Att 24_Crosswalk

Cross walk - 2020 form changes
ABCs:
1.

2020 ABCs Case Report Form

Current Form
7a. Hospital /Lab ID where culture identified
T4 – Site from which organism isolated
Options: Sterile Sites
1=Blood
2=Bone
3=Brain
4=CSF
5=Heart
6=Joint
7=Kidney
8=Other Sterile Site
9=unknown
10=Liver
11=Lung
12=Lymph node
13=Muscle/Fascia/Tendon (GAS only)
14=Ovary
15=Pancreas
16=Pericardial Fluid
17=Peritoneal Fluid
18=Pleural fluid
19=Spleen
20=Vascular Tissue
21=Vitreous fluid
Non-Sterile Sites
22=Amniotic fluid
23=Middle ear
24=Placenta
25=Sinus
26=Sputum
27=Wound
T8- If isolate/specimen not available, why not?
Options: 1=N/A at Hospital Lab 2=N/A at State Lab,
3=Hospital refuses, 4=Isolate Discrepancy (2x), 5=No DNA
(non-viable)

Proposed changes
T3a. Hospital/Lab ID where test identified
T4 – Removed several response options under ‘Non-Sterile sites’;
Options: Sterile Sites
1=Blood
2=Bone
3=Brain
4=CSF
5=Heart
6=Joint
7=Kidney
8=Other Sterile Site
9=unknown
10=Liver
11=Lung
12=Lymph node
13=Muscle/Fascia/Tendon (GAS only)
14=Ovary
15=Pancreas
16=Pericardial Fluid
17=Peritoneal Fluid
18=Pleural fluid
19=Spleen
20=Vascular Tissue
21=Vitreous fluid
Non-Sterile Sites
22=Amniotic fluid
24=Placenta
27=Wound

Question T8 – added response option ‘6=Isolate N/A for collection’
T8- If isolate/specimen not available, why not?
Options: 1=N/A at Hospital Lab 2=N/A at State Lab, 3=Hospital
refuses, 4=Isolate Discrepancy (2x), 5=No DNA (non-viable),
6=Isolate N/A for collection
Added new question: T9- Shipped to CDC? 1=Yes, 0=No
Added new question: T9- If Shipped, Accession #

27. Underlying causes or prior illnesses

Added new question:
24d.  Mark if this is a GBS Blood Spot Study case that lives outside
ABCs catchment area
27. Added sub-Checkbox under ‘Immunosuppressive Therapy’ –
‘Ravulizumab (Ultomiris)
For N. meningitidis cases only

27d. Other substance abuse, current
 None  Unknown
If yes, check all that apply:
mode of delivery
 Illicit opioid
 IDU  non-IDU  Unk
 Prescription Opioid
 IDU  non-IDU  Unk
 Stimulant
 IDU  non-IDU  Unk
 Other ___________  IDU  non-IDU  Unk
 Unknown Substance  IDU  non-IDU  Unk

28c. Were records obtained to verify vaccination history? 
Yes  No
If yes, what is the source of the information?
 Vaccine Registry  Healthcare Provider  Other
(specify)_____________________

Added checkbox ‘Opioid, NOS’ and separated checkbox ‘Cocaine or
Methamphetamine’ into two separate checkboxes;
27d. Other substances
 None  Unknown
Documented Use disorder mode of delivery
 Marijuana/Cannabinoid (other than smoking) DUD or Abuse
 IDU  Skin Popping  non-IDU  Unk
 Opioid, DEA Schedule I
DUD or Abuse
 IDU
 Skin Popping  non-IDU  Unk
 Opioid, DEA Schedule II- IV
DUD or Abuse  IDU
 Skin Popping  non-IDU  Unk
 Opioid, NOS
DUD or Abuse  IDU
 Skin Popping  non-IDU  Unk
 Cocaine
DUD or Abuse  IDU
 Skin Popping  non-IDU  Unk
 Methamphetamine
DUD or Abuse  IDU
 Skin Popping  non-IDU  Unk
 Other ___________
DUD or Abuse  IDU
 Skin Popping  non-IDU  Unk
 Unknown Substance DUD or Abuse  IDU
 Skin Popping  non-IDU  Unk
Removed this question from the form.

2. 2019 2020 Neonatal Infection Expanded Tracking Form
2019 form
2020 Form

12a. Number of prior pregnancies
__ __  Unknown (9)

Added new question:
3c. Gestational age determined by:
 Dates (1)
 Physical Exam (2)
 Ultrasound (3)
 Unknown
(9)
Added new questions:
10a. Did the infant receive antibiotics anytime during the birth
hospitalization?
 Yes (1)
 No (0)
 Unknown (9)
10b. IF YES, was it a beta-lactam?
 Yes (1)
 No (0)
 Unknown (9)
Variable value changed to harmonize with other unknown indicator
variables. Recoding needed for 2018-2019 to match the 2020 change going
forward.
12a. Number of prior pregnancies
__ __  Unknown (1)
Added new question
14a. Maternal underlying or prior illnesses:
(check all that apply OR if NONE or CHART UNAVAILABLE, check
appropriate box)
 None
 Unknown
 AIDS or CD4
 Connective tissue  Immunosuppressive
count <200
disease
therapy



21a. Date & time antibiotics 1st administered:
(before delivery)
Date: __/__/____
Time: _ _ _ _  Unknown (9)
3.

 Asthma



(Lupus, etc...)
CSF Leak

(Steroids, etc.)
 Leukemia



 Atherosclerotic
CVD
(ASCVD)/CAD
 Bone Marrow
Transplant
(BMT)
 CVA/Stroke/TIA



Dementia

 Multiple Myeloma





 Multiple Sclerosis





 Myocardial
Infarction
 Nephrotic
Syndrome
 Neuromuscular
Disorder
 Obesity



 Chronic Hepatitis
C
 Chronic Kidney
Disease
 Chronic Liver
Disease/
Cirrhosis
 Chronic Skin
Breakdown

Diabetes Mellitus,
HbA1C____(%),
Date: __/__/___
Emphysema/
COPD
Heart
Failure/CHF
HIV infection

 Parkinson’s Disease









Hodgkin’s
Disease/
Lymphoma
Immunoglobulin
Deficiency

 Complement
 Peptic Ulcer
Deficiency
Disease
Variable value changed to harmonize with other unknown indicator
variables.
21a. Date & time antibiotics 1st administered: (before delivery)
Date: __/__/____ Time: _ _ _ _  Unknown (1)

2020 ABCs Severe GAS Infection: Supplemental Form

2019 form

2020 Form

1. Soft-tissue necrosis (necrotizing fasciitis, necrotizing myositis,
necrotizing gangrene)?
1  Yes 2  No 9  DK
OPTIONAL: e. Is a pathology report available?
1  Yes 2  No 9  DK
f. Is a surgical report available?
1  Yes 2  No 9  DK
3. If the case died and was not hospitalized, please indicate date of
death: --/--/----(mm/dd/yyyy)

Removed OPTIONAL section from the form.

Removed this question from the form.

Added Laboratory Values Table for Surveillance Officer’s to
reference on page 2

4. 2020 ABCs Invasive Pneumococcal Disease in Children (aged ≥2 months to <5 years)
2019 form
2020 Form





Added option to record source of vaccination for each reported
dose.

Added option to record source of vaccination for each reported
dose. Also added collection of lot # for this vaccine type.
Removed this question

FoodNet
5-7. Active Surveillance
Variable
Current data collection
SalGroup
Collected
StecO157
Collected
StecH7
Collected
StecNM
Collected
agclinictesttype;
Alere Shiga Toxin Quik Chek
agsphltesttype
Immunocard STAT! EHEC (Meridian);
Duopath Verotoxins (Merck);

pcrclinictesttype;

Premier EHEC (Meridian);
ProSpecT STEC (Remel);
VTEC Screen (Denka Seiken);
ProSpecT Campylobacter assay (Remel);
PREMIER™ CAMPY assay (Meridian);
ImmunoCard STAT! CAMPY (Meridian);
Xpect Campylobacter assay (Remel);
Other;
Unknown
Biofire FilmArray GI Panel

pcrsphltesttype

BD Max Enteric Bacterial

otherclinictesttype;
othersphltesttype

Diatherix;
Luminex xTAG GI Panel;
ProGastroSSCS;
Medical diagnostics;
Metametrix
Verigene (Nanosphere) Enteric Pathogen Test
Seegene
Biofire Filmarray Meningitis/Encephalitis (ME)
Panel
Biofire Filmarray Blood Culture Indentification
Panel
Verigene (Nanosphere) Gram-positive Blood
Culture Test
Staten Serum Institut PCR assay
Lab-developed test
Unknown
Other;
Unknown

dxo157testype

ImmunoCard STAT! O157 (Meridian)

Proposed Changes
Suspended (optional in MMG)
Suspended (optional in MMG)
Suspended (optional in MMG)
Suspended (optional in MMG)
Abbott Shiga Toxin Quik Check;
Merck Duopath STEC Rapid Test;
Meridian Premier EHEC;
Meridian ImmunoCard STAT! E. coli O157
Plus;
Meridian ImmunoCard STAT! EHEC;
Remel ProSpecT STEC;
Meridian ImmunoCard STAT! CAMPY;
Meridian Premier CAMPY;
Remel ProSpecT Campylobacter;
Remel Xpect Campylobacter;
Other;
Unknown
Biofire Filmarray Gastrointestinal (GI);
Biofire Filmarray Meningitis/Encephalitis
(ME);
Biofire Filmarray Blood Culture
Identification (BCID);
BD Max Enteric Bacterial;
BD Max Extended Enteric Bacterial;
Diatherix Gastrointestinal;
Hologic Prodesse ProGastro SSCS;
Luminex Gram-Positive Blood Culture;
Luminex Verigene Enteric Pathogens;
Luminex xTag Gastrointestinal Pathogens;
Medical Diagnostics;
Lab-developed test
Unknown

Autoflourescence
Stained Wet Mount;
Wet Mount;
Vero Cell Asay;
Other;
Unknown
Meridian ImmunoCard STAT! E. coli O157
Plus;

Biofire FilmArray;
Diatherix;
Luminex;
Metametrix;
Other
pcrclinic;
pcrsphl

Stx1+;
Stx2+;
Stx1+ & Stx2+;
Positive Undifferentiated;
Negative;
Not Tested
Positive;
Negative;
Not tested
Vibrios
V. cholerae
Vibrios&V. cholerae

AR_antibiotic_use

Amoxicillin
Amoxicillin/Clavulanate
Ampicillin
Augmentin
Azithromycin
Bactrim
Biaxin

Biofire Filmarray Gastrointestinal (GI);
Diatherix Gastrointestinal;
Luminex xTag Gastrointestinal Pathogens;
Metametrix;
Lab-developed test;
Other
Stx1+;
Stx2+;
Stx1+ & Stx2+;
Positive Undifferentiated;
Negative;
Not Tested
Positive;
Negative;
Not tested
Vibrios
V cholerae
Vibrios&V cholerae
Not Tested
Shigella/Stx undiff
Shigella/Stx1
Shigella/Stx2
Shigella/Stx1&2
Amoxicillin
Amoxicillin / Clavulanate
Ampicillin
Augmentin
Azithromycin
Bactrim
Biaxin

Ceclor
Cefaclor
Ceftrin
Cefixime
Cefuorixime
Cefzil
Cefprozil
Cephalexin
Cephradine
Ciprofloxacin/Cipro
Clarithromycin
Dapsone

Ceclor
Cefaclor
Ceftin
Cefixime
Ceftriaxone
Cefuorixime
Cefzil
Cefprozil
Cephalexin
Cephradine
Chloramphenicol
Ciprofloxacin / Cipro

Doxycycline
Duricef
Erythromycin

Clarithromycin
Dapsone
Doxycycline

Erythromycin/sulfisoxizole
Flagyl
Floxin
Keflex
Keftab
Levofloxacin
Levoquin
Metronidazole
Norfloxacin/Norflox
Ofloxacin/Oflox
Pediazole
Penicillin/Pen VK
Septra
Suprax
Tetracycline
Trimox
Trimethoprim/Sulfa
Zithromax/Z-Pak
Other
Unknown

AR_antacid_any

Aluminium hydroxide
Ami-Lac
Amphojel
Axid
Calcium carbonate
Cal-Guest
Caltrate
calcium-based supplements

Duricef
Erythromycin
Erythromycin / sulfisoxizole
Flagyl
Floxin
Keflex
Keftab
Levofloxacin
Levoquin
Metronidazole
Norfloxacin / Norflox
Ofloxacin / Oflox
Pediazole
Penicillin / Pen VK
Septra
Suprax
Tetracycline
Trimox
Trimethoprim / Sulfa
Zithromax / Z-Pak
Other
Unknown
Aluminium hydroxide
Ami-Lac
Amphojel
Axid
Calcium carbonate
Cal Gest
Caltrate
calcium-based supplements

Dexilant
Dialume
Di-Gel
Gas-X with Maalox
Gaviscon
Gelusil
Genaton
Isopan
Maalox / Maox
Magaldrate
Magnesium Hydroxide
Masanti

Dexilant
Dialume
Di-Gel
Gas-X with Maalox
Gaviscon
Gelusil
Genaton
Isopan
Maalox / Maox
Magaldrate
Magnesium Hydroxide
Masanti

Mi-Acid
Milantex
Milk of Magnesia

Mi-Acid
Milantex
Milk of Magnesia

Outfetal

Mintox
Mylanta
Nexium
Nizatidine
Os-Cal
Oysco
Oyster (shell) calcium
Pepcid
Pepto Children's
Prevacid
Prilosec
Protonix
Ri-Mag
Riopan
Rolaids
Ron-Acid
Rulox
Tagamet
Tempo
Titralac
Tums
Zantac
Zegerid
Other
Unknown
Still pregnant;
Fetal death;
Induced abortion;
Delivery
Unknown;

Diagnostic Laboratory Practices and Volume
Reflex CX
Yes, always
When requested by provider
Only for special projects or outbreaks
No, specimen sent to reference laboratory for
culture
No, never

Mintox
Mylanta
Nexium
Nizatidine
Os-Cal
Oysco
Oyster (shell) calcium
Pepcid
Pepto Children's
Prevacid
Prilosec
Protonix
Ri-Mag
Riopan
Rolaids
Ron-Acid
Rulox
Tagamet
Tempo
Titralac
Tums
Zantac
Zegerid
Other
Unknown
Still pregnant;
Fetal death;
Delivery
Unknown;

Yes, always for EIP purposes
Yes, always for antimicrobial susceptibility
testing
Yes, always for public health purposes
Sometimes, when requested by a provider
Sometimes, for special projects or outbreaks
Sometimes, for special populations
No, always send to a reference laboratory
No, sometime send to a reference laboratory
No and don’t send to a reference laboratory

FluSurv-NET
8.

