the
patient is housed on the survey date. CDC location codes appear in
Appendix 1. Hospital units should be mapped to the appropriate CDC
location codes in advance of the survey date. The CDC location code
for the unit of each bed number selected for inclusion in the survey
should appear on the randomly-sorted bed number list that the EIPT
provides to the PT to use on the survey date. Record this code on the
PIF. Only one CDC location should be recorded on the PIF. If bed
numbers from heterogeneous units (those units with multiple patient
types, and with no single patient type comprising 80% or more of the
unit’s population) are included on the randomly sorted bed number list,
and there are multiple possible CDC location codes that could
potentially be assigned, depending upon the type of patient occupying
the bed on the day of the survey, you should select the single most
appropriate code based on the type of patient or the clinical service to
which the patient was admitted.
For example, Bed 100 on Unit 6 East is included in the survey. 6 East is
a unit with the following patient types: 30% general medicine, 40%
orthopedic surgery, 30% hematology/oncology. On the randomly-sorted
bed number list, the CDC location column has the following entry: “W-M
or W-ORT orW-ONCHONC.” You should evaluate the medical record
for the patient in Bed 100 on the day of the survey and record ONE
CDC location code based on the patient type or clinical service. If the
patient is admitted to the medical service for treatment of pneumonia,
for example, you would record only “W-M” on the PIF.
Race of patient as noted in the medical record. Race may be noted on
the medical record “face sheet.” Multiple boxes can be checked. Do not
make assumptions based on name or native language. If race is
unknown, please check “unknown”.

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Data Field

Instructions
The minimum categories for the Federal statistics of race data are
defined as follows:
 American Indian or Alaskan Native: A person having
origins in any of the original peoples of North and South
America (including Central America) and who maintain
tribal affiliation or community attachment.
 Asian: A person having origins in any of the original people
of the Far East, Southeast Asia, or the Indian subcontinent.
Can include the following: Cambodia, China, Japan,
Korea, Malaysia, Pakistan, the Philippine Islands, Thailand,
and Vietnam.
 Black or African American: A person having origins in any
of the black racial groups of Africa. Terms such as
“Haitian” or “Negro” can be used in addition to “Black or
African American”.
 Native Hawaiian or other Pacific Islander: A person having
origins in any of the original peoples of Hawaii, Guam,
Samoa, or other Pacific Islands.
 White: A person having origins in any of the original
peoples of Europe, the Middle East, or North Asia.
Note: “Race” instructions modified from 2014 EIP Case Report Form
Instructions, revised 1/14/2014.

Ethnicity

(see OMB Standards for Data on Race and Ethnicity, as published in
1997 Federal Register,
http://www.whitehouse.gov/omb/fedreg_1997standards/)
Ethnicity of patient as noted in medical record. Ethnicity may be
indicated on the medical record “face sheet.” Indicate ethnicity EVEN IF
race is already indicated. Hispanic or Latino ethnicity indicates a person
of Cuban, Mexican, Puerto Rican, South or Central American, or other
Spanish culture or origin, regardless of race. For example, many whites
are also Hispanic or Latino. Do not make assumptions based on name
or native language. If not noted or unsure, check "unknown."
*Note: Some institutions combine race/ethnic coding. For example, they
might define a person’s race as “Hispanic or Latino”. In this case race
would be coded “unknown” on the PIF, and ethnicity would be “Hispanic
or Latino”. If “Caucasian” is indicated in the medical record, race should
be coded as “White” and ethnicity should be coded as “Not Hispanic or
Latino.”
Note: “Ethnicity” instructions modified from 2014 EIP Case Report Form
Instructions, revised 1/14/2014.

Primary Payer

(see OMB Standards for Data on Race and Ethnicity, as published in
1997 Federal Register,
http://www.whitehouse.gov/omb/fedreg_1997standards/)
Check the primary type of health insurance as noted in the hospital
chart. If a patient’s insurance status changes during hospitalization,
indicate insurance status at time of admission. If insurance type is not
noted in the chart or unknown, check “Unknown.”
Clarifications of insurance types:

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Data Field

Instructions
Medicare: the national health insurance program for people 65 years
and older (also covers some people under the age of 65 with disabilities
and people with end-stage renal disease).
Medicaid: program that pays for medical assistance for certain people
with low incomes and resources. State assistance programs are those
state programs that provide medical coverage to individuals who are
otherwise uninsured, uninsurable or those with special health care
needs.
Private insurance: patient receives and pays for medical care as part of
a private or managed care system.
Self-pay: patient pays out of pocket at the time of service. Include
patients without insurance coverage in this category.
No charge: patient (and/or insurance company) was not billed for
medical services. This is uncommon.
Other: health insurance or health care coverage not meeting the above
categories; for example, Tricare for active duty military.
Unknown: patient’s primary payer unable to be determined from
information present in the medical record.

Section III. Weight and height
NOTE: Sources of Body Mass Index (BMI), height and weight information include medication
administration or other pharmacy records, vital signs flow sheets, and admission and progress notes.
Data Field
For infants in neonatal
locations:
Birthweight:
For other patients:
BMI:
Height: (if BMI unknown)
Weight: (if BMI unknown)

Instructions
For infants (less than 12 months of age) in neonatal locations only
(defined as locations coded as CC-NURS, CCS-NURS, S-NURS, WNURS, W-LDRP), record the birthweight in pounds and ounces or in
grams. If the birthweight cannot be located in the medical record, check
“Birthweight unknown.”
For patients who are 12 months of age and older, regardless of hospital
location, enter the Body Mass Index (BMI) recorded on the day of the
survey. If there is no BMI on the survey date, enter the BMI that is
recorded closest to the survey date, BEFORE the survey date. For
example, if the patient is surveyed on August 10, and the patient has a
BMI of 22.7 on August 1, BMI 22.5 on August 5, and BMI 22.2 on
August 11, you will record a BMI of 22.5 since August 5 is the closest
date to the survey date that is BEFORE the survey date.
If the patient has no BMI recorded on the survey date or before the
survey date, check “Unknown” and enter the patient’s height (in feet
and inches or in centimeters) and weight (in pounds and ounces or in
kilograms). You may use height and weight data recorded on different
days, as long as those days are the survey date or a day prior to the
survey date. Use height and weight data recorded on the survey date
whenever possible; if no weight information is available on the survey
date, record height and weight closest in time to the survey date,
BEFORE the survey date (going as far back as the survey hospital
admission date if necessary). If there is no height or weight information
in the medical record on the survey date or on days prior to the survey
date, check “Unknown.”

