Att D-4 _Rev of Est Annual Cost Burden

National Healthcare Safety Network (NHSN)

OMB Control No. 0920-0666

Revision Request April 2017

Revision of Estimated Annual Cost Burden*

		Total Estimated Burden (Hours)		Estimated Hourly Wage of Respondent		Total Estimated Annual Cost Burdena		Change in Estimated Annual Cost Burdena
Form Number	Form Name	04/2017	05/2016	04/2017	05/2016	04/2017	05/2016
57.100	NHSN Registration Form	167	167	$39.66	$39.66	$6,610	$6,610	$0
57.101	Facility Contact Information	333	333	$39.66	$39.66	$13,220	$13,220	$0
57.103	Patient Safety Component--Annual Hospital Survey	5,000	4,583	$39.66	$39.66	$198,300	$181,775	$16,525
57.105	Group Contact Information	83	83	$39.66	$39.66	$3,305	$3,305	$0
57.106	Patient Safety Monthly Reporting Plan	18,000	18,000	$39.66	$39.66	$713,880	$713,880	$0
57.108	Primary Bloodstream Infection (BSI)	145,200	132,000	$39.66	$39.66	$5,758,632	$5,235,120	$523,512
57.111	Pneumonia (PNEU)	64,800	216,000	$39.66	$39.66	$2,569,968	$8,566,560	($5,996,592)
57.112	Ventilator-Associated Event	403,200	360,000	$39.66	$39.66	$15,990,912	$14,277,600	$1,713,312
57.113	Pediatric Ventilator-Associated Event (PedVAE)	6,000	100,000	$39.66	$39.66	$237,960	$3,966,000	$3,728,040
57.114	Urinary Tract Infection (UTI)	80,000	80,000	$39.66	$39.66	$3,172,800	$3,172,800	$0
57.115	Custom Event	106,167	106,167	$39.66	$39.66	$4,210,570	$4,210,570	$0
57.116	Denominators for Neonatal Intensive Care Unit (NICU)	288,000	162,000	$32.45	$32.45	$9,345,600	$5,256,900	$4,088,700
57.117	Denominators for Specialty Care Area (SCA)/Oncology (ONC)	271,080	270,000	$32.45	$32.45	$8,796,546	$8,761,500	$35,046
57.118	Denominators for Intensive Care Unit (ICU)/Other locations (not NICU or SCA)	1,807,200	1,800,000	$32.45	$32.45	$58,643,640	$58,410,000	$233,640
57.120	Surgical Site Infection (SSI)	126,000	126,000	$39.66	$39.66	$4,997,160	$4,997,160	$0
57.121	Denominator for Procedure	540,000	540,000	$32.45	$32.45	$17,523,000	$17,523,000	$0
57.123	Antimicrobial Use and Resistance (AUR)-Microbiology Data Electronic Upload Specification Tables	350	6,000	$18.73	$18.73	$6,556	$112,380	($105,825)
57.124	Antimicrobial Use and Resistance (AUR)-Pharmacy Data Electronic Upload Specification Tables	800	6,000	$58.41	$58.41	$46,728	$350,460	($1,487,250)
57.125	Central Line Insertion Practices Adherence Monitoring	4,167	41,667	$39.66	$39.66	$165,250	$1,652,500	($1,487,250)
57.126	MDRO or CDI Infection Form	216,000	216,000	$39.66	$39.66	$8,566,560	$8,566,560	$0
57.127	MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring	36,000	36,000	$39.66	$39.66	$1,427,760	$1,427,760	$0
57.128	Laboratory-identified MDRO or CDI Event	480,000	480,000	$39.66	$39.66	$19,036,800	$19,036,800	$0
57.129	Adult Sepsis	5,208	5,208	$39.66	$39.66	$206,563	$206,563	$0
57.137	Long-Term Care Facility Component – Annual Facility Survey	5,200	378	$39.66	$39.66	$206,232	$14,991	$191,241
57.138	Laboratory-identified MDRO or CDI Event for LTCF	10,400	1,050	$39.66	$39.66	$412,464	$41,643	$370,821
57.139	MDRO and CDI LabID Event Reporting Monthly Summary Data for LTCF	5,200	700	$39.66	$39.66	$206,232	$27,762	$178,470
57.140	Urinary Tract Infection (UTI) for LTCF	21,233	2,450	$39.66	$39.66	$842,114	$97,167	$744,947
57.141	Monthly Reporting Plan for LTCF	2,600	350	$39.66	$39.66	$103,116	$13,881	$89,235
57.142	Denominators for LTCF Locations	124,800	14,070	$39.66	$39.66	$4,949,568	$558,016	$4,391,552
57.143	Prevention Process Measures Monthly Monitoring for LTCF	2,600	300	$39.66	$39.66	$103,116	$11,898	$91,218
57.150	LTAC Annual Survey	400	367	$39.66	$39.66	$15,864	$14,542	$1,322
57.151	Rehab Annual Survey	1000	917	$39.66	$39.66	$39,660	$36,355	$3,305
57.200	Healthcare Personnel Safety Component Annual Facility Survey	400	400	$33.75	$33.75	$13,500	$13,500	$0
57.203	Healthcare Personnel Safety Monthly Reporting Plan	1,417	1,417	$33.75	$33.75	$47,813	$47,813	$0
57.204	Healthcare Worker Demographic Data	3,333	3,333	$33.75	$33.75	$112,500	$112,500	$0
57.205	Exposure to Blood/Body Fluids	2,500	2,500	$33.75	$33.75	$84,375	$84,375	$0
57.206	Healthcare Worker Prophylaxis/Treatment	375	375	$33.75	$33.75	$12,656	$12,656	$0
