Att D-3 Revision of Estimated Annual Burden Hours

National Healthcare Safety Network (NHSN)

OMB Control No. 0920-0666

Revision Request July 2017

Revision of Estimated Annual Burden Hours

		Number of Respondents (Annual)		Responses per Respondent (Annual)		Burden per Response (Hours)		Total Annual Burden (Hours)*		Change in Burden (Hours)*
Form Number	Form Name	04/2017	05/2016	04/2017	05/2016	04/2017	05/2016	04/2017	05/2016
57.100	NHSN Registration Form	2,000	2,000	1	1	5/60	5/60	167	167	0
57.101	Facility Contact Information	2,000	2,000	1	1	10/60	10/60	333	333	0
57.103	Patient Safety Component--Annual Hospital Survey1	5,000	5,000	1	1	60/60	55/60	5,000	4,583	417
57.105	Group Contact Information	1,000	1,000	1	1	5/60	5/60	83	83	0
57.106	Patient Safety Monthly Reporting Plan	6,000	6,000	12	12	15/60	15/60	18,000	18,000	0
57.108	Primary Bloodstream Infection (BSI)	6,000	6,000	44	44	33/60	30/60	145,200	132,000	13,200
57.111	Pneumonia (PNEU)	1,800	6,000	30	72	30/60	30/60	64,800	216,000	151,200
57.112	Ventilator-Associated Event	6,000	6,000	144	144	28/60	25/60	403,200	360,000	43,200
57.113	Pediatric Ventilator-Associated Event (PedVAE)	100	2,000	120	120	30/60	25/60	6,000	100,000	94,000
57.114	Urinary Tract Infection (UTI)	6,000	6,000	40	40	20/60	20/60	80,000	80,000	0
57.115	Custom Event	600	2,000	91	91	35/60	35/60	31,850	106,167	74,317
57.116	Denominators for Neonatal Intensive Care Unit (NICU)	6,000	6,000	12	9	4	3	288,000	162,000	126,000
57.117	Denominators for Specialty Care Area (SCA)/Oncology (ONC)	6,000	6,000	9	9	5.02	5.02	271,080	270,000	1,080
57.118	Denominators for Intensive Care Unit (ICU)/Other locations (not NICU or SCA)	6,000	6,000	60	60	5.02	5.02	1,807,200	1,800,000	7,200
57.120	Surgical Site Infection (SSI)	6,000	6,000	36	36	35/60	35/60	126,000	126,000	0
57.121	Denominator for Procedure	6,000	6,000	540	540	10/60	10/60	540,000	540,000	0
57.123	Antimicrobial Use and Resistance (AUR)-Microbiology Data Electronic Upload Specification Tables	350	6,000	12	12	5/60	5/60	350	6,000	5,650
57.124	Antimicrobial Use and Resistance (AUR)-Pharmacy Data Electronic Upload Specification Tables	800	6,000	12	12	5/60	5/60	800	6,000	5,200
57.125	Central Line Insertion Practices Adherence Monitoring	100	1,000	100	100	25/60	25/60	4,167	41,667	37,500
57.126	MDRO or CDI Infection Form	6,000	6,000	72	72	30/60	30/60	216,000	216,000	0
57.127	MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring	6,000	6,000	24	24	15/60	15/60	36,000	36,000	0
57.128	Laboratory-identified MDRO or CDI Event	6,000	6,000	240	240	20/60	20/60	480,000	480,000	0
57.129	Adult Sepsis	50	50	250	250	25/60	25/60	5,208	5,208	0
57.137	Long-Term Care Facility Component – Annual Facility Survey	2,600	350	1	1	2	1.08	5,200	378	4,822
57.138	Laboratory-identified MDRO or CDI Event for LTCF	2,600	350	12	12	20/60	15/60	10,400	1,050	9,350
57.139	MDRO and CDI LabID Event Reporting Monthly Summary Data for LTCF	2,600	350	12	12	10/60	10/60	5,200	700	4,500
57.140	Urinary Tract Infection (UTI) for LTCF	2,600	350	14	14	35/60	30/60	21,233	2,450	18,783
57.141	Monthly Reporting Plan for LTCF	2,600	350	12	12	5/60	5/60	2,600	350	2,250
57.142	Denominators for LTCF Locations	2,600	350	12	12	4	3.35	124,800	14,070	110,730
57.143	Prevention Process Measures Monthly Monitoring for LTCF	2,600	300	12	12	5/60	5/60	2,600	300	2,300
57.150	LTAC Annual Survey	400	400	1	1	60/60	55/60	400	367	33
57.151	Rehab Annual Survey	1,000	1,000	1	1	60/60	55/60	1000	917	83
57.200	Healthcare Personnel Safety Component Annual Facility Survey	50	50	1	1	8	8	400	400	0
57.203	Healthcare Personnel Safety Monthly Reporting Plan	17,000	17,000	1	1	5/60	5/60	1,417	1,417	0
57.204	Healthcare Worker Demographic Data	50	50	200	200	20/60	20/60	3,333	3,333	0
57.205	Exposure to Blood/Body Fluids	50	50	50	50	1	1	2,500	2,500	0