Section IV: Devices (in place on the survey date)

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NOTE: Information on devices (urinary catheters, ventilators and central lines) may be found in nursing
notes and patients’ daily flow sheets (e.g., sheets that include information on vital signs, fluid balance,
nursing assessments, operating room flow sheets, etc.). Progress notes and procedure notes may also
contain information on device use. Ventilator information may be found in respiratory therapy notes and in
intensive care unit flow sheets in sections documenting the patient’s respiratory status. Finally, some
record systems (particularly electronic record systems) may have a specific location where information on
the presence and status of medical devices is recorded. There is no minimum duration the device must
have been in place.
Data Field
Urinary catheter

Instructions
Check “yes” if the patient has an indwelling urethral catheter (also
called a Foley catheter) on the survey date. Otherwise, check “no.”
Check “no” for patients who receive intermittent catheterization or
“straight” catheterization. Check “no” for patients with nephrostomy
tubes or suprapubic catheters.
A urinary catheter is defined as “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.”
It does not include straight in-and-out catheters, suprapubic catheters,
or nephrostomy tubes.

Ventilator

Check “unknown” only if portions of the medical record are missing and
this information cannot be ascertained (this should be uncommon).
Check “yes” if the patient has a device to assist or control respiration
through a tracheostomy or by endotracheal intubation on the survey
date. Otherwise, check “no.”
A ventilator is defined as “A device to assist or control respiration,
inclusive of the weaning period, through a tracheostomy or by
endotracheal intubation. NOTE: Lung expansion devices such as
intermittent positive pressure breathing (IPPB); nasal positive endexpiratory pressure (PEEP); continuous nasal positive airway pressure
(CPAP, hypoCPAP) are not considered ventilators unless delivered via
tracheostomy or endotracheal intubation (e.g., ET-CPAP).”

Central line

Check “unknown” only if portions of the medical record are missing and
this information cannot be ascertained (this should be uncommon).
Check “yes” if the patient has a central line in place on the survey date.
Otherwise, check “no.”
A central line is defined as:“An intravascular catheter that terminates at
or close to the heart or in one of the great vessels which is used for
infusion, withdrawal of blood, or hemodynamic monitoring. The
following are considered great vessels for the purpose of reporting
central-line infections: aorta, pulmonary artery, superior vena cava,
inferior vena cava, brachiocephalic veins, internal jugular veins,
subclavian veins, external iliac veins, common iliac veins, and femoral
veins.”
NOTE: Neither the insertion site nor the type of device may be used to
determine if a line qualifies as a central line. The device must terminate
in one of these vessels or in or near the heart, and be used for one of
the purposes outlined above, to qualify as a central line.
NOTE: At times an intravascular line may migrate from its original great
vessel location. Subsequent to the original confirmation, ongoing

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confirmation that a line resides in a great vessel is not required.
Therefore, once a line is identified to be a central line, it is considered a
central line until discontinuation, regardless of migration.
NOTE: An introducer is considered an intravascular catheter, and
depending on the location of its tip and use, may be a central line.
NOTE: Pacemaker wires and other nonlumened devices inserted into
central blood vessels or the heart are not considered central lines,
because fluids are not infused, pushed, nor withdrawn through such
devices.
NOTE: In neonates, the umbilical artery/vein is considered a great
vessel.
NOTE: The following devices are not considered central lines:
extracorporeal membrane oxygenation (ECMO), femoral arterial
catheters, intraaortic balloon pump (IABP) devices, and hemodialysis
reliable outflow (HeRO) dialysis catheters.
If the patient has a central line, check “yes,” and indicate whether the
patient has 1 central line, more than 1 central line, or an unknown
number of central lines in place on the survey date. NOTE: Indicate the
number of individual central lines, NOT the number of lumens (for
example, if the patient has one double-lumen central line in place, you
will check the box to indicate that the patient has 1 central line).
Check “unknown” only if portions of the medical record are missing and
this information cannot be ascertained (this should be uncommon).
Section V. Antimicrobials
NOTE: Use the paper or electronic Medication Administration Record (MAR) (including the Emergency
Department MAR and the inpatient MAR) and operating room flow sheets (on which surgical prophylaxis
antibiotics may be recorded) to determine whether patients are being administered or are scheduled to be
administered antimicrobials.
Data field
Antimicrobials
administered or scheduled
to be administered:
On the survey date:
On the day before the
survey date:

Instructions
This question should be answered for every patient included in the
survey. Check “yes” if the patient was administered or was scheduled
to be administered at least one dose of an antimicrobial drug.
Acceptable antimicrobials are those that appear in Appendix 3 that are
administered (or are scheduled to be administered) by any of the
following routes: IV, IM, orally, enterally, or via inhalation.
Make sure to indicate whether the patient was administered or
scheduled to be administered antimicrobials on the survey date AND on
the day before the survey date (one response for each day).
Check “unknown” only if portions of the medical record are missing and
this information cannot be ascertained (this should be uncommon).

Patient Information Form page 2 (PIF, completed by PTs and/or EIPTs)
Data Field
CDC ID
Data collector initials

Instructions
Record CDC identification code.
Enter data collector’s initials.