2019-2020 Influenza Hospitalization Surveillance Network Case Report Form
Question on 2018-19 Form

E8a. Substance Abuse Type (current use only)?
▪ IVDU
▪ Opioids
▪ Other, specify
▪ Unknown

E9. Current Non-Tobacco Smoker
▪ Marijuana
▪ E-cigarettes
▪ Other
E10b. Chronic Lung Disease
▪ Active tuberculosis/TB
▪ Chronic bronchitis
▪ Chronic respiratory failure
▪ Cystic fibrosis
▪ Emphysema/Chronic obstructive pulmonary
disease (COPD)
▪ Other, specify

Question on 2019-20 Form
E8a. Substance Abuse Type (current use only)?
▪ IVDU
▪ Opioids
▪ Cocaine
▪ Methamphetamines
▪ Other, specify
▪ Unknown
E9. Current Non-Tobacco Smoker
▪ Marijuana
▪ E-nicotine delivery system (ENDS)
▪ Other
E10b. Chronic Lung Disease
▪ Active tuberculosis/TB
▪ Asbestosis
▪ Bronchiectasis
▪ Bronchiolitis obliterans
▪ Chronic bronchitis
▪ Chronic respiratory failure
▪ Cystic fibrosis (CF)
▪ Emphysema/Chronic obstructive pulmonary disease
(COPD)
▪ Interstitial lung disease (ILD)
▪ Oxygen (O2) dependent
▪ Obstructive sleep apnea (OSA)
▪ Pulmonary fibrosis
▪ Restrictive lung disease
▪ Sarcoidosis
▪ Other, Specify

E10c. Chronic Metabolic Disease
▪ Diabetes mellitus (DM)
▪ Thyroid dysfunction
▪ Other, specify

E10c. Chronic Metabolic Disease
▪ Adrenal disorders (Addison’s, Adrenal insufficiency,
Cushing syndrome, Congenital adrenal hyperplasia)
▪ Diabetes mellitus (DM)
▪ Glycogen or other storage diseases (see list)
▪ Hyper/Hypofunction of pituitary gland
▪ Inborn errors of metabolism (see list)
▪ Metabolic syndrome
▪ Parathyroid syndrome
▪ Parathyroid dysfunction (Hyperparathyroidism,
Hypoparathyroidism)
▪ Thyroid dysfunction (Grave’s disease, Hashimoto’s
disease, Hyperthyroidism, Hypothyroidism)
▪ Other, specify

10d. Blood Disorders/Hemoglobinopathy
▪ Aplastic anemia
▪ Sickle cell disease
▪ Splenectomy/Asplenia
▪ Other, specify

10d. Blood Disorders/Hemoglobinopathy
▪ Alpha thalassemia
▪ Aplastic anemia
▪ Beta thalassemia
▪ Coagulopathy (Factor V Leiden, Von Willebrand
disease (VWD), see list)
▪ Hemoglobin S-beta thalassemia

Question on 2018-19 Form

Question on 2019-20 Form
▪
▪
▪
▪
▪
▪
▪
▪
▪

Leukopenia
Myelodysplastic syndrome (MDS)
Neutropenia
Pancytopenia
Polycythemia vera
Sickle cell disease
Splenectomy/Asplenia
Thrombocytopenia
Other, specify

10e. Cardiovascular Disease
▪ Aortic aneurysm
▪ Aortic stenosis
▪ Atherosclerotic cardiovascular disease
▪ Atrial fibrillation
▪ Cardiomyopathy
▪ Cerebral vascular accident
(CVA)/Incident/Stroke
▪ Congenital heart disease
▪ Coronary artery disease
▪ Heart failure/Congestive heart failure
▪ Ischemic cardiomyopathy
▪ Non-ischemic cardiomyopathy
▪ Other, specify

10e. Cardiovascular Disease
▪ Aortic aneurysm (AAA)
▪ Aortic regurgitation (AR)
▪ Aortic stenosis (AS)
▪ Atherosclerotic cardiovascular disease (ASCVD)
▪ Atrial fibrillation (AFib)
▪ Atrioventricular (AV) blocks
▪ Automated implantable devices (AID/AICD)/
Pacemaker
▪ Bundle branch block (BBB/RBBB/LBBB)
▪ Cardiomyopathy
▪ Carotid stenosis
▪ Cerebral vascular accident (CVA)/Incident/Stroke
▪ Congenital heart disease (Specify)
o Atrial septal defect
o Pulmonary stenosis
o Tetralogy of Fallot
o Ventricular septal defect
o Other, specify
▪ Coronary artery bypass grafting (CABG)
▪ Coronary artery disease (CAD)
▪ Deep vein thrombosis (DVT)
▪ Heart failure/Congestive heart failure (CHF)
▪ Myocardial infarction (MI), history of
▪ Mitral stenosis (MS)
▪ Mitral regurgitation (MR)
▪ Peripheral artery disease (PAD)
▪ Peripheral vascular disease (PVD)
▪ Pulmonary embolism (PE)
▪ Pulmonary hypertension (PHTN)
▪ Pulmonic stenosis
▪ Pulmonic regurgitation
▪ Transient ischemic attack (TIA)
▪ Tricuspid stenosis
▪ Tricuspid regurgitation (TR)
▪ Ventricular tachycardia (VT, VTach)
▪ Ventricular fibrillation (VF, VFib)
▪ Aortic/Mitral/Tricuspid/Pulmonic valve replacement
▪ Other, specify

10f. Neuromuscular Disorder
▪ Duchenne muscular dystrophy
▪ Mitochondrial disorder
▪ Multiple sclerosis (MS)
▪ Muscular dystrophy (see list)
▪ Myasthenia gravis (MG)
▪ Parkinson’s disease

10f. Neuromuscular Disorder
▪ Amyotrophic lateral sclerosis (ALS)
▪ Mitochondrial disorder (see list)
▪ Multiple sclerosis (MS)
▪ Muscular dystrophy (see list)
▪ Myasthenia gravis (MG)
▪ Parkinson’s disease

Question on 2018-19 Form
▪

Other, specify

Question on 2019-20 Form
▪
▪

Scoliosis/Kyphoscoliosis
Other, specify

10g. Neurologic disorder
▪ Cerebral palsy
▪ Cognitive dysfunction
▪ Dementia/Alzheimer’s disease
▪ Developmental delay
▪ Down syndrome
▪ Epilepsy/Seizure/Seizure disorder
▪ Plegias/Paralysis/Quadriplegia
▪ Other, Specify

10g. Neurologic disorder
▪ Cerebral palsy
▪ Cognitive dysfunction
▪ Dementia/Alzheimer’s disease
▪ Developmental delay
▪ Down syndrome/Trisomy 21
▪ Edwards Syndrome/Trisomy 18
▪ Epilepsy/Seizure/Seizure disorder
▪ Neuropathy
▪ Neural tube defects/Spina bifida (See list)
▪ Plegias/Paralysis/Quadriplegia
▪ Traumatic brain injury (TBI)
▪ Other, Specify

10i. Immunocompromised Condition
▪ AIDS or CD4 count<200
▪ Complement deficiency
▪ HIV infection
▪ Immunoglobulin deficiency
▪ Immunosuppressive therapy
▪ Organ Transplant Stem cell transplant (e.g.,
bone marrow transplant)
▪ Steroid therapy (taken within 2 weeks of
admission)
▪ Other, specify

10i. Immunocompromised Condition
▪ AIDS or CD4 count<200
▪ Complement deficiency (See list)
▪ Grafts vs host disease/GVHD
▪ HIV infection
▪ Immunoglobulin deficiency/ immunodeficiency (See
list)
▪ Immunosuppressive therapy (within the last 12
months of admission)(See list)
o If yes, for what condition?:
▪ Leukemia*
▪ Lymphoma/Hodgkins/Non-Hodgkins (NHL)*
▪ Metastatic cancer*
▪ Multiple myeloma*
▪ Solid organ malignancy*
o If yes, which organ?
▪ Steroid therapy (within 2 weeks of admission)
▪ Transplant, hematopoietic stem cell (Bone marrow
transplant (BMT), peripheral stem cell transplant
(PSCT))
▪ Transplant, solid organ (SOT)
▪ Other, specify
*Current/in treatment or diagnosed in last 12 months

10j. Renal Disease
▪ Chronic kidney disease /chronic renal
insufficiency
▪ End stage renal disease/Dialysis
▪ Glomerulonephritis/GN
▪ Nephrotic syndrome
▪ Other, specify

10k. Liver Disease
▪ Cirrhosis
▪ Viral hepatitis (B or C)
▪ Other, specify

10j. Renal Disease
▪ Chronic kidney disease (CKD)/chronic renal
insufficiency (CRI)
▪ End stage renal disease (ESRD)
▪ Dialysis (HD)
▪ Glomerulonephritis/GN
▪ Nephrotic syndrome
▪ Polycystic kidney disease (PCKD)
▪ Other, specify
10k. Gastrointestinal/Liver Disease (Do Not Record
GERD)
▪ Alcoholic hepatitis
▪ Autoimmune hepatitis
▪ Barrett’s esophagitis
▪ Chronic liver disease

Question on 2018-19 Form

(N/A)

Question on 2019-20 Form
▪ Chronic pancreatitis
▪ Cirrhosis/End stage liver disease (ESLD)
▪ Crohn’s disease
▪ Esophageal varices
▪ Esophageal strictures
▪ Hepatitis B, chronic (HBV)
▪ Hepatitis C, chronic (HCV)
▪ Non-alcoholic fatty liver disease/NASH/NAFLD
▪ Ulcerative colitis (UC)
▪ Other, specify
10o. Rheumatologic/Autoimmune/Inflammatory
Conditions
▪ Ankylosing spondylitis
▪ Dermatomyositis
▪ Juvenile idiopathic arthritis
▪ Kawasaki disease
▪ Microscopic polyangiitis
▪ Polyarteritis nodosum (PAN)
▪ Polymyalgia rheumatica
▪ Polymyositis
▪ Psoriatic arthritis
▪ Rheumatoid arthritis (RA)
▪ Systemic lupus erythematosus/SLE/Lupus
▪ Systemic sclerosis
▪ Takayasu arteritis
▪ Temporal/Giant cell arteritis
▪ Vasculitis, other (see list)
▪ Other, specify

10o. Other
▪ Systemic lupus erythematosus/SLE/Lupus
▪ Other, specify

10p. Other
▪ Feeding tube dependent (PEG, see list)
▪ Trach dependent/Vent dependent
▪ Wheelchair dependent
▪ Other, specify

10p. Pediatric cases only
▪ Abnormality of airway (see instructions)
▪ Chronic lung disease of
prematurity/Bronchopulmonary dysplasia (BPD)
▪ History of febrile seizures
▪ Long term aspirin therapy
▪ Premature (gestation age <37weeks at birth for
patients <2 yrs)

10p. Pediatric cases only
▪ Abnormality of airway (see instructions)
▪ History of febrile seizures
▪ Long term aspirin therapy
▪ Premature (gestation age <37weeks at birth for
patients <2 yrs)

I. Influenza Treatment
▪ Oseltamivir (Tamiflu)
▪ Peramivir (Rapivab)
▪ Zanamivir (Relenza)
▪ Other, specify
▪ Unknown

I. Influenza Treatment
▪ Oseltamivir (Tamiflu)
▪ Peramivir (Rapivab)
▪ Zanamivir (Relenza)
▪ Baloxavir marboxil (Xofluza)
▪ Other, specify
▪ Unknown

