Form 0920-0978 HAIC Staphylococcus aureus Laboratory Survey: Use of Nuc

CDC’s Healthcare-Associated Infections Community Interface (HAIC) Staphylococcus
aureus Laboratory Survey: Use of Nucleic Acid Amplification Testing (NAAT)

Form approved
OMB No. 0920-0978
Expires xx/xx/xxxx

Date Survey Completed: _________________ EIP Site: __________ Completed by: ______________________________
Hospital/Lab ID: ________________________ Lab contact to complete the survey (name/title): ______________________
□ Lab did not respond – END SURVEY
1.

Type of laboratory

□ Hospital laboratory
□ Commercial or private reference laboratory
□ State or local public health laboratory
□ Other, please specify______________________________________________________________________
2.

During the past year, has your lab changed testing methods used to detect any of the following pathogens:
Yes
No
Not applicable/
no surveillance

□
□

MRSA only
All Staphylococcus aureus

□
□

□
□

2a. If yes when did the change occur?
MRSA (i.e., not for MSSA) (Month/year of change) _______/_________
Staphylococcus aureus (i.e., both MRSA and MSSA) (Month/year of change) _______/____________

Staphylococcus aureus (methicillin-sensitive and methicillin-resistant)
1.

Do you set up culture for sterile sites (blood, CSF, bone, etc.) for Staphylococcus aureus on site
(in-house) at your laboratory? □ Yes - GO TO Q2 □ No

1a. [If no] To which laboratory do you send sterile specimens for Staphylococcus aureus culture?
____________________________________
2. Do you run any culture independent diagnostic tests (CIDT) for detection of Staphylococcus
aureus or MRSA either directly from a sterile source (CSF, Blood, etc.) or from a positive blood
culture?

□ Yes

□ No GO to Q2d

2a. [If yes] Do you run the CIDT on-site or send out to another lab?
□ On-site
□ Send out, please specify lab __________________
2b. Which CIDTs do you use (sterile site sources only, i.e. blood, CSF, pleural fluid, bone, etc.)? Please
check all that apply.

□ FilmArray® Blood Culture Identification Panel..Date started__________
□ Verigene® Gram-Positive Blood Culture Test…Date started__________
□ Verigene® Staphylococcus Blood Culture Test…Date started__________
□ Cepheid Xpert® MRSA/SA BC…Date started__________
□ BD Geneohm® StaphSR…Date started__________
Public reporting burden of this collection of information is estimated to average 8 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to a collection of information unless it displays a current valid OMB control number. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Rd NE, MS D-74, Atlanta, Georgia 30329;
ATTN: PRA (xxxx-xxxx)

–IMPORTANT – PLEASE COMPLETE THE BACK OF THIS FORM –

□ AdvanDx Staphylococcus QuickFISH blood culture kit…Date started__________
□ AdvanDx S. aureus/CNS PNA FISH…Date started__________
□ Alere BinaxNOW® Staphylococcus aureus test…Date started__________
□ Great Basin Staph ID/R blood culture panel…Date started__________
□ T2Bacteria® Panel…Date started__________
□ Accelerate PhenoTest™ BC kit…Date started ________________
□ iCubate iC-GPC Assay™…Date started ________________
□ mecA XpressFISH® …Date started ________________
□ Micacom hemoFISH Masterpanel … Date started ________________
□ ePlex BCID-GP Panel … Date started ________________
□ Other, Lab Developed Test (detects MRSA or SA)… Date started ____________________
□ Other commercial test, Specify_______...Date started__________
2c. [If using any of the above tests on sterile site specimens] Do you still obtain an isolate for S. aureus
or MRSA?
□ Yes
□ No - GO to Q3

2d. [If no] Do you plan to start offering any CIDTs for S. aureus or MRSA within the next year?

□ Yes

□ No – END SURVEY

2e. When do you plan to start offering culture independent diagnostic tests?

Month/Year: ____/____

3. How does your lab use the CIDT for detection of Staphylococcus aureus or MRSA? (select one)

□ Test concurrently with culture
□ Reflex to culture after positive by CIDT panel
□ Only run CIDT panel, no additional testing is done
□ Other, specify _____________

END SURVEY