57.207	Follow-Up Laboratory Testing	625	625	$18.73	$18.73	$11,706	$11,706	$0
57.210	Healthcare Worker Prophylaxis/Treatment-Influenza	417	417	$33.75	$33.75	$14,063	$14,063	$0
57.300	Hemovigilance Module Annual Survey – Acute Care Facility	1,000	1,000	$34.99	$34.99	$34,990	$34,990	$0
57.301	Hemovigilance Module Monthly Reporting Plan	100	100	$34.99	$34.99	$3,499	$3,499	$0
57.303	Hemovigilance Module Monthly Reporting Denominators	7,020	7,020	$34.99	$34.99	$245,630	$245,630	$0
57.305	Hemovigilance Incident	833	833	$34.99	$34.99	$29,158	$29,158	$0
57.306	Hemovigilance Module Annual Survey - Non-Acute Care Facility	117	117	$34.99	$34.99	$4,082	$4,082	$0
57.307	Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction	667	833	$34.99	$34.99	$23,327	$29,158	($5,832)
57.308	Hemovigilance Adverse Reaction - Allergic Transfusion Reaction	667	833	$34.99	$34.99	$23,327	$29,158	($5,832)
57.309	Hemovigilance Adverse Reaction - Delayed Hemolytic Transfusion Reaction	167	208	$34.99	$34.99	$5,832	$7,290	($1,458)
57.310	Hemovigilance Adverse Reaction - Delayed Serologic Transfusion Reaction	333	417	$34.99	$34.99	$11,663	$14,579	($2,916)
57.311	Hemovigilance Adverse Reaction - Febrile Non-hemolytic Transfusion Reaction	667	833	$34.99	$34.99	$23,327	$29,158	($5,832)
57.312	Hemovigilance Adverse Reaction - Hypotensive Transfusion Reaction	167	208	$34.99	$34.99	$5,832	$7,290	($1,458)
57.313	Hemovigilance Adverse Reaction - Infection	167	208	$34.99	$34.99	$5,832	$7,290	($1,458)
57.314	Hemovigilance Adverse Reaction - Post Transfusion Purpura	167	208	$34.99	$34.99	$5,832	$7,290	($1,458)
57.315	Hemovigilance Adverse Reaction - Transfusion Associated Dyspnea	167	208	$34.99	$34.99	$5,832	$7,290	($1,458)
57.316	Hemovigilance Adverse Reaction - Transfusion Associated Graft vs. Host Disease	167	208	$34.99	$34.99	$5,832	$7,290	($1,458)
57.317	Hemovigilance Adverse Reaction - Transfusion Related Acute Lung Injury	167	208	$34.99	$34.99	$5,832	$7,290	($1,458)
57.318	Hemovigilance Adverse Reaction - Transfusion Associated Circulatory Overload	333	417	$34.99	$34.99	$11,663	$14,579	($2,916)
57.319	Hemovigilance Adverse Reaction - Unknown Transfusion Reaction	167	208	$34.99	$34.99	$5,832	$7,290	($1,458)
57.320	Hemovigilance Adverse Reaction - Other Transfusion Reaction	167	208	$34.99	$34.99	$5,832	$7,290	($1,458)
57.400	Outpatient Procedure Component—Annual Facility Survey	833	417	$32.45	$32.45	$27,042	$13,521	$13,521
57.401	Outpatient Procedure Component - Monthly Reporting Plan	20,000	15,000	$32.45	$32.45	$649,000	$486,750	$162,250
57.402	Outpatient Procedure Component Same Day Outcome Measures	20,000	83,333	$32.45	$32.45	$649,000	$2,704,167	($2,055,167)
57.403	Outpatient Procedure Component - Monthly Denominators for Same Day Outcome Measures	9,600	40,000	$32.45	$32.45	$311,520	$1,298,000	($986,480)
57.404	OPC- SSI Denominator	450,000	-	$32.45	-	$14,602,500	-	$14,602,500
57.405	OPC Surgical Site Infection (SSI) Event	105,000	-	$39.66	-	$4,164,300	-	$4,164,300
57.500	Outpatient Dialysis Center Practices Survey	14,350	13,000	$39.66	$39.66	$569,121	$515,580	$53,541
57.501	Dialysis Monthly Reporting Plan	7,000	6,500	$32.45	$32.45	$227,150	$210,925	$16,225
57.502	Dialysis Event	175,000	162,500	$32.45	$32.45	$5,678,750	$5,273,125	$405,625
57.503	Denominator for Outpatient Dialysis	14,000	13,000	$32.45	$32.45	$454,300	$421,850	$32,450
57.504	Prevention Process Measures Monthly Monitoring for Dialysis	30,000	22,500	$32.45	$32.45	$973,500	$730,125	$243,375
57.505	Dialysis Patient Influenza Vaccination	4,063	4,063	$32.45	$32.45	$131,828	$131,828	$0
57.506	Dialysis Patient Influenza Vaccination Denominator	271	271	$32.45	$32.45	$8,789	$8,789	$0
57.507	Home Dialysis Center Practices Survey	175	250	$39.66	$39.66	$6,941	$9,915	($2,975)
Total Estimated Annual Cost Burden						$194,782,795	$180,066,067	$14,716,728

*Cost for some data collection forms remained the same, due to no changes in annual wages.

^aValues were rounded prior to summation.

Revision of estimated national annual cost burden of data collection by NHSN data collection form. 5