Question on 2018-19 Form
J2b. For first abnormal chest x-ray, please check all
that apply
▪ Report not available
▪ Air space density
▪ Air space opacity
▪ Bronchopneumonia/pneumonia
▪ Cannot rule out pneumonia
▪ Consolidation
▪ Cavitation
▪ ARDS (acute respiratory distress syndrome)
▪ Lung infiltrate
▪ Interstitial infiltrate
▪ Lobar infiltrate
▪ Other

Question on 2019-20 Form
J2b. For first abnormal chest x-ray, please check all that
apply
▪ Report not available
▪ Air space density
▪ Air space opacity
▪ Bronchopneumonia/pneumonia
▪ Cannot rule out pneumonia
▪ Consolidation
▪ Cavitation
▪ ARDS (acute respiratory distress syndrome)
▪ Lung infiltrate
▪ Interstitial infiltrate
▪ Lobar infiltrate
▪ Other
▪ Pleural effusion/empyema

9. 2019-20 FluSurv-NET/RSV Laboratory Survey
Question on 2018-19 form
4a. Select the kit name(s) (manufacturer) for the rapid
influenza diagnostic test(s) performed at the laboratory
(Check all that apply):
▪ BD Directigen™ EZ Flu A+B (Becton-Dickinson
& Co.)
▪ BD Veritor™ System for Rapid Detection of Flu
A+B (CLIA-waived), (Becton Dickinson & Co.)
▪ BD Veritor™ System for Rapid Detection of Flu
A+B (Moderately Complex), (Becton Dickinson &
Co.)
▪ Binax NOW® Influenza A&B Test (Alere
Scarborough, Inc.)
▪ BioSign® Flu A+B or OraSure QuickFlu Rapid
A+B Test or Polymedco Poly stat Flu A&B Test
or LifeSign LLC Status Flu A&B (Princeton
BioMedtech Corp.)
▪ ClearView Exact II Influenza A&B Test or Alere
Influenza A&B Test (Alere Scarborough, Inc.)
▪ OSOM® Influenza A&B Test (Sekisui
Diagnostics)
▪ QuickVue® Influenza A/B Test (Quidel Corp.)
▪ QuickVue® Influenza A+B Test (Quidel Corp.)
▪ RAMP Influenza A/B Assay or 3M™ Rapid
Detection Flu A+B Test (Response Biomedical
Corp.) SAS™ FluAlert A&B Test (SA Scientific,
Inc.)
▪ SAS™ Influenza A Test (SA Scientific, Inc.)
▪ SAS™ Influenza B Test (SA Scientific, Inc.)
▪ Sofia® Analyzer and Influenza A+B FIA (CLIAwaived) (Quidel Corp.)
▪ Sofia® Analyzer and Influenza A+B FIA (Quidel
Corp.)
▪ TRU FLU® (Meridian Bioscience, Inc.)
▪ XPECT™ Influenza A/B (Remel Inc./Thermo
Fisher Scientific)
▪ Other, specify

Question on 2019-20 form
4a. Select the kit name(s) (manufacturer) for the rapid
influenza diagnostic test(s) performed at the laboratory
(Check all that apply):
▪ BD Veritor™ System for Rapid Detection of Flu
A+B (CLIA-waived), (Becton Dickinson & Co.)
▪ BD Veritor™ System for Rapid Detection of Flu
A+B (Moderately Complex), (Becton Dickinson &
Co.)
▪ Binax NOW® Influenza A&B Card 2 (Abbott)
▪ BioSign® Flu A+B or OraSure QuickFlu Rapid
A+B Test or Polymedco Poly stat Flu A&B Test
or LifeSign LLC Status Flu A&B (Princeton
BioMedtech Corp.)
▪ QuickVue® Influenza A+B Test (Quidel Corp.)
▪ Sofia® Analyzer and Influenza A+B FIA (CLIAwaived) (Quidel Corp.)
▪ Sofia® Analyzer and Influenza A+B FIA (Quidel
Corp.)
▪ XPECT™ Influenza A/B (Remel Inc./Thermo
Fisher Scientific)
▪ Other, specify:

4b. If more than one kit is selected above, please select the
one kit that is (or will be) used most frequently for rapid
influenza diagnostic testing at the laboratory during the
current influenza season:
▪

BD Directigen™ EZ Flu A+B (Becton-Dickinson
& Co.)
▪ BD Veritor™ System for Rapid Detection of Flu
A+B (CLIA-waived), (Becton Dickinson & Co.)
▪ BD Veritor™ System for Rapid Detection of Flu
A+B (Moderately Complex), (Becton Dickinson &
Co.)
▪ Binax NOW® Influenza A&B Test (Alere
Scarborough, Inc.)
▪ BioSign® Flu A+B or OraSure QuickFlu Rapid
A+B Test or Polymedco Poly stat Flu A&B Test
or LifeSign LLC Status Flu A&B (Princeton
BioMedtech Corp.)
▪ ClearView Exact II Influenza A&B Test or Alere
Influenza A&B Test (Alere Scarborough, Inc.)
▪ OSOM® Influenza A&B Test (Sekisui
Diagnostics)
▪ QuickVue® Influenza A/B Test (Quidel Corp.)
▪ QuickVue® Influenza A+B Test (Quidel Corp.)
▪ RAMP Influenza A/B Assay or 3M™ Rapid
Detection Flu A+B Test (Response Biomedical
Corp.) SAS™ FluAlert A&B Test (SA Scientific,
Inc.)
▪ SAS™ Influenza A Test (SA Scientific, Inc.)
▪ SAS™ Influenza B Test (SA Scientific, Inc.)
▪ Sofia® Analyzer and Influenza A+B FIA (CLIAwaived) (Quidel Corp.)
▪ Sofia® Analyzer and Influenza A+B FIA (Quidel
Corp.)
▪ TRU FLU® (Meridian Bioscience, Inc.)
▪ XPECT™ Influenza A/B (Remel Inc./Thermo
Fisher Scientific)
▪ Other, specify
4c. What does the laboratory do if a rapid influenza
diagnostic test result is negative for influenza?
▪ Report the negative result and do nothing else
▪ Reflex to molecular assay (PCR) for confirmation
▪ Report the negative result and submit specimen to
state/regional public health lab for PCR
confirmation
▪ Report the negative result with a disclaimer asking
the physician to submit a second specimen for
testing with a more sensitive assay
▪ Send for PCR confirmation by provider request
▪ Other, specify:

4b. If more than one kit is selected above, please select the
one kit that is (or will be) used most frequently for rapid
influenza diagnostic testing at the laboratory during the
current influenza season:
▪
▪
▪
▪

▪
▪
▪
▪
▪

BD Veritor™ System for Rapid Detection of Flu
A+B (CLIA-waived), (Becton Dickinson & Co.)
BD Veritor™ System for Rapid Detection of Flu
A+B (Moderately Complex), (Becton Dickinson &
Co.)
Binax NOW® Influenza A&B Card 2 (Abbott)
BioSign® Flu A+B or OraSure QuickFlu Rapid
A+B Test or Polymedco Poly stat Flu A&B Test
or LifeSign LLC Status Flu A&B (Princeton
BioMedtech Corp.)
QuickVue® Influenza A+B Test (Quidel Corp.)
Sofia® Analyzer and Influenza A+B FIA (CLIAwaived) (Quidel Corp.)
Sofia® Analyzer and Influenza A+B FIA (Quidel
Corp.)
XPECT™ Influenza A/B (Remel Inc./Thermo
Fisher Scientific)
Other, specify:

Question Removed

4d. What does the laboratory do if a rapid influenza
diagnostic test result is positive for influenza?
▪ Report the positive result and do nothing else
▪ Reflex to another influenza test for confirmation
▪ Reflex to a confirmatory test only if early in
influenza season or off-season
▪ Report the positive result with a disclaimer asking
the physician to submit a second specimen for
testing with a more sensitive assay
▪ Report the positive result and submit specimen to
state/regional public health lab for PCR
confirmation
▪ Other, specify
5. Does the laboratory perform rapid molecular assays (e.g.
Alere-i, cobas Liat; results available ≤30 minutes) for
influenza?
5a. What does the laboratory do if the rapid molecular assay
is negative for influenza?

Question Removed

Question Removed

Question Removed

▪
▪

Report the negative result and do nothing else
Reflex to standard molecular assay (PCR) for
confirmation
▪ Report the negative result with a disclaimer asking
the physician to submit a second specimen for
testing with a more sensitive assay
▪ Report the negative result and submit specimen to
state/regional public health lab for PCR
confirmation
▪ Other, specify
5b. What does the laboratory do if the rapid molecular is
positive for influenza?
▪ Report the positive result and do nothing else
▪ Reflex to standard molecular assay (PCR) for
confirmation
▪ Report the positive result with a disclaimer asking
the physician to submit a second specimen for
testing with a standard molecular assay
▪ Report the positive result and submit specimen to
state/regional public health lab for PCR
confirmation
▪ Reflex for subtyping
▪ Other, specify
6. Does the laboratory perform standard molecular assays
(e.g., RT-PCR; with results available > 30 minutes) for
influenza?

Question Removed

5. Does the laboratory perform molecular assays (including
rapid molecular, RT-PCR, RVPs) for influenza?

6a. Select kit name(s) (manufacturer) for all molecular
assays performed at the laboratory (Check all that apply):
▪ Alere i NAT Flu A/B (CLIA Waived), (Alere)
▪ Alere i NAT Flu A/B (Moderate), (Alere)
▪ ARIES® Flu A/B & RSV Assay, (Luminex)
▪ CDC Human Influenza Virus Real-Time RT-PCR
Diagnostic Panel (Influenza A/B Typing Kit4),
(CDC Influenza Division)
▪ CDC Human Influenza Virus Real-Time RT-PCR
Detection and Characterization Panel, (CDC
Influenza Division)
▪ CDC Influenza A/H5 (Asian Lineage) Virus RealTime RT-PCR Primer and Probe Set, (CDC
Influenza Division)
▪ CDC Influenza 2009 A(H1N1)pdm Real-Time
RT-PCR Panel, (CDC Influenza Division)
▪ Cepheid Xpert Flu Assay, (Cepheid)
▪ Cepheid Xpert Flu/RSV XC Assay, (Cepheid)
▪ Cepheid Xpert Express Flu Assay, (Cepheid)
▪ Cepheid Xpert Express Flu/RSV Assay, (Cepheid)
▪ Cobas Liat Influenza A/B, (Roche Diagnostics)
▪ Cobas Liat Influenza A/B & RSV, (Roche
Diagnostics)
▪ ePlex Respiratory Pathogen Panel (GenMark
Diagnostices)
▪ eSensor® Respiratory Viral Panel (RVP),
(GenMark Diagnostics)
▪ FilmArray Respiratory Panel, (BioFire
Diagnostics, LLC)
▪ Ibis PLEX-ID Flu, (Ibis/Abbott)
▪ IMDx Flu A/B and RSV for Abbott m2000,
(IMDx)
▪ Nx-TAG Respiratory Pathogen Panel (Luminex
Molecular Diagnostics Inc)
▪ Prodesse PROFLU™, (GenProbe/Hologic)
▪ Prodesse ProFAST™, (GenProbe/Hologic)
▪ Qiagen Artus Influenza A/B Rotor-gene RT-PCR
kit, (Qiagen)
▪ Quidel Molecular Influenza A+B, (Quidel)
▪ Simplexa™ Flu A/B & RSV, (Focus Diagnostics,
3M)
▪ Simplexa™ Flu A/B & RSV Direct, (Focus
Diagnostics, 3M)
▪ Simplexa™ Influenza A H1N1 (2009), (Focus
Diagnostics, 3M)
▪ U.S. Army JBAIDS Influenza A&B Detection Kit
, (Biofire Defense)
▪ U.S. Army JBAIDS Influenza A Subtyping Kit,
(Biofire Defense)
▪ U.S. Army JBAIDS Influenza A/H5 Kit ,(Biofire
Defense)
▪ Verigene® Respiratory Virus Nucleic Acid Test,
(Nanosphere, Inc)
▪ Verigene® Respiratory Virus Plus Nucleic Acid
Test (RV+), (Nanosphere, Inc)
▪ Verigene® Respiratory Pathogen Nucleic Acid
Test (RP Flex), (Nanosphere, Inc)
▪ x-TAG® Respiratory Viral Panel (RVP),
(Luminex Molecular Diagnostics Inc)