57.206	Healthcare Worker Prophylaxis/Treatment	50	50	30	30	15/60	15/60	375	375	0
57.207	Follow-Up Laboratory Testing	50	50	50	50	15/60	15/60	625	625	0
57.210	Healthcare Worker Prophylaxis/Treatment-Influenza	50	50	50	50	10/60	10/60	417	417	0
57.300	Hemovigilance Module Annual Survey – Acute Care Facility	500	500	1	1	2	2	1,000	1,000	0
57.301	Hemovigilance Module Monthly Reporting Plan	500	500	12	12	1/60	1/60	100	100	0
57.303	Hemovigilance Module Monthly Reporting Denominators	500	500	12	12	1.17	1.17	7,020	7,020	0
57.305	Hemovigilance Incident	500	500	10	10	10/60	10/60	833	833	0
57.306	Hemovigilance Module Annual Survey - Non-Acute Care Facility	200	200	1	1	35/60	35/60	117	117	0
57.307	Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction	500	500	4	4	20/60	25/60	667	833	167
57.308	Hemovigilance Adverse Reaction - Allergic Transfusion Reaction	500	500	4	4	20/60	25/60	667	833	167
57.309	Hemovigilance Adverse Reaction - Delayed Hemolytic Transfusion Reaction	500	500	1	1	20/60	25/60	167	208	42
57.310	Hemovigilance Adverse Reaction - Delayed Serologic Transfusion Reaction	500	500	2	2	20/60	25/60	333	417	83
57.311	Hemovigilance Adverse Reaction - Febrile Non-hemolytic Transfusion Reaction	500	500	4	4	20/60	25/60	667	833	167
57.312	Hemovigilance Adverse Reaction - Hypotensive Transfusion Reaction	500	500	1	1	20/60	25/60	167	208	42
57.313	Hemovigilance Adverse Reaction - Infection	500	500	1	1	20/60	25/60	167	208	42
57.314	Hemovigilance Adverse Reaction - Post Transfusion Purpura	500	500	1	1	20/60	25/60	167	208	42
57.315	Hemovigilance Adverse Reaction - Transfusion Associated Dyspnea	500	500	1	1	20/60	25/60	167	208	42
57.316	Hemovigilance Adverse Reaction - Transfusion Associated Graft vs. Host Disease	500	500	1	1	20/60	25/60	167	208	42
57.317	Hemovigilance Adverse Reaction - Transfusion Related Acute Lung Injury	500	500	1	1	20/60	25/60	167	208	42
57.318	Hemovigilance Adverse Reaction - Transfusion Associated Circulatory Overload	500	500	2	2	20/60	25/60	333	417	83
57.319	Hemovigilance Adverse Reaction - Unknown Transfusion Reaction	500	500	1	1	20/60	25/60	167	208	42
57.320	Hemovigilance Adverse Reaction - Other Transfusion Reaction	500	500	1	1	20/60	25/60	167	208	42
57.400	Outpatient Procedure Component—Annual Facility Survey	5,000	5,000	1	1	10/60	5/60	833	417	417
57.401	Outpatient Procedure Component - Monthly Reporting Plan	5,000	5,000	12	12	20/60	15/60	20,000	15,000	5,000
57.402	Outpatient Procedure Component Same Day Outcome Measures	1,200	5,000	25	25	40/60	40/60	63,333	83,333	20,000
57.403	Outpatient Procedure Component - Monthly Denominators for Same Day Outcome Measures	1,200	5,000	12	12	40/60	40/60	9,600	40,000	30,400
57.404	OPC- SSI Denominator	5,000	-	540	-	10/60	-	450,000	-	450,000
57.405	OPC Surgical Site Infection (SSI) Event	5,000	-	36	-	35/60	-	105,000	-	105,000
57.500	Outpatient Dialysis Center Practices Survey	7,000	6,500	1	1	2.05	2	14,350	13,000	1,350
57.501	Dialysis Monthly Reporting Plan	7,000	6,500	12	12	5/60	5/60	7,000	6,500	500
57.502	Dialysis Event	7,000	6,500	60	60	25/60	25/60	175,000	162,500	12,500
57.503	Denominator for Outpatient Dialysis	7,000	6,500	12	12	10/60	10/60	14,000	13,000	1,000
57.504	Prevention Process Measures Monthly Monitoring for Dialysis	2,000	1,500	12	12	1.25	1.25	30,000	22,500	7,500
57.505	Dialysis Patient Influenza Vaccination	325	325	75	75	10/60	10/60	4,063	4,063	0
57.506	Dialysis Patient Influenza Vaccination Denominator	325	325	5	5	10/60	10/60	271	271	0
57.507	Home Dialysis Center Practices Survey	350	600	1	1	30/60	25/60	175	250	75
Total Estimated Annual Burden (Hours)								5,575,467	5,110,968	464,498

* Cost increased due to increase or decrease in the number of facilities. ^aValues were rounded prior to summation.

1

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