Section VI. Follow-up information

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NOTE: In many instances, EIP Teams will collect this information. Check with your EIP Team to
determine if/when the PT will complete this section of the form.
NOTE: Data collectors should attempt to ascertain hospital discharge date and patient outcome at the
time of discharge for all patients included in the survey, unless 6 months has elapsed since the survey
date and the patient is still in the hospital (same hospitalization that includes the survey date). Once 6
months have passed since the survey date, attempts to collect discharge and outcome information may
stop.
Data field
Enter date of follow-up
data collection:
Hospital discharge date

Patient outcome at time of
hospital discharge

Instructions
Enter using mm/dd/yyyy format.
Enter using mm/dd/yyyy format. If the patient was discharged but
records are not available to determine the specific discharge date,
check “unknown.” If the patient is still in the hospital at the time of
follow-up, and 6 months have passed since the survey date, check the
“still in hospital” box. If 6 months have not passed since the survey
date, wait until 6 months have passed before completing the follow-up
information section for the patient.
Indicate whether the patient was alive at discharge (survived), died, or if
the outcome is unknown. If the patient is still in the hospital at the time
of follow-up, and 6 months have passed since the survey date, check
the “still in hospital” box. If 6 months have not passed since the survey
date, wait until 6 months have passed before completing the follow-up
information section for the patient.

WHAT TO DO WITH COMPLETED FORMS
Primary Teams:
1) Copy the Healthcare Facility Assessment (HFA) once it is completed.
2) Copy each Patient Information Form (PIF) once it is completed.
3) Submit the original HFA and the PIFs to the EIPT according to arrangements made with the
EIPT, in accordance with local and/or state guidelines and with all necessary precautions taken to
protect patient identifiers.
4) Store copies of the HFA and PIFs in a secure location at the survey hospital in the care of the PT,
in accordance with local and/or state guidelines.
5) Once the EIPT has been notified by CDC that all project activities are complete, the forms may be
destroyed as long as this is in accordance with local guidelines. In some instances, IRBs may
require that forms be maintained for longer periods of time. Check with your IRB for further
information and guidance.

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APPENDIX 1: CDC PATIENT LOCATIONS AND MAPPING PROCESS
NOTE: Locations with asterisks (*) represent locations that were not used in the Phase 3 2011 survey,
but should be used where appropriate in the 2015 survey.
CDC Patient Location/Service
Inpatient Adult Critical Care
Burn Critical Care

Code

Description

CC-B

Critical care area specializing in the
care of patients with
significant/major burns.

Medical Cardiac Critical Care

CC-C

Medical Critical Care

CC-M

Medical/Surgical Critical Care

CC-MS

Critical care area specializing in the
care of patients with serious heart
problems that do not require heart
surgery.
Critical care area for patients who
are being treated for nonsurgical
conditions.
An area where critically ill patients
with medical and/or surgical
conditions are managed.

Neurologic Critical Care

CC-N

Critical care area for the care of
patients with life-threatening
neurologic diseases.

Neurosurgical Critical Care

CC-NS

*ONC Medical Critical Care

CC-ONCM

*ONC Surgical Critical Care

CC-ONCS

*ONC Medical-Surgical Critical Care

CC-ONCMS

Prenatal Critical Care

CC-PNATL

Critical care area for the surgical
management of patients with severe
neurologic diseases or those at risk
for neurologic injury as a result of
surgery.
Critical care area for the care of
oncology patients who are being
treated for nonsurgical conditions
related to their malignancy. (CCONCM maps to 2011 CC-M location
code).
Critical care area for the evaluation
and management of oncology
patients with serious illness before
and/or after cancer-related surgery.
(CC-ONCS maps to 2011 CC-S
location code).
Critical care area for the care of
oncology patients with medical
and/or surgical conditions related to
their malignancy. (CC-ONCMS
maps to 2011 CC-MS location
code).
Critical care area for the care of
pregnant patients with complex
medical or obstetric problems
requiring a high level of care to
prevent the loss of the fetus and to
protect the life of the mother.

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CDC Patient Location/Service
Respiratory Critical Care

Code
CC-R

Surgical Cardiothoracic Critical Care

CC-CT

Surgical Critical Care

CC-S

Trauma Critical Care

CC-T

Neonatal Units
Well Baby Nursery (Level I)

W-NURS

Step down Neonatal Nursery (Level II)

S-NURS

Description
Critical care area for the evaluation
and treatment of patients with
severe respiratory conditions.
Critical care area specializing in the
care of patients following cardiac
and thoracic surgery.
Critical care area for the evaluation
and management of patients with
serious illness before and/or after
surgery.
Critical care area specializing in the
care of patients who require a high
level of monitoring and/or
intervention following trauma or
during critical illness related to
trauma.
Hospital area for evaluation and
postnatal care of healthy newborns.
May include neonatal resuscitation
and stabilization of ill newborns until
transfer to a facility at which
specialty neonatal care is provided.
The capabilities of Level II, listed
below, are from the American
Academy of Pediatrics definitions of
levels of neonatal care1.
Level II special care nursery
Level I capabilities plus:

Neonatal Critical Care (Level II/III)

CCS-NURS

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 Provide care for infants born ≥32
wk gestation and weighing ≥1500
g who have physiologic immaturity
or who are moderately ill with
problems that are expected to
resolve rapidly and are not
anticipated to need subspecialty
services on an urgent basis
 Provide care for infants
convalescing after intensive care
 Provide mechanical ventilation for
brief duration (<24 h) or
continuous positive airway
pressure or both
 Stabilize infants born before 32 wk
gestation and weighing less than
1500 g until transfer to a neonatal
intensive care facility.
Combined nursery housing both
Level II and III newborns and
infants.

CDC Patient Location/Service
Neonatal Critical Care (Level III)

Code
CC-NURS

Description
A hospital neonatal intensive care
unit (NICU) organized with
personnel and equipment to provide
continuous life support and
comprehensive care for extremely
high-risk newborn infants and those
with complex and critical illness.
NOTE: The capabilities of Level III
and Level IV, listed below, are from
the American Academy of Pediatrics
definitions of levels of neonatal
care.1 NOTE: These
classifications are all considered
Level III NICUs for the purposes
of the prevalence survey (and for
NHSN).
Additional details on Level III NICU:
Level II capabilities plus:
 Provide sustained life support
 Provide comprehensive care for
infants born < 32 wks gestation
and weighing <1500 g and infants
born at all gestational ages and
birth weights with critical illness
 Provide prompt and readily
available access to a full range of
pediatric medical subspecialists,
pediatric surgical specialists,
pediatric anesthesiologists, and
pediatric opthalmologists
 Provide a full range of respiratory
support that may include
conventional and/or highfrequency ventilation and inhaled
nitric oxide
 Perform advanced imaging, with
interpretation on an urgent basis,
including computed tomography,
MRI, and echocardiography
Additional details on Level IV
Regional NICU:
Level III capabilities plus:
 Located within an institution with
the capability to provide surgical
repair of complex congenital or
acquired conditions

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CDC Patient Location/Service

Code

Description
 Maintain a full range of pediatric
medical subspecialists, pediatric
surgical subspecialists, and
pediatric subspecialists at the site
 Facilitate transport and provide
outreach education.