5a. Select the kit name(s) (manufacturer) for all molecular
assays performed at the laboratory (Check all that apply):
▪ ID Now™ Influenza A&B (CLIA Waived),
(Abbott)
▪ Accula Flu A/Flu B (Mesa Biotech, Inc.)
▪ ARIES® Flu A/B & RSV Assay, (Luminex)
▪ CDC Human Influenza Virus Real-Time RT-PCR
Diagnostic Panel (Influenza A/B Typing Kit4),
(CDC Influenza Division)
▪ CDC Human Influenza Virus Real-Time RT-PCR
Detection and Characterization Panel, (CDC
Influenza Division)
▪ CDC Influenza A/H5 (Asian Lineage) Virus RealTime RT-PCR Primer and Probe Set, (CDC
Influenza Division)
▪ CDC Influenza 2009 A(H1N1)pdm Real-Time
RT-PCR Panel, (CDC Influenza Division)
▪ Cepheid Xpert Flu Assay, (Cepheid)
▪ Cepheid Xpert Flu/RSV XC Assay, (Cepheid)
▪ Cepheid Xpert Express Flu Assay, (Cepheid)
▪ Cepheid Xpert Express Flu/RSV Assay, (Cepheid)
▪ Cobas Liat Influenza A/B, (Roche Diagnostics)
▪ Cobas Liat Influenza A/B & RSV, (Roche
Diagnostics)
▪ ePlex Respiratory Pathogen Panel (GenMark
Diagnostices)*
▪ eSensor® Respiratory Viral Panel (RVP),
(GenMark Diagnostics)*
▪ FilmArray® Respiratory Panel, (BioFire
Diagnostics, LLC)*
▪ FilmArray® Respiratory Panel, EZ (BioFire
Diagnostics, LLC)*
▪ Idylla Respiratory IFV-RSV Panel, (Biocartis)*
▪ IMDx Flu A/B and RSV for Abbott m2000,
(IMDx)
▪ Lyra Influenza A+B Assay, (Quidel) Nx-TAG
Respiratory Pathogen Panel, (Luminex Molecular
Diagnostics Inc)*
▪ Panther Fusion® Flu A/B RSV, (Assay Hologic)
▪ Prodesse PROFLU™, (GenProbe/Hologic)
▪ Prodesse ProFAST™, (GenProbe/Hologic)*
▪ Silaris Infuenza A & Btg, (Sekisui Diagnostic)
▪ Solana Influenza A+B Assay, (Quidel)
▪ Simplexa™ Flu A/B & RSV, (Focus Diagnostics,
3M)
▪ Simplexa™ Flu A/B & RSV Direct, (Focus
Diagnostics, 3M)
▪ Simplexa™ Influenza A H1N1 (2009), (Focus
Diagnostics, 3M)
▪ Verigene® Respiratory Virus Nucleic Acid Test,
(Nanosphere, Inc)
▪ Verigene® Respiratory Virus Plus Nucleic Acid
Test (RV+), (Luminex) Verigene® Respiratory
Pathogen Nucleic Acid Test (RP Flex)*,
(Luminex)
▪ x-TAG® Respiratory Viral Panel Fast (RVP
FAST)*, (Luminex Molecular Diagnostics Inc)
▪ In-house developed PCR assay
▪ Other, specify

▪
▪
▪

x-TAG® Respiratory Viral Panel Fast (RVP
FAST), (Luminex Molecular Diagnostics Inc)
In-house developed PCR assay
Other, specify

6b. If more than one kit is selected above, please select the
one kit that is (or will be used) most frequently for
molecular assay at the laboratory during the current
influenza season:
▪ Alere i NAT Flu A/B (CLIA Waived), (Alere)
▪ Alere i NAT Flu A/B (Moderate), (Alere)
▪ ARIES® Flu A/B & RSV Assay, (Luminex)
▪ CDC Human Influenza Virus Real-Time RT-PCR
Diagnostic Panel (Influenza A/B Typing Kit4),
(CDC Influenza Division)
▪ CDC Human Influenza Virus Real-Time RT-PCR
Detection and Characterization Panel, (CDC
Influenza Division)
▪ CDC Influenza A/H5 (Asian Lineage) Virus RealTime RT-PCR Primer and Probe Set, (CDC
Influenza Division)
▪ CDC Influenza 2009 A(H1N1)pdm Real-Time
RT-PCR Panel, (CDC Influenza Division)
▪ Cepheid Xpert Flu Assay, (Cepheid)
▪ Cepheid Xpert Flu/RSV XC Assay, (Cepheid)
▪ Cepheid Xpert Express Flu Assay, (Cepheid)
▪ Cepheid Xpert Express Flu/RSV Assay, (Cepheid)
▪ Cobas Liat Influenza A/B, (Roche Diagnostics)
▪ Cobas Liat Influenza A/B & RSV, (Roche
Diagnostics)
▪ ePlex Respiratory Pathogen Panel (GenMark
Diagnostices)
▪ eSensor® Respiratory Viral Panel (RVP),
(GenMark Diagnostics)
▪ FilmArray Respiratory Panel, (BioFire
Diagnostics, LLC)
▪ Ibis PLEX-ID Flu, (Ibis/Abbott)
▪ IMDx Flu A/B and RSV for Abbott m2000,
(IMDx)
▪ Nx-TAG Respiratory Pathogen Panel (Luminex
Molecular Diagnostics Inc)
▪ Prodesse PROFLU™, (GenProbe/Hologic)
▪ Prodesse ProFAST™, (GenProbe/Hologic)
▪ Qiagen Artus Influenza A/B Rotor-gene RT-PCR
kit, (Qiagen)
▪ Quidel Molecular Influenza A+B, (Quidel)
▪ Simplexa™ Flu A/B & RSV, (Focus Diagnostics,
3M)
▪ Simplexa™ Flu A/B & RSV Direct, (Focus
Diagnostics, 3M)
▪ Simplexa™ Influenza A H1N1 (2009), (Focus
Diagnostics, 3M)
▪ U.S. Army JBAIDS Influenza A&B Detection Kit
, (Biofire Defense)
▪ U.S. Army JBAIDS Influenza A Subtyping Kit,
(Biofire Defense)
▪ U.S. Army JBAIDS Influenza A/H5 Kit ,(Biofire
Defense)
▪ Verigene® Respiratory Virus Nucleic Acid Test,
(Nanosphere, Inc)
▪ Verigene® Respiratory Virus Plus Nucleic Acid
Test (RV+), (Nanosphere, Inc)
▪ Verigene® Respiratory Pathogen Nucleic Acid
Test (RP Flex), (Nanosphere, Inc)

5b. If more than one kit is selected above, please select the
one kit that is (or will be used) most frequently for
molecular assay at the laboratory during the current
influenza season:
▪ ID Now™ Influenza A&B (CLIA Waived),
(Abbott)
▪ Accula Flu A/Flu B (Mesa Biotech, Inc.)
▪ ARIES® Flu A/B & RSV Assay, (Luminex)
▪ CDC Human Influenza Virus Real-Time RT-PCR
Diagnostic Panel (Influenza A/B Typing Kit4),
(CDC Influenza Division)
▪ CDC Human Influenza Virus Real-Time RT-PCR
Detection and Characterization Panel, (CDC
Influenza Division)
▪ CDC Influenza A/H5 (Asian Lineage) Virus RealTime RT-PCR Primer and Probe Set, (CDC
Influenza Division)
▪ CDC Influenza 2009 A(H1N1)pdm Real-Time
RT-PCR Panel, (CDC Influenza Division)
▪ Cepheid Xpert Flu Assay, (Cepheid)
▪ Cepheid Xpert Flu/RSV XC Assay, (Cepheid)
▪ Cepheid Xpert Express Flu Assay, (Cepheid)
▪ Cepheid Xpert Express Flu/RSV Assay, (Cepheid)
▪ Cobas Liat Influenza A/B, (Roche Diagnostics)
▪ Cobas Liat Influenza A/B & RSV, (Roche
Diagnostics)
▪ ePlex Respiratory Pathogen Panel (GenMark
Diagnostices)*
▪ eSensor® Respiratory Viral Panel (RVP),
(GenMark Diagnostics)*
▪ FilmArray® Respiratory Panel, (BioFire
Diagnostics, LLC)*
▪ FilmArray® Respiratory Panel, EZ (BioFire
Diagnostics, LLC)*
▪ Idylla Respiratory IFV-RSV Panel, (Biocartis)*
▪ IMDx Flu A/B and RSV for Abbott m2000,
(IMDx)
▪ Lyra Influenza A+B Assay, (Quidel) Nx-TAG
Respiratory Pathogen Panel, (Luminex Molecular
Diagnostics Inc)*
▪ Panther Fusion® Flu A/B RSV, (Assay Hologic)
▪ Prodesse PROFLU™, (GenProbe/Hologic)
▪ Prodesse ProFAST™, (GenProbe/Hologic)*
▪ Silaris Infuenza A & Btg, (Sekisui Diagnostic)
▪ Solana Influenza A+B Assay, (Quidel)
▪ Simplexa™ Flu A/B & RSV, (Focus Diagnostics,
3M)
▪ Simplexa™ Flu A/B & RSV Direct, (Focus
Diagnostics, 3M)
▪ Simplexa™ Influenza A H1N1 (2009), (Focus
Diagnostics, 3M)
▪ Verigene® Respiratory Virus Nucleic Acid Test,
(Nanosphere, Inc)
▪ Verigene® Respiratory Virus Plus Nucleic Acid
Test (RV+), (Luminex) Verigene® Respiratory
Pathogen Nucleic Acid Test (RP Flex)*,
(Luminex)
▪ x-TAG® Respiratory Viral Panel Fast (RVP
FAST)*, (Luminex Molecular Diagnostics Inc)

▪
▪
▪
▪

x-TAG® Respiratory Viral Panel (RVP),
(Luminex Molecular Diagnostics Inc)
x-TAG® Respiratory Viral Panel Fast (RVP
FAST), (Luminex Molecular Diagnostics Inc)
In-house developed PCR assay
Other, specify

▪
▪

In-house developed PCR assay
Other, specify

6d. What testing kit does the testing facility use (or will it
use) most often to perform influenza A sub-typing during
the current influenza season? (Select one)
▪ Alere i NAT Flu A/B (CLIA Waived), (Alere)
Alere i NAT Flu A/B (Moderate), (Alere)
▪ ARIES® Flu A/B & RSV Assay, (Luminex)
▪ CDC Human Influenza Virus Real-Time RT-PCR
Diagnostic Panel (Influenza A/B Typing Kit4),
(CDC Influenza Division)
▪ CDC Human Influenza Virus Real-Time RT-PCR
Detection and Characterization Panel, (CDC
Influenza Division)
▪ CDC Influenza A/H5 (Asian Lineage) Virus RealTime RT-PCR Primer and Probe Set, (CDC
Influenza Division)
▪ CDC Influenza 2009 A(H1N1)pdm Real-Time
RT-PCR Panel, (CDC Influenza Division)
▪ Cepheid Xpert Flu Assay, (Cepheid)
▪ Cepheid Xpert Flu/RSV XC Assay, (Cepheid)
▪ Cepheid Xpert Express Flu Assay, (Cepheid)
▪ Cepheid Xpert Express Flu/RSV Assay, (Cepheid)
▪ Cobas Liat Influenza A/B, (Roche Diagnostics)
▪ Cobas Liat Influenza A/B & RSV, (Roche
Diagnostics)
▪ eSensor® Respiratory Viral Panel (RVP),
(GenMark Diagnostics)
▪ FilmArray Respiratory Panel, (BioFire
Diagnostics, LLC)
▪ Ibis PLEX-ID Flu, (Ibis/Abbott) IMDx Flu A/B
and RSV for Abbott m2000, (IMDx)
▪ Prodesse PROFLU™, (GenProbe/Hologic)
▪ Prodesse ProFAST™, (GenProbe/Hologic)
▪ Qiagen Artus Influenza A/B Rotor-gene RT-PCR
kit, (Qiagen)
▪ Quidel Molecular Influenza A+B, (Quidel)
▪ Simplexa™ Flu A/B & RSV, (Focus Diagnostics,
3M)
▪ Simplexa™ Flu A/B & RSV Direct, (Focus
Diagnostics, 3M)
▪ Simplexa™ Influenza A H1N1 (2009), (Focus
Diagnostics, 3M)
▪ U.S. Army JBAIDS Influenza A&B Detection Kit
, (Biofire Defense)
▪ U.S. Army JBAIDS Influenza A Subtyping Kit,
(Biofire Defense)
▪ U.S. Army JBAIDS Influenza A/H5 Kit ,(Biofire
Defense)
▪ Verigene® Respiratory Virus Nucleic Acid Test,
(Nanosphere, Inc)
▪ Verigene® Respiratory Virus Plus Nucleic Acid
Test (RV+), (Nanosphere, Inc)
▪ Verigene® Respiratory Pathogen Nucleic Acid
Test (RP Flex), (Nanosphere, Inc)
▪ x-TAG® Respiratory Viral Panel (RVP),
(Luminex Molecular Diagnostics Inc)
▪ x-TAG® Respiratory Viral Panel Fast (RVP
FAST), (Luminex Molecular Diagnostics Inc)
▪ In-house developed PCR assay
▪ Other, specify

5d. What testing kit does the testing facility use (or will it
use) most often to perform influenza A sub-typing during
the current influenza season?
▪ ePlex Respiratory Pathogen Panel (GenMark
Diagnostices)*
▪ eSensor® Respiratory Viral Panel (RVP),
(GenMark Diagnostics)
▪ FilmArray Respiratory Panel, (BioFire
Diagnostics, LLC)
▪ Idylla Respiratory IFV-RSV Panel, (Biocartis)
▪ Nx-TAG Respiratory Pathogen Panel (Luminex
Molecular Diagnostics Inc)
▪ Verigene® Respiratory Pathogen Nucleic Acid
Test (RP Flex), (Nanosphere, Inc)
▪ x-TAG® Respiratory Viral Panel Fast (RVP
FAST), (Luminex Molecular Diagnostics Inc)
▪ In-house developed PCR assay
▪ Other, specify

8a. Which influenza test method does the laboratory
perform most frequently for pediatric patients (aged 0-17
years)? (Select one)
▪ Viral culture Indirect fluorescent antibody
(IFA)/direct fluorescent antibody stain (DFA)
▪ Rapid influenza antigen diagnostic test (rapid test,
RIDT)
▪ Rapid Molecular assay (e.g. RT-PCR, NAAT) –
singleplex (influenza only)
▪ Rapid Molecular assay (e.g. RT-PCR, NAAT) –
dualplex (influenza/RSV)
▪ Standard Molecular assay (e.g. RT-PCR, NAAT) –
singleplex (influenza only)
▪ Standard Molecular assay (e.g. RT-PCR, NAAT) –
dualplex (influenza/RSV)
▪ Standard Molecular assay (e.g. RT-PCR, NAAT) –
multiplex/respiratory viral panel (RVP)
▪ Not applicable (no pediatric testing)
8b. Which influenza test method does the laboratory
perform most frequently for adult patients (aged ≥18
years)? (Select one)
▪ Viral culture Indirect fluorescent antibody
(IFA)/direct fluorescent antibody stain (DFA)
▪ Rapid influenza antigen diagnostic test (rapid test,
RIDT)
▪ Rapid Molecular assay (e.g. RT-PCR, NAAT) –
singleplex (influenza only)
▪ Rapid Molecular assay (e.g. RT-PCR, NAAT) –
dualplex (influenza/RSV)
▪ Standard Molecular assay (e.g. RT-PCR, NAAT) –
singleplex (influenza only)
▪ Standard Molecular assay (e.g. RT-PCR, NAAT) –
dualplex (influenza/RSV)
▪ Standard Molecular assay (e.g. RT-PCR, NAAT) –
multiplex/respiratory viral panel (RVP)
▪ Not applicable (no pediatric testing)
9. Based on tests that were performed during the 2017-19
influenza season, approximately what percent of the time
are each of these test types used to test for flu overall?
(Answers should add to 100%)
▪ % Viral culture
▪ % Indirect fluorescent antibody stain (IFA)/direct
fluorescent antibody stain (DFA)
▪ % Rapid influenza antigen diagnostic test (rapid
test, RIDT)
▪ % Rapid Molecular assay (e.g. RT-PCR, NAAT) –
singleplex (influenza only)
▪ % Rapid Molecular assay (e.g. RT-PCR, NAAT) –
dualplex (influenza/RSV)
▪ % Standard Molecular assay (e.g. RT-PCR,
NAAT) – singleplex (influenza only)
▪ % Standard Molecular assay (e.g. RT-PCR,
NAAT) – dualplex (influenza/RSV)
▪ % Standard Molecular assay (e.g. RT-PCR,
NAAT) – multiplex/respiratory viral panel (RVP)

7a. Which influenza test method does the laboratory
perform most frequently for pediatric patients (aged 0-17
years)? (Select one)
▪ Viral culture Indirect fluorescent antibody
(IFA)/direct fluorescent antibody stain (DFA)
▪ Rapid influenza diagnostic test (rapid test, RIDT)
▪ Rapid Molecular assay – singleplex or dualplex
▪ Standard Molecular assay (e.g. RT-PCR, NAAT) –
singleplex or duplex
▪ Standard Molecular assay (e.g. RT-PCR, NAAT) –
multiplex/respiratory viral panel (RVP)
▪ Not applicable (no pediatric testing)

7b. Which influenza test method does the laboratory
perform most frequently for adult patients (aged ≥18
years)? (Select one)
▪ Viral culture Indirect fluorescent antibody
(IFA)/direct fluorescent antibody stain (DFA)
▪ Rapid influenza diagnostic test (rapid test, RIDT)
▪ Rapid Molecular assay – singleplex or dualplex
▪ Standard Molecular assay (e.g. RT-PCR, NAAT) –
singleplex or duplex
▪ Standard Molecular assay (e.g. RT-PCR, NAAT) –
multiplex/respiratory viral panel (RVP)
▪ Not applicable (no pediatric testing)

8. Based on tests that were performed during the 2018-19
influenza season, approximately what percent of the time
are each of these test types used to test for flu overall?
▪
▪
▪
▪
▪
▪

% Viral culture
% Indirect fluorescent antibody stain (IFA)/direct
fluorescent antibody stain (DFA)
% Rapid influenza diagnostic test (rapid test,
RIDT)
% Rapid Molecular assay – singleplex or dualplex
% Standard Molecular assay (e.g. RT-PCR,
NAAT) – singleplex or dualplex
% Standard Molecular assay (e.g. RT-PCR,
NAAT) – multiplex/respiratory viral panel (RVP)

13a. Select the kit name(s) (manufacturer for the RSV rapid
antigen detection test(s) performed at the laboratory:
▪
▪
▪
▪

BinaxNOW® RSV Card (Alere Scarborough, Inc.)
Clearview® RSV (Alere Scarborough, Inc.)
QuickVue RSV Test (Quidel Corp.)
Sofia RSV FIA (Quidel Corp.) Directigen™ EZ
RSV Kit (Becton-Dickinson & Co.) TRU RSV®
Kit (Meridian Bioscience, Inc.)
▪ RAMP™ Rapid Detection RSV Test Kit
(Response Biomedical Corp.)
▪ SAS™ RSVAlert (SA Scientific, Inc.)
▪ Xpect™ RSV Test (Remel Inc./Thermo Fisher
Scientific)
▪ BD Veritor System for Rapid Detection of RSV
(Becton-Dickinson & Co.)
▪ Other, specify
13b. If more than one kit is selected above, please select the
one kit that is (or will be) used most frequently for RSV
rapid antigen detection testing at the laboratory during the
current RSV season:
▪
▪
▪
▪

▪
▪
▪
▪
▪

BinaxNOW® RSV Card (Alere Scarborough, Inc.)
Clearview® RSV (Alere Scarborough, Inc.)
QuickVue RSV Test (Quidel Corp.)
Sofia RSV FIA (Quidel Corp.) Directigen™ EZ
RSV Kit (Becton-Dickinson & Co.) TRU RSV®
Kit (Meridian Bioscience, Inc.)
RAMP™ Rapid Detection RSV Test Kit
(Response Biomedical Corp.)
SAS™ RSVAlert (SA Scientific, Inc.)
Xpect™ RSV Test (Remel Inc./Thermo Fisher
Scientific)
BD Veritor System for Rapid Detection of RSV
(Becton-Dickinson & Co.)
Other, specify

12a. Select the kit name(s) (manufacturer) for the RSV
rapid antigen detection test(s) performed at the laboratory:
▪
▪
▪
▪
▪
▪
▪

BinaxNOW® RSV Card (Abott)
Clearview® RSV (Alere Scarborough, Inc.)
QuickVue RSV Test (Quidel Corp.)
Sofia RSV FIA (Quidel Corp.) Directigen™
EZ RSV Kit (Becton-Dickinson & Co.)
TRU RSV® Kit (Meridian Bioscience, Inc.)
RAMP™ Rapid Detection RSV Test Kit
(Response Biomedical Corp.)
▪ SAS™ RSVAlert (SA Scientific, Inc.)
▪ Xpect™ RSV Test (Remel Inc./Thermo Fisher
Scientific)
▪ BD Veritor System for Rapid Detection of RSV
(Becton-Dickinson & Co.)
▪ Other, specify
12b. If more than one kit is selected above, please select the
one kit that is (or will be) used most frequently for RSV
rapid antigen detection testing at the laboratory during the
current RSV season:
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪
▪

BinaxNOW® RSV Card (Abott)
Clearview® RSV (Alere Scarborough, Inc.)
QuickVue RSV Test (Quidel Corp.)
Sofia RSV FIA (Quidel Corp.) Directigen™
EZ RSV Kit (Becton-Dickinson & Co.)
TRU RSV® Kit (Meridian Bioscience, Inc.)
RAMP™ Rapid Detection RSV Test Kit
(Response Biomedical Corp.)
SAS™ RSVAlert (SA Scientific, Inc.)
Xpect™ RSV Test (Remel Inc./Thermo Fisher
Scientific)
BD Veritor System for Rapid Detection of RSV
(Becton-Dickinson & Co.)
Other, specify

14a. Select kit name(s) (manufacturer) for all molecular
assays used at the laboratory:
▪ ARIES® Flu A/B & RSV Assay (Luminex)
▪ Alere™ i RSV (Alere)
▪ Cepheid Xpert Flu/RSV XC Assay (Cepheid)
▪ Cobas® Liat® Influenza A/B and RSV Assay
(Roche Molecular Systems, Inc.)
▪ eSensor® Respiratory Viral Panel (RVP)
(GenMark Diagnostics)
▪ FilmArray Respiratory Panel (BioFire Diagnostics
LLC)
▪ IMDx Flu A/B and RSV for Abbott m2000
(IMDx)
▪ Prodesse PROFLU™+ (GenProbe/Hologic)
▪ Simplexa™ Flu A/B & RSV (Focus Diagnostics,
3M)
▪ Simplexa™ Flu A/B & RSV Direct (Focus
Diagnostics, 3M)
▪ Verigene® Respiratory Virus Nucleic Acid Test
(Nanosphere, Inc)
▪ Verigene® Respiratory Virus Plus Nucleic Acid
Test (RV+) (Nanosphere, Inc)
▪ Verigene® Respiratory Pathogen Nucleic Acid
Test (RP Flex) (Nanosphere, Inc)
▪ x-TAG® Respiratory Viral Panel (RVP) (Luminex
Molecular Diagnostics Inc)
▪ x-TAG® Respiratory Viral Panel Fast (RVP
FAST) (Luminex Molecular Diagnostics Inc)
▪ In-house developed PCR assay
▪ CDC Respiratory Syncytial Virus Real-Time RTPCR Assay
▪ Other, specify

13a. Select kit name(s) (manufacturer) for all molecular
assays used at the laboratory
▪ ARIES® Flu A/B & RSV Assay (Luminex)
▪ Alere™ i RSV (Alere) Cepheid Xpert Flu/RSV
XC Assay (Cepheid)
▪ Cepheid Xpert Xpress Flu/RSV Assay (Cepheid)
▪ Cobas® Liat® Influenza A/B and RSV Assay
(Roche Molecular Systems, Inc.)
▪ eSensor® Respiratory Viral Panel (RVP)
(GenMark Diagnostics)
▪ FilmArray Respiratory Panel (BioFire Diagnostics
LLC)
▪ FilmArray Respiratory Panel EZ (BioFire
Diagnostics LLC) IMDx Flu A/B and RSV for
Abbott m2000 (IMDx)
▪ Prodesse PROFLU™+ (GenProbe/Hologic)
▪ Simplexa™ Flu A/B & RSV (Focus Diagnostics,
3M)
▪ Simplexa™ Flu A/B & RSV Direct (Focus
Diagnostics, 3M)
▪ Verigene® Respiratory Virus Nucleic Acid Test
(Luminex)
▪ Verigene® Respiratory Virus Plus Nucleic Acid
Test (RV+) (Luminex)
▪ Verigene® Respiratory Pathogen Nucleic Acid
Test (RP Flex) (Luminex)
▪ x-TAG® Respiratory Viral Panel Fast (RVP
FAST) (Luminex Molecular Diagnostics Inc)
▪ In-house developed PCR assay
▪ CDC Respiratory Syncytial Virus Real-Time RTPCR Assay
▪ Other, specify

14b. If more than one kit is selected above, please select the
one kit that is (or will be) used most frequently for
molecular assays at the laboratory during the current RSV
season:
▪ ARIES® Flu A/B & RSV Assay (Luminex)
▪ Alere™ i RSV (Alere)
▪ Cepheid Xpert Flu/RSV XC Assay (Cepheid)
▪ Cobas® Liat® Influenza A/B and RSV Assay
(Roche Molecular Systems, Inc.)
▪ eSensor® Respiratory Viral Panel (RVP)
(GenMark Diagnostics)
▪ FilmArray Respiratory Panel (BioFire Diagnostics
LLC)
▪ IMDx Flu A/B and RSV for Abbott m2000
(IMDx)
▪ Prodesse PROFLU™+ (GenProbe/Hologic)
▪ Simplexa™ Flu A/B & RSV (Focus Diagnostics,
3M)
▪ Simplexa™ Flu A/B & RSV Direct (Focus
Diagnostics, 3M)
▪ Verigene® Respiratory Virus Nucleic Acid Test
(Nanosphere, Inc)
▪ Verigene® Respiratory Virus Plus Nucleic Acid
Test (RV+) (Nanosphere, Inc)
▪ Verigene® Respiratory Pathogen Nucleic Acid
Test (RP Flex) (Nanosphere, Inc)
▪ x-TAG® Respiratory Viral Panel (RVP) (Luminex
Molecular Diagnostics Inc)
▪ x-TAG® Respiratory Viral Panel Fast (RVP
FAST) (Luminex Molecular Diagnostics Inc)
▪ In-house developed PCR assay
▪ CDC Respiratory Syncytial Virus Real-Time RTPCR Assay
▪ Other, specify