Pediatric Critical Care
*ONC Pediatric Critical Care

CC-ONCPED

Pediatric Burn Critical Care

CC-BPED

Pediatric Cardiothoracic Critical Care

CC-CTPED

Pediatric Medical Critical Care

CC-MPED

Pediatric Medical/Surgical Critical Care

CC-MSPED

Critical care area for the care of
oncology patients ≤ 18 years old
who are being treated for surgical or
nonsurgical conditions related to
their malignancy. (CC-ONCPED
maps to 2011 CC-MSPED location
code).
Critical care area specializing in the
care of patients ≤ 18 years old with
significant/major burns
Critical care area specializing in the
care of patients ≤ 18 years old
following cardiac and thoracic
surgery.
Critical care area for patients ≤ 18
years old who are being treated for
nonsurgical conditions. In the NNIS
system, this was called Pediatric
ICU (PICU).
An area where critically ill patients ≤
18 years old with medical and/or
surgical conditions are managed.

Pediatric Neurology Critical Care

CC-NPED

Critical care area for patients ≤ 18
years old specializing in treating lifethreatening neurological diseases.

Pediatric Neurosurgical Critical Care

CC-NSPED

Pediatric Respiratory Critical Care

CC-RPED

Pediatric Surgical Critical Care

CC-SPED

Pediatric Trauma Critical Care

CC-TPED

Critical care area specializing in the
surgical management of patients ≤
18 years old with severe
neurological diseases or those at
risk for neurological injury as a
result of surgery.
Critical care area for the evaluation
and treatment of the patients ≤ 18
years old with severe respiratory
conditions.
Critical care area for the evaluation
and management of patients ≤ 18
years old with serious illness before
and/or after surgery.
Critical care area specializing in the
care of patients ≤ 18 years old who
require a high level of monitoring
and/or intervention following trauma
or during critical illness related to
trauma.

Inpatient Specialty Care Areas

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CDC Patient Location/Service
Long Term Acute Care (LTAC)

Code
SCA-LTAC

Inpatient Acute Dialysis Unit

SCA-DIAL

Solid Organ Transplant SCA

SCA-SOTP

Pediatric Dialysis SCA

SCA-DIALPED

Pediatric Long Term Acute Care
(LTAC)

SCA-LTACPED

Pediatric Solid Organ Transplant SCA

SCA-SOTPPED

Adult Wards
Antenatal Care Ward

W-ANT

Inpatient Burn Ward

W-B

Inpatient Ear/Nose/Throat Ward

W-ENT

Inpatient Gastrointestinal Ward

W-GI

Inpatient Genitourinary Ward

W-GU

Inpatient Gerontology Ward

W-GNT

Phase 4 Prevalence Survey PT Instructions, 20150430

Description
Area that provides acute care
services to patients suffering
medically complex conditions, or
patients who have suffered recent
catastrophic illness or injury and
require an extended stay in an
acute care environment.
Hospital specialty care area for
patients who require acute dialysis
as a temporary measure.
Hospital specialty area for the
postoperative care of patients who
have had a solid organ transplant
(e.g., heart/lung, kidney, liver,
pancreas)
Hospital specialty care area for
patients ≤ 18 years old who require
acute dialysis as part of their care.
These patients may be chronic or
acute dialysis patients.
Area that provides acute care
services to patients ≤ 18 years old
suffering medically complex
conditions, or who suffered recent
catastrophic illness or injury and
require an extended stay in an
acute care environment.
Hospital specialty area for the
postoperative care of patients ≤ 18
years old who have had a solid
organ transplant (e.g., heart/lung,
kidney, liver, pancreas).
Hospital area for observation,
evaluation, treatment or surgery of
high risk pregnancy patients.
Hospital area for evaluation and
treatment of patients who have
burns.
Hospital area for the evaluation,
treatment, or surgery of patients
with ear, nose, or throat disorders
Hospital area for evaluation,
treatment or surgery of patients with
disorders of the gastrointestinal
tract.
Hospital area for the evaluation,
treatment or surgery of patients with
disorders of the genitourinary
system.
Hospital area for the evaluation,
treatment or surgery of patients with
age-related diseases.

20

CDC Patient Location/Service
Inpatient Gynecology Ward

Code
W-GYN

Inpatient Jail Unit

W-J

Labor and Delivery Ward

W-LD

Labor, Delivery, Recovery, Postpartum
Room (LDRP)

W-LDRP

Inpatient Medical Ward

W-M

Hospital area for the evaluation and
treatment of patients with medical
conditions or disorders.

Inpatient Medical/Surgical Ward

W-MS

Hospital area for the evaluation of
patients with medical and/or surgical
conditions.

Inpatient Neurology Ward

W-N

Hospital inpatient area where
patients with neurological disorders
are evaluated and treated.

Inpatient Neurosurgical Ward

W-NS

Inpatient Ophthalmology Ward

W-OPH

Inpatient Orthopedic Ward

W-ORT

Inpatient Orthopedic Trauma Ward

W-TORT

Hospital area for care of patients
whose primary reason for admission
is to have neurosurgery or to be
cared for by a neurosurgeon after
head or spinal trauma.
Hospital area for care of patients
whose primary reason for admission
is to have eye surgery or to be
cared for by an ophthalmologist
after eye trauma.
Hospital area for evaluation,
treatment or surgery on bones,
joints, and associated structures by
an orthopedist.
Hospital inpatient area where
patients with orthopedic injuries or
disorders are evaluated and treated.