13b. If more than one kit is selected above, please select the
one kit that is (or will be) used most frequently for
molecular assays at the laboratory during the current RSV
season:
▪ ARIES® Flu A/B & RSV Assay (Luminex)
▪ Alere™ i RSV (Alere) Cepheid Xpert Flu/RSV
XC Assay (Cepheid)
▪ Cepheid Xpert Xpress Flu/RSV Assay (Cepheid)
▪ Cobas® Liat® Influenza A/B and RSV Assay
(Roche Molecular Systems, Inc.)
▪ eSensor® Respiratory Viral Panel (RVP)
(GenMark Diagnostics)
▪ FilmArray Respiratory Panel (BioFire Diagnostics
LLC)
▪ FilmArray Respiratory Panel EZ (BioFire
Diagnostics LLC) IMDx Flu A/B and RSV for
Abbott m2000 (IMDx)
▪ Prodesse PROFLU™+ (GenProbe/Hologic)
▪ Simplexa™ Flu A/B & RSV (Focus Diagnostics,
3M)
▪ Simplexa™ Flu A/B & RSV Direct (Focus
Diagnostics, 3M)
▪ Verigene® Respiratory Virus Nucleic Acid Test
(Luminex)
▪ Verigene® Respiratory Virus Plus Nucleic Acid
Test (RV+) (Luminex)
▪ Verigene® Respiratory Pathogen Nucleic Acid
Test (RP Flex) (Luminex)
▪ x-TAG® Respiratory Viral Panel Fast (RVP
FAST) (Luminex Molecular Diagnostics Inc)
▪ In-house developed PCR assay
▪ CDC Respiratory Syncytial Virus Real-Time RTPCR Assay
▪ Other, specify

HAIC
10. 2020 MuGSI Case Report Form for Carbapenem-resistant Enterobacteriaceae (CRE) and Acinetobacter baumannii
(CRAB)

Question on 2019 form
Title: 2019 Carbapenem Resistant
Enterobacteriaceae (CRE)/ Carbapenem
Resistant A. baumannii (CRAB) Multi-site
Gram-Negative Surveillance Initiative
(MuGSI) Healthcare Associated Infection
Community Interface (HAIC) Case Report
10. ORGANISM:
Carbapenem-resistant:
□ Enterobacteriaceae (CRE)
□ Escherichia coli
□ Enterobacter cloacae
□ Klebsiella aerogenes
□ Klebsiella pneumoniae
□ Klebsiella oxytoca
□ A. baumannii (CRAB)

17. TYPES OF INFECTION ASSOCIATED
WITH CULTURE(S): (Check all that apply)
 None
 Unknown

Question on 2020 form
Title: 2020 Carbapenem Resistant Enterobacteriaceae
(CRE)/ Carbapenem Resistant A. baumannii (CRAB) Multisite Gram-Negative Surveillance Initiative (MuGSI)
Healthcare Associated Infection Community Interface
(HAIC) Case Report
(change in title)
10. ORGANISM:
□ CRE
□ CRAB
If CRE, select one of the following:
□ Escherichia coli
□ Enterobacter cloacae
□ Klebsiella aerogenes
□ Klebsiella pneumoniae
□ Klebsiella oxytoca
(change in formatting)
17a. TYPES OF INFECTION ASSOCIATED WITH
CULTURE(S): (Check all that apply)
 None
 Unknown
 Colonized
(adding the option to choose “colonized”
17b. RECURRENT UTI
 Yes
 No
 Unknown
(new question)
17c. WAS THE PATIENT TREATED FOR THE MUGSI
ORGANISM?
 Yes
 No
 Unknown
(new question)

18. UNDERLYING CONDITIONS: (Check
all that apply)
RENAL DISEASE
 Chronic kidney disease
Lowest serum creatinine: _______mg/DL

19 SUBSTANCE USE
OTHER SUBSTANCES: (Check all that
apply)
 Cocaine or methamphetamine

18. UNDERLYING CONDITIONS: (Check all that apply)
RENAL DISEASE
 Chronic kidney disease
Lowest serum creatinine: _______mg/DL
 Unknown or not done
(Added an option for “Unknown or not done”)
19. SUBSTANCE USE
OTHER SUBSTANCES: (Check all that apply)
 Opioid, NOS
(new check box)
 Cocaine
 Methamphetamine
(split out cocaine and methamphetamine)
During the current hospitalization did the patient receive
medication assisted treatment (MAT) for opioid use
disorder?
 Yes  No  N/A (patient not hospitalized or did not have
DUD

24c. IF TESTED, WHAT WAS THE
TESTING RESULT?
Molecular Test Results:
□ NDM
□ KPC
□ OXA
□ OXA-48
□ VIM
□ IMP

(New question)
24c. IF TESTED, WHAT WAS THE TESTING RESULT?
Molecular Test Results:
□ NDM
□ KPC
□ OXA
□ OXA-48
□ VIM
□ IMP
□ Other (specify):
(added other specify check box)
31d. DATE OF ABSTRACTION:
___ ___ - ___ ___ - ___ ___ ___ ___

31d. COMMENTS:
__________________________________

(new question)
31e. COMMENTS:
__________________________________
(changed question number)

11.

2020 Multi-site Gram-Negative Surveillance Initiative (MuGSI)- Extended-Spectrum Beta-Lactamase-Producing
Enterobacteriaceae (ESBL)

Question on 2019 form
Title: 2019 Carbapenem Resistant Enterobacteriaceae (CRE)/
Carbapenem Resistant A. baumannii (CRAB) Multi-site Gram-Negative
Surveillance Initiative (MuGSI) Healthcare Associated Infection
Community Interface (HAIC) Case Report
17. TYPES OF INFECTION ASSOCIATED WITH CULTURE(S):
(Check all that apply)
 None
 Unknown

18. RECURRENT UTI

Question on 2020 form
Title: 2020 Extended-Spectrum Beta-Lactamase (ESBL)Producing Enterobacteriaceae Multi-site Gram-Negative
Surveillance Initiative (MuGSI) Healthcare Associated Infection
Community Interface (HAIC) Case Report
(change in title)
17a. TYPES OF INFECTION ASSOCIATED WITH
CULTURE(S): (Check all that apply)
 None
 Unknown
 Colonized
(adding the option to choose “colonized”)
17b. RECURRENT UTI
(changed question number)

19. UNDERLYING CONDITIONS: (Check all that apply)
RENAL DISEASE
 Chronic kidney disease
Lowest serum creatinine: _______mg/DL

19 SUBSTANCE USE
OTHER SUBSTANCES: (Check all that apply)
 Cocaine or methamphetamine

18. UNDERLYING CONDITIONS: (Check all that apply)
RENAL DISEASE
 Chronic kidney disease
Lowest serum creatinine: _______mg/DL
 Unknown or not done
(Changed question number, added an option for “Unknown or
not done”)
19. SUBSTANCE USE
OTHER SUBSTANCES: (Check all that apply)
 Opioid, NOS
(new check box)
 Cocaine
 Methamphetamine
(split out cocaine and methamphetamine)

During the current hospitalization did the patient receive
medication assisted treatment (MAT) for opioid use disorder?
 Yes  No  N/A (patient not hospitalized or did not have
DUD

21. RISK FACTORS: (Check all that apply)

(New question)
20. RISK FACTORS: (Check all that apply)

22a. WEIGHT

(Changed question number)
21a. WEIGHT

22b. HEIGHT

(Changed question number)
21b. HEIGHT

22c. BMI

(Changed question number)
21c. BMI

23. RECORD THE COLONY COUNT:

(Changed question number)
22. RECORD THE COLONY COUNT:

(Changed question number)
24. SIGNS AND SYMPTOMS ASSOCIATED WITH URINE
CULTURE:

23. SIGNS AND SYMPTOMS ASSOCIATED WITH URINE
CULTURE:
(Changed question number)
27d. DATE OF ABSTRACTION:
___ ___ - ___ ___ - ___ ___ ___ ___

27d. COMMENTS: __________________________________

12.

(New question)
27e. COMMENTS: __________________________________
(Changed question number)

2020 Invasive MRSA Infection Case Report Form
Questions on 2019 Form
29. RENAL DISEASE
 Chronic kidney disease
Lowest serum creatinine: _______mg/DL

30.
 Opioid, DEA
schedule I (e.g.,
heroin)
 Opioid, DEA
schedule II
(e.g.,
methadone,
oxycodone)

30.
 Cocaine or
methamphetamine

 Documented
use disorder
 Documented
use disorder

 Documented
use disorder

30.

31. Prior healthcare exposure(s)

 IDU  Skin
popping  NonIDU Unknown
 IDU  Skin
popping  NonIDU Unknown

 IDU  Skin
popping  NonIDU Unknown

Questions on 2020 Form
29. RENAL DISEASE
 Chronic kidney disease
Lowest serum creatinine: _______mg/DL
 Unknown or not done
(Added an option for “Unknown or not done”)
30. Was the patient homeless in the year before DISC?
 Yes  No  Unknown
(New question)
31.
 Opioid, DEA
 Documented
 IDU  Skin
schedule I (e.g.,
use disorder
popping  Nonheroin)
IDU Unknown
 Opioid, DEA
 Documented
 IDU  Skin
schedule II (e.g.,
use disorder
popping  Nonmethadone,
IDU Unknown
oxycodone)
 Opioid, NOS
 Documented
 IDU  Skin
use disorder
popping  NonIDU Unknown
(Updated question number, added question opioid, not otherwise
specified)
31.
 Cocaine
 Documented
 IDU  Skin
use disorder
popping  NonIDU Unknown

 Documented
 IDU  Skin
Methamphetamine use disorder
popping  NonIDU Unknown
(separated cocaine and methamphetamine)
31. During the current hospitalization did the patient receive
medication assisted treatment (MAT) for opioid use disorder?
 Yes  No  N/A (patient not hospitalized or did not have DUD
(New question)
32. Prior healthcare exposure(s)
(Updated question number)

32. Patient outcome
33. Was case identified through audit?
34. CRF Status
35. Does this case have recurrent MRSA disease?
36. Date reported to EIP site

33. Patient outcome
(Updated question number)
34. Was case identified through audit?
(Updated question number)
35. CRF status
(Updated question number)
36 Does this case have recurrent MRSA disease?
(Updated question number)
37. Date reported to EIP site
(Updated question number)
38. Date of abstraction: ___-___-_______
(New question)
39. S.O. Initials
____________
(Updated question number)
40. Comments:
(Updated question number)

37. S.O. Initials:
__________
38. Comments:
13. 2020 Invasive MSSA Infections Case Report Form
Questions on 2019 Form
29. RENAL DISEASE
 Chronic kidney disease
Lowest serum creatinine: _______mg/DL

30.

30.
 Opioid, DEA
schedule I (e.g.,
heroin)
 Opioid, DEA
schedule II (e.g.,
methadone,
oxycodone)

 Documented
use disorder
 Documented
use disorder

 IDU  Skin
popping  NonIDU Unknown
 IDU  Skin
popping  NonIDU Unknown

Questions on 2020 Form
29. RENAL DISEASE
 Chronic kidney disease
Lowest serum creatinine: _______mg/DL
 Unknown or not done
(Added an option for “Unknown or not done”)
30. Was the patient homeless in the year before DISC?
 Yes  No  Unknown
(New question)
31.
 Opioid, DEA
 Documented
 IDU  Skin
schedule I (e.g.,
use disorder
popping  Nonheroin)
IDU Unknown
 Opioid, DEA
 Documented
 IDU  Skin
schedule II (e.g.,
use disorder
popping  Nonmethadone,
IDU Unknown
oxycodone)
 Opioid, NOS
 Documented
 IDU  Skin
use disorder
popping  NonIDU Unknown
(Updated question number, added question opioid, not otherwise
specified)

30.
 Cocaine or
methamphetamine


Documented
use disorder

 IDU  Skin
popping  NonIDU Unknown

31.
 Cocaine
 Methamphetamine

30.