Inpatient Plastic Surgery Ward

W-PLS

Inpatient Postpartum Ward

W-PP

Inpatient Pulmonary Ward

W-PULM

Stroke (Acute) Unit

W-STRK

Phase 4 Prevalence Survey PT Instructions, 20150430

Description
Hospital area for the evaluation,
treatment, or surgery of female
patients with reproductive tract
disorders.
Overnight stay patient care area of
a hospital or correctional facility
used only for those who are in
custody of law enforcement during
their treatment.
Hospital area where women labor
and give birth.
Hospital suite used for labor,
delivery, recovery and post partum
(LDRP) – all within the same suite.

Hospital area for the care of
patients who have reconstructive
surgery performed by a plastic
surgeon.
Hospital area for the patient who is
recovering from childbirth.
Hospital area where patients with
respiratory system conditions or
disorders are evaluated and treated.
Hospital area for evaluation,
stabilization and treatment of

21

CDC Patient Location/Service

Code

Description
patients who have experienced an
acute stroke.

Inpatient Surgical Ward

W-S

Telemetry Unit

W-TELE

Inpatient Vascular Surgery Ward

W-VS

ONC Leukemia Ward

W-ONCLEUK

ONC Lymphoma Ward

W-ONCLYMPH

ONC Leukemia/Lymphoma Ward

W-ONCLL

ONC Solid Tumor Ward

W-ONCST

ONC Hematopoietic Stem Cell
Transplant Ward

W-ONCHSCT

ONC General Hematology/Oncology
Ward

W-ONCHONC

Hospital area for evaluation and
treatment of patients who have
undergone a surgical procedure.
Hospital area dedicated to providing
evaluation and treatment of patients
requiring continuous cardiac
monitoring.
Hospital area for evaluation and
treatment of patients who have
undergone vascular surgery.
Area for the evaluation and
treatment of patients with leukemia.
(W-ONCLEUK maps to 2011 SCAHONC location code).
Area for the evaluation and
treatment of patients with
lymphoma. (W-ONCLYMPH maps
to 2011 SCA-HONC location code).
Area for the evaluation and
treatment of patients with leukemia
and/or lymphoma.(W-ONCLL maps
to 2011 SCA-HONC location code).
Area for the evaluation and
treatment of patients with solid
tumors. (W-ONCST maps to 2011
SCA-HONC location code).
Area for the evaluation and
treatment of patients who undergo
stem cell transplant for the
treatment of cancers and/or blood
or immune system disorders. (WONCHSCT maps to 2011 SCA-BMT
location code).
Area for the evaluation and
treatment of patients with cancer
and/or blood disorders. (WONCHONC maps to 2011 SCAHONC location code).

Pediatric Wards
Inpatient Pediatric Burn Ward

W-BPED

Inpatient Pediatric Ear, Nose, Throat

W-ENTPED

Inpatient Pediatric Genitourinary

W-GUPED

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Hospital area specializing in the
evaluation and treatment of patients
≤18 years who have tissue injury
caused by burns.
Hospital area for evaluation and
management of patients ≤18 years
old with disorders of the ear, nose
and/or throat.
Hospital inpatient area where
patients ≤ 18 years old with
disorders of the genitourinary
system are evaluated and treated.

CDC Patient Location/Service
Inpatient Pediatric Medical Ward

Code
W-MPED

Inpatient Pediatric Medical-Surgical
Ward

W-MSPED

Inpatient Pediatric Neurology Ward

W-NPED

Inpatient Pediatric Neurosurgical Ward

W-NSPED

Inpatient Pediatric Orthopedic Ward

W-ORTPED

Inpatient Pediatric Surgical Ward

W-SPED

ONC Pediatric Hematopoietic Stem
Cell Transplant Ward

W-ONCHSCTPED

ONC Pediatric Hematology/Oncology
Ward

W-ONCHONCPED

Step Down Units
Adult step Down Unit

STEP

Pediatric Step Down Unit

STEP-PED

ONC Step Down Unit

STEP-ONC

Phase 4 Prevalence Survey PT Instructions, 20150430

23

Description
Hospital inpatient area where
patients ≤ 18 years old with medical
conditions or disorders are
evaluated and treated.
Hospital inpatient area where
patients ≤ 18 years old with medical
and/or surgical conditions are
managed.
Hospital inpatient area where
patients ≤ 18 years old with
neurological disorders are
evaluated and treated.
Hospital area for care of patients ≤
18 years old whose primary reason
for admission is to have
neurosurgery or to be cared for by a
neurosurgeon after head or spinal
trauma.
Hospital area where patients ≤ 18
years old with orthopedic injuries or
disorders are evaluated and treated.
Hospital area for evaluation and
treatment of patients ≤ 18 years old
who have undergone a surgical
procedure.
Area for care of patients ≤ 18 years
old who undergo stem cell
transplant for the treatment of
cancers and/or blood or immune
system disorders. (WONCHSCTPED maps to 2011 SCABMTPED location code).
Area for care of patients ≤ 18 years
old with cancer and/or blood
disorders. (W-ONCHONCPED
maps to 2011 SCA-HONCPED
location code).
Hospital area for adult patients that
are hemodynamically stable who
can benefit from close supervision
and monitoring, such as frequent
pulmonary toilet, vital signs, and/or
neurological and neurovascular
checks.
Patients ≤ 18 years old that are
hemodynamically stable who can
benefit from close supervision and
monitoring, such as frequent
pulmonary toilet, vital signs, and/or
neurological and neurovascular
checks.
Area for oncology patients who are
hemodynamically stable and can

CDC Patient Location/Service

Code

Description
benefit from close supervision and
monitoring such as frequent
pulmonary toilet, vital signs, and/or
neurologic and neurovascular
checks, (STEP-ONC maps to 2011
STEP or STEP-PED location
codes).