Documented
use disorder

Documented
use disorder

 IDU  Skin
popping  NonIDU Unknown
 IDU  Skin
popping  NonIDU Unknown

(separated cocaine and methamphetamine)
31. During the current hospitalization did the patient receive
medication assisted treatment (MAT) for opioid use disorder?
 Yes  No  N/A (patient not hospitalized or did not have DUD

31. Prior healthcare exposure(s)
32. Patient outcome
33. Was case identified through audit?
34. CRF Status
35. Does this case have recurrent MSSA disease?
36. Date reported to EIP site

37. S.O. Initials:
__________
38. Comments:

(New question)
32. Prior healthcare exposure(s)
(Updated question number)
33. Patient outcome
(Updated question number)
34. Was case identified through audit?
(Updated question number)
35. CRF status
(Updated question number)
36 Does this case have recurrent MSSA disease?
(Updated question number)
37. Date reported to EIP site
(Updated question number)
38. Date of abstraction: ___-___-_______
(New question)
39. S.O. Initials
____________
(Updated question number)
40. Comments:
(Updated question number)

14. 2020 CDI Case Report and Treatment Form
Question on 2019 Form

Question on 2020 Form

9. Positive diagnostic assay for C.diff (Check all that apply)
□ EIA
□ Culture
□ GDH
□ Cytotoxin
□ NAAT
□ Other (specify) ____________
Unknown

9. Diagnostic assay for C.diff
9a. EIA
□ Positive
□ Negative
□ Not tested
9b. GDH
□ Positive
□ Negative
□ Not tested
9c. Cytotoxin
□ Positive
□ Negative
□ Not tested
9d. NAAT (C. diff only)
□ Positive
□ Negative
□ Not tested
9e. NAAT (GI panel)
□ Positive
□ Negative
□ Not tested
9.e.1 If positive, was result suppressed?
□ Yes
□ No
□ Unknown
9f. Other (specify): ___________
□ Positive
□ Negative
□ Not tested

[21. Underlying conditions]
Renal disease
□ Chronic kidney disease
Lowest serum creatinine:
_______________________mg/DL

[23c. Other substances]
[not on 2019 CRF]

[23c. Other substances]
□ Cocaine or methamphetamine
□ DUD or abuse
□IDU □Skin popping □Non-IDU
□Unknown

[not on 2019 CRF]

[not on 2019 CRF]

39. Comments

15. 2020 HAIC Candidemia Case Report

(split out each option into positive/negative/not tested,
assigned a question number to each assay, split out
NAAT into C. diff only tests and GI panel tests, added
question about suppression of GI panel results, re-ordered
response options, removed culture as an option)
[21. Underlying conditions]
Renal disease
□ Chronic kidney disease
Lowest serum creatinine:
_______________________mg/DL
□ Unknown or not done
(added option for unknown or not done)
[23c. Other substances]
□ Opioid, NOS
□ DUD or abuse
□IDU □Skin popping □Non-IDU □Unknown
[23c. Other substances]
□ Cocaine
□ DUD or abuse
□IDU □Skin popping □Non-IDU □Unknown
□ Methamphetamine
□ DUD or abuse
□IDU □Skin popping □Non-IDU □Unknown
(Split into two questions)
[23c. Other substances]
During the current hospitalization, did the patient receive
medication assisted treatment (MAT) for opioid use
disorder?
□ Yes □ No □ N/A (patient not hospitalized or did
not have DUD)
(new question)
39. Date of abstraction
__ __ / __ __ / __ __ __ __
(new question)
40. Comments
(updated question number)

Questions from 2019
26. Additional non-Candida organisms isolated from blood
cultures in the 7 days before the DISC:
1 Yes 0 No 9 Unknown

27. Any subsequent positive Candida blood cultures in the 30
days after the DISC? 1 Yes 0 No 9 Unknown

28. Documented negative Candida blood culture in the 30 days
after the DISC? 1 Yes 0 No 9 Unknown

29. Did the patient have any of the following types of
infection/colonization related to their Candida infection?
(check all that apply):
None
Unknown
Abscess
Splenic
Liver
Pulmonary
Candiduria
CNS involvement (meningitis, brain abscess)
Eyes (endophthalmitis or chorioretinitis)
Endocarditis
Peritonitis
Respiratory specimen with Candida
Septic emboli
Lungs
Brain
Osteomyelitis
Skin lesions
Other (specify): _____________________

Questions from 2020
26. Additional non-Candida organisms isolated from
blood cultures on the day of or in the 6 days before the
DISC:
1 Yes 0 No 9 Unknown
(Updated timeframe wording to be clearer)
28. Any subsequent positive Candida blood cultures in
the 29 days after, not including the DISC?
1 Yes 0 No 9 Unknown
(Updated timeframe wording to be clearer)
29. Documented negative Candida blood culture on the
day of or in the 29 days after the DISC?
1 Yes 0 No 9 Unknown
(Updated timeframe wording to be clearer)
30. Did the patient have any of the following types of
infection/colonization related to their Candida
infection?
(check all that apply):
None
Unknown
Abscess
Splenic
Liver
Pulmonary
Other (specify): _____________
Candiduria
CNS involvement (meningitis, brain abscess)
Eyes (endophthalmitis or chorioretinitis)
Endocarditis
Peritonitis
Respiratory specimen with Candida
Septic emboli
Lungs
Brain
Osteomyelitis
Skin lesions
Other (specify): _____________________

36. Overnight stay in LTCF in the 90 days before the DISC: 1
Yes
0 No 9

(Added another option “Other, specify” under the
heading of Abscess)
37. Previous Hospitalization in the 90 days before, not
including the DISC: 1 Yes 0 No 9
Unknown
(Updated timeframe wording to be clearer)
38. Overnight stay in LTACH in the 90 days before, not
including the DISC: 1 Yes 0 No 9
Unknown
(Updated timeframe wording to be clearer)
39. Overnight stay in LTCF in the 90 days before, not
including the DISC: 1 Yes 0 No 9

37. Underlying Conditions

(Updated timeframe wording to be clearer)
40. Underlying Conditions

34. Previous Hospitalization in the 90 days before the DISC: 1
Yes
0 No 9 Unknown

35. Overnight stay in LTACH in the 90 days before the DISC: 1
Yes
0 No 9 Unknown

Renal Disease
Chronic Kidney Disease
Lowest serum creatinine: ______________mg/DL

Renal Disease
Chronic Kidney Disease
Lowest serum creatinine: ______________mg/DL
Unknown or not done

(Added a checkbox for unknown lowest serum
creatinine)
40. Other Substances (Check all that apply):
 None
 Unknown
 Marijuana (other

 IDU  Skin
than smoking)
Documented popping  Nonuse disorder IDU Unknown
 Opioid, DEA

 IDU  Skin
schedule I (e.g.,
Documented popping  Nonheroin)
use disorder IDU Unknown
 Opioid, DEA

 IDU  Skin
schedule II-IV (e.g.,
Documented popping  Nonmethadone,
use disorder IDU Unknown
oxycodone)
 Cocaine or

 IDU  Skin
methamphetamine
Documented popping  Nonuse disorder IDU Unknown
 Other (Specify):

 IDU  Skin
Documented popping  Nonuse disorder IDU Unknown
 Unknown

 IDU  Skin
substance
Documented popping  Nonuse disorder IDU Unknown

NEW QUESTION

44. Surgeries in the 90 days before the DISC:
Abdominal surgery
Non-abdominal surgery (specify): __________________
No surgery

45. Pancreatitis in the 90 days before the DISC:
1 Yes
0 No

43. Other Substances (Check all that apply :)
 None
 Unknown
 Marijuana (other

 IDU  Skin
than smoking)
Documented popping  Nonuse disorder IDU Unknown
 Opioid, DEA

 IDU  Skin
schedule I (e.g.,
Documented popping  Nonheroin)
use disorder IDU Unknown
 Opioid, DEA

 IDU  Skin
schedule II-IV (e.g., Documented popping  Nonmethadone,
use disorder IDU Unknown
oxycodone)
 Opioid, NOS

 IDU  Skin
Documented popping  Nonuse disorder IDU Unknown
 Cocaine

 IDU  Skin
Documented popping  Nonuse disorder IDU Unknown
 Methamphetamine 
 IDU  Skin
Documented popping  Nonuse disorder IDU Unknown
 Other (Specify):

 IDU  Skin
Documented popping  Nonuse disorder IDU Unknown
 Unknown

 IDU  Skin
substance
Documented popping  Nonuse disorder IDU Unknown
(Added a new option, Opioid, NOS for instances where
the medical chart does not specify the exact Opioid;
Cocaine and Methamphetamines were separated out to
be different questions)
44. During the current hospitalization, did the patient
receive medication-assisted treatment (MAT) for opioid
use disorder?
1 Yes
0 No
8 N/A (patient not
hospitalized or did not have DUD)
9 Unknown
47. Surgeries on the day of or in the 89 days before the
DISC:
Abdominal surgery
Non-abdominal surgery (specify):
__________________
No surgery
(Updated timeframe wording to be clearer)
48. Pancreatitis on the day of or in the 89 days before
the DISC:
1 Yes
0 No
9 Unknown
(Updated timeframe wording to be clearer and added an
unknown option)

46a. If yes, did the patient have any urinary tract procedures in
the 90 days before the DISC?
1 Yes
0 No
9 Unknown

47. Was the patient neutropenic in the 2 calendar days before
the DISC?
1 Yes
0 No
9 Unknown (no WBC days -2 or 0,
or no differential)

48. Was the patient in an ICU in the 14 days before the DISC?
1 Yes
0 No
9 Unknown

50. Did the patient have a CVC in the 2 calendar days before the
DISC?
1 Yes
2 No
3 Had CVC but can’t find dates 9
Unknown

50b. Were all CVCs removed or changed in the 7 days after the
DISC?
1 Yes
2 No
3 CVC removed, but can’t find dates
5 Died or discharged before indwelling catheter replaced
9 Unknown

51. Did the patient have a midline catheter in the 2 calendar
days before the DISC?
1 Yes
0 No
9 Unknown

52. Did the patient have any of the following indwelling devices
present in the 3 calendar days before the DISC?
Urinary Catheter/Device
Indwelling urethral
Suprapubic
Respiratory
ET/NT
Tracheostomy
Gastrointestinal
Gastrostomy

53. Did the patient receive systemic antibacterial medication in
the 14 days before the DISC?
1 Yes 0 No 9 Unknown

49a. If yes, did the patient have any urinary tract
procedures on the day of or in the 89 days before the
DISC?
1 Yes
0 No
9 Unknown
(Updated timeframe wording to be clearer)
50. Was the patient neutropenic in the 2 calendar days
before, not including the DISC?
1 Yes
0 No
9 Unknown (no WBC days 2 or 0, or no differential)
(Updated timeframe wording to be clearer)
33. Was the patient in an ICU in the 14 days before, not
including the DISC?
1 Yes
0 No
9 Unknown
(Updated timeframe wording to be clearer)
51. Did the patient have a CVC in the 2 calendar days
before, not including the DISC?
1 Yes
2 No
3 Had CVC but can’t find
dates 9 Unknown
(Updated timeframe wording to be clearer)
51b. Were all CVCs removed or changed on the day of
or in the 6 days after the DISC?
1 Yes
2 No
3 CVC removed, but can’t find dates
5 Died or discharged before indwelling catheter
replaced
9 Unknown
(Updated timeframe wording to be clearer)
52. Did the patient have a midline catheter in the 2
calendar days before, not including the DISC?
1 Yes
0 No
9 Unknown
(Updated timeframe wording to be clearer)
53. Did the patient have any of the following indwelling
devices present in the 2 calendar days before, not
including the DISC?
None
Unknown
Urinary Catheter/Device
Indwelling urethral
Suprapubic
Respiratory
ET/NT
Tracheostomy
Gastrointestinal
Abdominal drain (specify): _________________
Gastrostomy
(Changed timeframe wording to be clearer, added a
none and unknown option for easier cleaning and
coding, added an option under gastrointestinal looking
at abdominal drains)
54. Did the patient receive systemic antibacterial
medication in the 14 days before, not including the
DISC?

1

Yes 0

No 9

Unknown

(Updated timeframe wording to be clearer)
54. Did the patient receive total parenteral nutrition (TPN) in the
14 days before the DISC?
1 Yes 0 No 9 Unknown

55. Did the patient receive total parenteral nutrition
(TPN) in the 14 days before, not including the DISC?
1 Yes 0 No 9 Unknown

55. Did the patient receive systemic antifungal medication in the
14 days before the DISC?
1 Yes (if Yes, fill out question 58)
0 No
9
Unknown

(Updated timeframe wording to be clearer)
56. Did the patient receive systemic antifungal
medication on the day of or in the 13 days before the
DISC?
1 Yes (if Yes, fill out question 58)
0 No
9
Unknown

56. Was the patient administered systemic antifungal medication
after the DISC?
1 Yes (if Yes, fill out question 58)
0 No
9
Unknown

(Updated timeframe wording to be clearer)
57. Was the patient administered systemic antifungal
medication after, not including the DISC?
1 Yes (if Yes, fill out question 58)
0 No
9
Unknown
(Updated timeframe wording to be clearer)

16. HAIC- Annual Survey of Laboratory Testing Practices for C. difficile Infections
Questions on 2019 Survey
Was this lab audited in 2018?

Questions on 2020 Survey
Was this lab audited in 2019?