Mixed Acuity Units
Adult Mixed Acuity Unit

MIX-ADULT

Mixed Age Mixed Acuity Ward

MIX-ALL

Pediatric Mixed Acuity Unit (NOTE: If
patients are of mixed age, use Mixed
Age, Mixed Acuity Ward)

MIX-PED

Hospital area for the evaluation and
treatment of adult patients whose
conditions are of varying levels of
acuity (e.g., critical care, ward-level
care, step-down type care, etc.).
Such a care area may be comprised
of patients followed by different
hospital services (e.g., coronary,
medical, surgical, etc.). This care
area may or may not include ''acuity
adaptable'' or ''universal'' beds (i.e.,
this model of patient care allows a
patient to stay in same bed during
all phases of his care, from critical
care through lower levels of care)
Hospital area for the evaluation and
treatment of a mixture of adult and
pediatric patients whose conditions
are of varying levels of acuity (e.g.,
critical care, ward-level care, stepdown type care, etc.). Such a care
area may be comprised of patients
followed by different hospital
services (e.g., coronary, medical,
surgical, etc.). This care area may
or may not include ''acuity
adaptable'' or ''universal'' beds (i.e.,
this model of patient care allows a
patient to stay in same bed during
all phases of his care, from critical
care through lower levels of care)
Hospital area for the evaluation and
treatment of patients ≤ 18 years old
whose conditions are of varying
levels of acuity (e.g., critical care,
ward-level care, step-down type
care, etc.). Such a care area may
be comprised of patients followed
by different hospital services (e.g.,
coronary, medical, surgical, etc.).
This care area may or may not
include ''acuity adaptable'' or
''universal'' beds (i.e., this model of
patient care allows a patient to stay
in same bed during all phases of his

Phase 4 Prevalence Survey PT Instructions, 20150430

24

CDC Patient Location/Service

Code

Description
care, from critical care through
lower levels of care).
ONC Mixed Acuity Unit (all ages)
MIX-ONC
Area for the evaluation and
treatment of mixed adult and
pediatric oncology patients whose
conditions are of varying levels of
acuity (e.g., critical care, ward-level
care, step-down type care, etc.).
This care area may or may not
include “acuity adaptable” or
universal beds (i.e. this model of
patient care allows a patient to stay
in the same bed during all phases of
care, from critical care through
lower levels of care). (MIX-ONC
maps to 2011 MIX-ALL location
code).
1American Academy of Pediatrics. Policy Statement Levels of Neonatal Care. Pediatrics 2012; 130 (3):
587-597.

Phase 4 Prevalence Survey PT Instructions, 20150430

25

APPENDIX 1 (CONTINUED): MAPPING HOSPITAL UNITS TO CDC LOCATIONS
1) Start the mapping process approximately 4 weeks prior to your hospitals’ survey dates, if
possible.
2) Because of current reporting requirements, many hospitals will have already mapped all of their
adult and pediatric medical, medical-surgical, and surgical wards and their adult, pediatric, and
neonatal intensive care units to NHSN location codes. However, you may still need to help
hospitals map their other acute care inpatient units because the prevalence survey is hospitalwide and includes all acute care inpatient units, not just those listed above.
3) The key to accurate mapping is adhering to the NHSN definition of “CDC location” and the “80%
Rule”:
A CDC location is “A CDC-defined designation given to a patient care area housing patients who
have similar disease conditions or who are receiving care for similar medical or surgical
specialties. Each facility location that is monitored is ‘mapped’ to one CDC Location. The specific
CDC Location code is determined by the type of patients cared for in that area according to the
80% Rule. That is, if 80% of patients are of a certain type (e.g., pediatric patients with orthopedic
problems) then that area is designated as that type of location (in this case, an Inpatient Pediatric
Orthopedic Ward). “
4) Ask your hospital contacts to send you lists (in Microsoft Word, Excel, or any other format you
find useful) of ALL of the units in their facilities that could house eligible acute care inpatients on
the survey date. Make sure that labor & delivery units, postpartum units and newborn nurseries
are included. Make sure that any mixed acuity (or mixed age mixed acuity) units are also
included. Your hospital contacts should include the CDC location codes for these units, where
available, or for units that are not mapped to CDC location codes (or where there is concern that
mapping may not have been done correctly), brief descriptions of each unit (with specific
percentages of different patient types), and whether each unit is already mapped to a CDC
location (and what the CDC location is). An example of a list is as follows.
Unit Name

Unit Description

3 South

20% general surgical patients, 80% general
orthopedic surgery patients

3 West

10% general surgery patients, 10% general
orthopedic surgery patients, 80% orthopedic
trauma patients
50% medical stepdown, 50% medical critical
care

2 North ICU

6 East

100% labor and delivery

6 North

100% well baby nursery

5 South

20% autologous hematopoietic stem cell
transplant, 10% adult hematology-oncology,
10% solid organ transplant, 60% general
medical

Phase 4 Prevalence Survey PT Instructions, 20150430

26

Already Mapped to CDC
Location?
Yes—
Adult orthopedic ward (WORT)
Yes—
Adult ortho trauma ward (WTORT)
Yes—split by bed assignment
into Step Down Unit (adult-STEP) and Medical Critical
Care (CC-M)
Yes—
W-LD
Yes—
Newborn nursery (W-NURS)
Yes—
Location assigned depending
on specialty (stem cell
transplant patients assigned to
SCA-BMT, heme/onc patients
to SCA-HONC, solid organ
transplant patients to SCA-

Unit Name

Unit Description

Already Mapped to CDC
Location?
SOTP, and general medical
patients to W-M)

5) You do not need to do a comprehensive review and re-mapping of units that the hospital has
already mapped to CDC locations, unless there is concern that the hospital did not use correct
procedures when assigning CDC location codes.
6) For hospitals and units that are not already mapped, go ahead and map them to the appropriate
CDC locations using the 80% rule and assigning the location codes outlined above in the
Appendix 1 table. You can use any CDC location listed in the table, including those locations that
are new for the 2015 survey. Please note that behavioral/psychiatric in acute care hospitals are
NOT included in the survey.
7) For units with heterogeneous patient populations, it is preferable to use the “virtual location”
approach. Virtual locations are created when a hospital is unable to meet the 80% rule for
location designation in a single physical unit, and data are therefore reported using location
designations for each of the major, specific patient types in that unit. The use of virtual locations
is recommended only for those physical units that are geographically split by patient service or
those in which beds are designated by service. For example, a facility has an ICU – called 5 West
– that is comprised of approximately 50% neurology patients and 50% neurosurgery patients.
Additionally, the neurology patients are housed in beds 1 thru 10 and the neurosurgery patients
are housed in beds 11 thru 20. Rather than map as a medical/surgical critical care unit, 2
locations are used:
5WEST_N: Neurologic Critical Care (10 beds)
5WEST_NS: Neurosurgical Critical Care (10 beds)
In the 5 South example from the sample table above, patients could be assigned any of 4
different CDC locations depending on the patient’s primary problem. For example, a
hematopoietic stem cell transplant recipient admitted to 5 South would be assigned the WONCHSCT CDC location, while a patient admitted for acute renal failure to the general medicine
service would be assigned the W-M CDC location.
Here are some additional examples from NHSN location mapping guidance:
Example 1: An ICU that is 85% Burn patients, 15% Trauma
CDC Location: Burn Critical Care (CC-B)
Why? Meets 80% rule for critical care acuity level and 80% rule for specific service (burn)
Example 2: An ICU that is 55% medical and 45% Surgical
CDC Location: Medical/Surgical Critical Care (CC-MS)
Why? Meets 80% rule for critical care acuity level and does not meet the 60% rule for designation as
either medical or surgical service level alone, therefore, use combined medical/surgical designation
Example 3: A unit that is comprised of 60% medical inpatients and 40% general observation patients
CDC Location: Medical Ward (W-M)
Why? This is a special scenario due to the mix of inpatients and outpatients in this unit. A location where
at least 51% of the patients have been formally admitted to the facility should be mapped as in inpatient
unit, rather than an outpatient observation unit. The 60% rule for general service and the 80% rule for
specific service still apply when deciding on the specific type of inpatient location to use; this location met
the 60% rule for medical service. Note that for the prevalence survey, observation patients should be
included in the survey if they have been in the hospital for ≥24 hours in an acute care inpatient location
Example 4: An ICU that is 40% Neurosurgical, 40% Surgical, and 20% Medical

Phase 4 Prevalence Survey PT Instructions, 20150430

27

Option 1 - Single CDC Location: Surgical Critical Care (CC-S)
Why? Meets 80% rule for critical care acuity level and does not meet the 80% rule for a specific service
level alone, but when surgical patients are combined, that total does equal 80%.
Option 2 - Multiple CDC Virtual Locations: Neurosurgical Critical Care (CC-NS) and Surgical Critical Care
(CC-S), with the medical patients reported with the Surgical Critical Care location since the general
surgical designation is the least specific of the two.
Why? By splitting this unit into 2 virtual locations, each meets the 80% rule for critical care acuity level
and one meets the 80% rule for designation as Neurosurgical Critical Care, while the other meets the
60% rule as general surgical service (when combining surgical and medical patients).
Example 5: A unit that is comprised of 60% Medical ICU and 40% Step-Down patients
Option 1 - Single CDC Location: Mixed Acuity Unit (MIX-ADULT)
Why? This location is not comprised of at least 80% of the patients of the same acuity level and therefore
meets the single location definition of a mixed acuity unit. Note that this location is not considered an ICU
location type for the purposes of NHSN reporting and therefore, would not be included in any ICU-specific
reporting requirements.
Option 2 - Multiple CDC Virtual Locations: Medical Critical Care (CC-M) and Step-Down Unit (STEP)
Why? By splitting this unit into 2 virtual locations, each meets the 80% rule for the appropriate acuity level
and each meets the 80% rule for type of service.
Example 6: A pediatric ward that is comprised of 70% neurosurgical patients and 30% orthopedic patients
Option 1 - Single CDC Location: Pediatric Surgical Ward (W-SPED)
Why? Meets 80% rule for ward-level acuity and does not meet the 80% rule for a specific service level
alone, but meets the 60% rule for general surgical service.
Option 2 - Multiple CDC Virtual Locations: Pediatric Neurosurgical Ward (W-NSPED) and Pediatric
Orthopedic Ward (W-ORTPED)
Why? By splitting this unit into 2 virtual locations, each meets the 80% rule for the appropriate acuity level
and each meets the 80% rule for type of service.

Phase 4 Prevalence Survey PT Instructions, 20150430

28

Flow diagram for CDC location mapping from NHSN guidance:

Step 1: Define the acuity level for the location

Is this patient care area comprised of at least 80% of
patients that are of the same acuity level?

YES

NO

Proceed to Step 2 and map to a location
type of that acuity level using the NHSN
80% Rule for that specific type

Can this patient care area be split into 2 or
more CDC locations for the purposes of
surveillance – also referred to as “virtual
locations”?

YES
NO
Proceed to Step 2 and
create CDC locations for
each of the acuity levels,
using the NHSN 80% Rule

List of Acuity Levels:
Adult Critical Care Units
Pediatric Critical Care Units
Neonatal Critical Care Units
Specialty Care Areas (SCA)/Oncology
Adult Wards
Pediatric Wards
Neonatal Wards
Step Down Units

Phase 4 Prevalence Survey PT Instructions, 20150430

Map to a CDC Mixed
Acuity location.

Mixed Acuity Units
Operating Rooms
Chronic Care
Long Term Acute Care
Rehabilitation
Outpatient (ACUTE) Locations
Clinic (Nonacute) Settings

29

Step 2: Define the type of service for the location

Is this patient care area a general medical,
surgical, or medical/surgical unit? Or is it
comprised of patients from a specific service
type (e.g., burn, cardiac)?
General

Specific

If the unit is comprised of
patients of a specific service
type, does this unit meet the
NHSN 80% Rule for locations2?

If general medical or surgical, are
more than 60% of patients either
medical or surgical?

YES

Create a
location in
NHSN that is
mapped to the
majority type
(i.e., medical
or surgical)

NO

YES

NO

Create a
location in
NHSN that is
mapped to that
CDC location
type

The mix of
patients should
then be a 50/50
to 60/40 mix of
medical and
surgical patients
Create a
location in
NHSN that is
mapped to a
combined
medicalsurgical CDC
location

Can this single unit be
split into 2 or more
units in NHSN for the
purposes of
surveillance – also
referred to as “virtual
locations3”?

YES
NO

Create
locations in
NHSN for each
of these
specific service
virtual
locations

Is the mix of patients in
this unit approximately
a 50/50 to 60/40 mix of
combined medical and
surgical?

NO
YES

Create a CDC location that is
mapped to a combined
medical/surgical unit

Phase 4 Prevalence Survey PT Instructions, 20150430

30

Create a CDC location
that is mapped to the
location of the majority
type (i.e., greater than
60%) - either medical or
surgical

APPENDIX 3: ANTIMICROBIAL DRUG LIST
NOTE: This table includes generic and brand names of antimicrobial drugs arranged in alphabetical
order.
Drug name
5-FC
Abelcet
acyclovir
amantadine
Ambisome
amikacin
Amikin
amoxicillin
amoxicillin/clavulanic acid
amoxicillin, clarithromycin, lansoprazole
Amoxil
amphotericin B cholesteryl sulfate complex
amphotericin B deoxycholate
amphotericin B lipid complex
amphotericin B liposome
Amphotec
ampicillin
ampicillin/sulbactam
Ancef
Ancobon
anidulafungin
Augmentin
Avelox
Avycaz
Azactam
azithromycin
aztreonam
Bactrim
Benzathine benzylpenicillin
benzylpenicillin
Biaxin
Bicillin C-R
Bicillin L-A
Bio-Statin
Bismuth subcitrate, metronidazole,
tetracycline

Drug name
Bismuth subsalicylate, metronidazole,
tetracyline
Cancidas
caspofungin
Cayston
Ceclor
Cedax
cefaclor
cefadroxil
cefazolin
cefdinir
cefditoren
cefepime
cefixime
Cefizox
Cefotan
cefotetan
cefotaxime
cefoxitin
cefpodoxime
cefprozil
ceftibuten
Ceftin
ceftaroline
ceftazidime
ceftazidime/avibactam
ceftizoxime
ceftolozane/tazobactam
ceftriaxone
cefuroxime
Cefzil
cephalexin
chloramphenicol
cidofovir
Cipro
ciprofloxacin
Claforan

Phase 4 Prevalence Survey Operational Manual, 20150430

31

Drug name

Drug name

clarithromycin

Fortaz

Cleocin

foscarnet

clindamycin

Foscavir

clotrimazole

fosfomycin

colistin

Fungizone

colistimethate sodium

ganciclovir

Cotrimaxozole

Garamycin

Cresemba

gemifloxacin

Cubicin

gentamicin

Cytovene

griseofulvin

dalbavancin

Helidac

Dalvance

Hiprex

dapsone

imipenem/cilastatin

daptomycin

Invanz

dicloxacillin

isavuconazonium sulfate (isavuconazole)

Dificid

isoniazid

Diflucan

isoniazid and rifampin

Doribax

isoniazid, pyrazinamide, and rifampin

doripenem

itraconazole

doxycycline

kanamycin

Duricef

Kantrex

Dynapen

Keflex

Eraxis

Ketek

ertapenem

ketoconazole

EryPed

Lamisil

Ery-Tab

Levaquin

Erythrocin

levofloxacin

erythromycin
erythromycin ethylsuccinate and sulfisoxazole
acetyl

linezolid

ethambutol
Factive
famciclovir
Famvir
Fasigyn
fidaxomicin
Flagyl
Floxin
fluconazole
flucytosine
Flumadine

Phase 4 Prevalence Survey Operational Manual, 20150430

Macrobid
Macrodantin
Maxipime
Mefoxin
meropenem
Merrem
methenamine
metronidazole
micafungin
miconazole
Minocin
minocycline

32

Drug name

Drug name

Monurol

posaconazole

Moxatag

pyrazinamide

moxifloxacin

Prevpac

Mycamine

Priftin

Mycelex

Primaxin

Mycobutin

Primsol

Mycostatin

Principen

nafcillin

Proquin XR

Nallpen

Pylera

neomycin

quinupristin/dalfopristin

Nilstat

Raniclor

nitrofurantoin

Rapivab

Nizoral

Relenza

norfloxacin

ribavirin

Noroxin

rifabutin

Noxafil

Rifadin

nystatin

Rifamate

ofloxacin

rifampin

Omnipen

rifapentine

Omnicef

Rifater

Oravig

rifaximin

Orbactiv

Rimactane

oritavancin

rimantadine

oseltamivir

Rocephin

oxacillin

Septra

penicillin G

Sivextro

penicillin G benzathine
penicillin G benzathine and penicillin G
procaine

spectinomycin

penicillin G potassium
penicillin G procaine
penicillin G sodium
penicillin V
penicillin V potassium
pentamidine isethionate
peramivir
Permapen
phenoxymethylpenicillin
piperacillin
piperacillin/tazobactam
polymyxin B

Phase 4 Prevalence Survey Operational Manual, 20150430

Spectracef
Sporanox
streptomycin
sulfisoxazole
sulfamethoxazole/trimethoprim
Suprax
Symmetrel
Synercid
Tamiflu
Tazicef
tedizolid
Teflaro
telavancin

33

Drug name
telithromycin
terbinafine
tetracycline
ticarcillin/clavulanate
tigecycline
Timentin
Tindamax
tinidazole
Tobi
tobramycin
trimethoprim
trimethoprim/sulfamethoxazole
Trimox
Trobicin
Tygacil
Unasyn
Unipen
Urex
valacyclovir
Valcyte
valganciclovir
Valtrex
vancomycin
Vancocin
Vantin
Vfend
Vibativ
Vistide
voriconazole
Xifaxan
zanamivir
Zerbaxa
Zinacef
Zithromax
Zmax
Zosyn
Zovirax
Zyvox

Phase 4 Prevalence Survey Operational Manual, 20150430

34


File Typeapplication/pdf
File Title2015 OPERATIONAL MANUAL
SubjectEmerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey
AuthorCDC
File Modified2015-05-04
File Created2015-05-04

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