2. What type and order of testing is routinely used by your
laboratory in standard testing for C. difficile?
(Enter letter from choices below; choose only one option for
each line of testing)

(Updated year referenced)
2. What type and order of testing is routinely used by your
laboratory in standard testing for C. difficile?
(Enter letter from choices below; choose only one option for
each line of testing)

1st line of testing: ________ 2nd line of testing: ________
3rd line of testing: ________
A. EIA Toxin A and B
B. EIA for Toxin A only
C. EIA for Toxin B only
D. EIA Antigen (GDH)
E. EIA Toxin A/B and Antigen (Simultaneous testing)
F. EIA Other
Specify other EIA type:
__________________________
G. Nucleic Acid Amplification (e.g. PCR, Illumigene,
Luminex)
H. Culture
I. Cytotoxin
J. Other
Specify other test type:
__________________________
K. No one routine test; clients can order from among
several tests

1st line of testing: ________ 2nd line of testing: ________
3rd line of testing: ________
A. EIA Toxin A and B
B. EIA for Toxin A only
C. EIA for Toxin B only
D. EIA Antigen (GDH)
E. EIA Toxin A/B and Antigen (Simultaneous testing)
F. EIA Other
Specify other EIA type:
__________________________
G. Nucleic Acid Amplification (e.g. PCR, Illumigene,
Luminex, Biofire)
H. Culture
I. Cytotoxin
J. Other
Specify other test type:
__________________________
K. No one routine test; clients can order from among
several tests

Specify types: __________________________
L. None

nd

2a. Which specimens are used during your 2 line of testing?
(Choose one)
⃝ Positive by the 1st line of testing
⃝ Negative by the 1st line of testing
⃝ Specimens with discordant results (e.g. EIA+/GDHor GDH+/EIA-)
⃝ All specimens
⃝ Do not use 2nd line of testing (go to question 3a)

2b. Which specimens are used during your 3rd line of testing?
(Choose one)
⃝ Positive by the 2nd line of testing
⃝ Negative by the 2nd line of testing
⃝ Specimens with discordant results (e.g. EIA+/GDHor GDH+/EIA-)
⃝ All specimens
⃝ Do not use 3rd line of testing (go to question 3a)
[Question did not exist]

Specify types: __________________________
L. None
(Added “Biofire” as an example to response option G)
2a. Which specimens are used during your 2nd line of testing?
(Choose one)
⃝ Positive by the 1st line of testing
⃝ Negative by the 1st line of testing
⃝ Specimens with discordant results (e.g. EIA+/GDHor GDH+/EIA-)
⃝ All specimens
⃝ Do not use 2nd line of testing
(removed “go to question 3a” from final response option)
2b. Which specimens are used during your 3rd line of testing?
(Choose one)
⃝ Positive by the 2nd line of testing
⃝ Negative by the 2nd line of testing
⃝ Specimens with discordant results (e.g. EIA+/GDHor GDH+/EIA-)
⃝ All specimens
⃝ Do not use 3rd line of testing
(removed “go to question 3a” from final response option)
2c. Does your laboratory perform any onsite testing for C.
difficile outside of your normal testing algorithm?

⃝ No, all onsite testing is done according to the testing algorithm
specified above
⃝ Yes, on physician request
Specify tests: __________________________
⃝ Other
Specify: __________________________

3b. Which Nucleic Acid Amplification test is currently used by
your laboratory? (Check all that apply)
□ BD-GeneOhm C. difficile
□ Cepheid Xpert C. difficile
□ Meridian Illumigene
□ Prodesse (Gen-Probe) Progastro CD
□ Luminex xTAG GPP
□ Biofire Filmarray GI Panel
□ Other
Specify other test: ____________________
□ N/A (Do not use nucleic acid amplification)

(New question)
3b. Which Nucleic Acid Amplification test is currently used
by your laboratory? (Check all that apply)
□ BD-GeneOhm C. difficile
□ BD MAX C. difficile
□ Cepheid Xpert C. difficile
□ Meridian Illumigene
□ Prodesse (Gen-Probe) Progastro CD
□ Luminex xTAG GPP
□ Biofire Filmarray GI Panel
□ Quidel AmpliVue C. difficile Assay
□ Great Basin Portrait Toxigenic C. difficile Assay
□ Nanosphere Verigene SP
□ Other
Specify other test: ____________________
□ N/A (Do not use nucleic acid amplification)
(Added response options)

3c. If your laboratory uses a multiplex PCR (e.g., Biofire
Filmarray GI Panel, Luminex xTAG GPP) to test for several GI
pathogens, does your laboratory suppress the result so that
clinicians cannot see it?
□ Yes
□ No
□ N/A (Do not use multiplex PCR)

[Question did not exist]

4a. If your laboratory uses a multiplexed molecular diagnostic
(e.g., Biofire Filmarray GI Panel, Luminex xTAG GPP) to
test for several GI pathogens, does your laboratory suppress
the C. diff result so that clinicians cannot see it?
□ Yes, always
□ Yes, at clinician request
□ Yes, but will release the result upon clinician request
□ Yes, sometimes
Specify: ______________
□ No, clinicians always see C. diff result
□ N/A (Do not use multiplexed molecular diagnostic)
(Changed wording of question and “No” and “N/A” response
options, expanded the “yes” response option for clarity, and
changed question number)
4b. If your laboratory uses a multiplexed diagnostic and the
result is suppressed, where does the suppression occur?
□ At the multiplexed molecular diagnostic instrument
level (the result is not entered into the laboratory
information management system (LIMS))
□ At the laboratory information management system
(LIMS) level
□ Other
Specify: ______________
□ N/A (Do not use multiplexed molecular diagnostic or
the result is never suppressed)

5a. (If yes) What was your previous type and order of testing?
(Enter letter from choices below; choose only one option for
each line of testing)

(New question)
5. What are the testing codes associated with the tests your lab
currently uses?
(Changed question number)
6. Has your lab testing algorithm for C. difficile changed since
January 1, 2019?
⃝ Yes
What date did this change occur? ______ / ______ /
______
⃝ No
(Changed question number and date referenced)
6a. (If yes) What was your previous type and order of testing?
(Enter letter from choices below; choose only one option for
each line of testing)

1st line of testing: ________ 2nd line of testing: ________
3 line of testing: ________
A. EIA Toxin A and B
B. EIA for Toxin A only
C. EIA for Toxin B only
D. EIA Antigen (GDH)
E. EIA Toxin A/B and Antigen (Simultaneous testing)
F. EIA Other

1st line of testing: ________ 2nd line of testing: ________
3 line of testing: ________
A. EIA Toxin A and B
B. EIA for Toxin A only
C. EIA for Toxin B only
D. EIA Antigen (GDH)
E. EIA Toxin A/B and Antigen (Simultaneous testing)
F. EIA Other

4. What are the testing codes associated with the tests your lab
currently uses?
5. Has your lab testing algorithm for C. difficile changed since
January 1, 2018?
⃝ Yes
What date did this change occur? ______ / ______ /
______
⃝ No

rd

rd

Specify other EIA type:
__________________________
G. Nucleic Acid Amplification (e.g. PCR, Illumigene,
Luminex)
H. Culture
I. Cytotoxin
J. Other
Specify other test type:
__________________________
K. No one routine test; clients can order from among
several tests
Specify types: __________________________
L. None

5b. Which specimens were used during your 2nd line of testing?

5c. Which specimens were used during your 3rd line of testing?

6. Does your lab have a policy to reject stool specimens for C.
difficile testing?
6a. Has your rejection policy for stool specimens changed since
January 1, 2018?
⃝ Yes
What date did this change occur?
______ / ______ / ______
Specify changes: __________________________
⃝ No

[Question did not exist]

Specify other EIA type:
__________________________
G. Nucleic Acid Amplification (e.g. PCR, Illumigene,
Luminex, Biofire)
H. Culture
I. Cytotoxin
J. Other
Specify other test type:
__________________________
K. No one routine test; clients can order from among
several tests
Specify types: __________________________
L. None
(Changed question number and added “Biofire” as an
example to response option G)
6b. Which specimens were used during your 2nd line of
testing?
(Changed question number)
6c. Which specimens were used during your 3rd line of
testing?
(Changed question number)
7. Does your lab have a policy to reject stool specimens for C.
difficile testing?
(Changed question number)
7a. Has your rejection policy for stool specimens changed
since January 1, 2019?
⃝ Yes
What date did this change occur?
______ / ______ / ______
Specify changes: __________________________
⃝ No
(Updated year referenced and question number)
8. How many stool samples did you test for C. diff each
month in 2019?
Month
January
February
March
April
May
June
July
August
September
October
November
December

Stool samples
tested

C. diff+ samples

7. Since your laboratory changed its testing algorithm for CDI
diagnosis in the past year and this may have had an impact in
the number of positive specimens, it is very important for us to
have information on the number of stool samples tested for C.
difficile and the number of stool samples positive for C.
difficile in the 3 months prior to and the 3 months following the
change in testing methodology.

(New question)
[Removed question]

17. HAIC- CDI Annual Surveillance Officers Survey
Questions on 2019 Survey
2. In 2018, did any laboratories drop out of participation?
3.

In 2018, did you identify any additional laboratories inside
or outside of your catchment area which identify C.diff
assays from persons who are residents of your catchment
area?

11. What software do you use for geocoding?

12. For each facility that treated a case in 2018, please provide
the following:
a. Facility ID or Provider ID as it appears on the
CRF
b. Type of facility (i.e. hospital inpatient, outpatient,
LTCF, LTACH, other). When possible, use the
CMS classification to determine type of facility
c. Either the state and county of the facility or an
indication of if the facility is in catchment or out
of catchment

Questions on 2020 Survey
2. In 2019, did any laboratories drop out of participation?
(Updated year referenced)
3. In 2019, did you identify any additional laboratories inside
or outside of your catchment area which identify C.diff
assays from persons who are residents of your catchment
area?
(Updated year referenced)
11. What application do you use for geocoding (e.g. ArcGIS
Pro, ArcMap, ArcGIS Online)?
12. Within this application, what geocoding tool do you use
(e.g, StreetMap Premium, Spacialitics Health Geocoder,
ArcGIS World Geocoding service, locally-created address
locator file)?
(Split into two questions, clarified the information we were
looking for in this question)
13. For each facility that treated a case in 2019, please provide
the following:
a. Facility ID or Provider ID as it appears on the
CRF
b. Type of facility (i.e. hospital inpatient, outpatient,
LTCF, LTACH, other). When possible, use the
CMS classification to determine type of facility
c. Either the state and county of the facility or an
indication of if the facility is in catchment or out
of catchment
(Updated year referenced, updated question number)

18. HAIC- Emerging Infections Program C. difficile Surveillance Nursing Home Telephone Survey (LTCF)
Questions on 2019 Survey
Speaking to correct person:
YES (proceed)
NO (go to question 3)
Record name and title:___________________
Phone number: _____________________
3. If NO,
Name of person and title:_______________________
Phone number:_______________________________
Best time to reach this person:___________________
1.

Is your facility a free-standing facility?
□ Yes

Questions on 2020 Survey
Speaking to correct person:
If YES,
Record name and title:___________________
Phone number: _____________________
If NO,
Name of person and title:_______________________
Phone number:_______________________________
Best time to reach this person:___________________
(Combined questions on the form, removed numbering)
[Removed question]

□ No, which hospital is your facility affiliated with?
_______________
2. Do you collect stool specimens in the facility to be sent for
Clostridioides difficile testing?
□ YES

1. Do you collect stool specimens in the facility to be sent for
Clostridioides difficile testing?
□ YES □ NO

□ NO

If YES, Do you send all your stool specimens for C. diff testing
to a reference laboratory?
□ YES (what is the name of the reference lab:
______________________________)
□ No, please name the laboratories you send stool
specimens for C. diff testing?
Name: ________________________________
Phone number: ___________________________
Name: ________________________________
Phone number: ___________________________
Name: ________________________________
Phone number: ___________________________

2.

If YES, please name the laboratories to which you send
stool specimens for C. diff testing:

Name: ________________________________
Phone number: ___________________________
Name: ________________________________
Phone number: ___________________________
Name: ________________________________
Phone number: ___________________________

(Removed sub-question about reference laboratory, renumbered question, rephrased question about where labs send
stools for testing)

19. HAIC- Invasive Staphyloccus aureus Laboratory Survey: Use of Nucleic Acid Amplification Testing (NAAT)
Questions on 2019 Survey
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__________
□ 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 ________________
□ Other, Lab Developed Test (detects MRSA or SA)… Date
started ____________________
□ Other commercial test, Specify_______...Date
started__________

Questions on 2020 Survey
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__________
□ 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 for sterile site cultures] Do
you still obtain an isolate for S. aureus or MRSA?
□ Yes □ No - GO to Q3

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

20. HAIC- Invasive Staphylococcus aureus Supplemental Surveillance Officers Survey
Question on 2019 Survey

Question on 2020 Survey
Section: Surveillance Area Characteristics
4a: If yes, what mechanism did you have in place that 2. Is MSSA reportable at your site?
allowed for SOs to have access to MSSA case counts
_______ yes
_______ no
and medical records?
_______MSSA is a reportable condition
(split question 4a into two parts)
_______ Agent of the state
_______ State Health Department Regulation
_______ Other, please explain:
__________________________________
2ai. If yes: What is your reportable definition of MSSA?
_______ All invasive MSSA statewide
_______ Invasive MSSA in residents among defined catchment
area
_______ Healthcare-associated invasive MSSA infection
_______ Other, please define:
___________________________________
(new question)
2aii: Is isolate submission to the State Health Department
Laboratory required?
_______ yes
_______ no

4a: If yes, what mechanism did you have in place that
allowed for SOs to have access to MSSA case counts
and medical records?
_______MSSA is a reportable condition
_______ Agent of the state
_______ State Health Department Regulation
_______ Other, please explain:
__________________________________

(new question)
2bi: If no: what mechanism do you have in place that allows for
SOs to have access to MSSA case counts and medical records?
_______ Agent of the state
_______ State Health Department Regulation
_______ Other, please explain:
__________________________________
(split question 4a into two parts)
2bii: If no, does your state/site plan to make MSSA reportable?
______yes _______no

2. Did your site send MRSA/MSSA isolates to CDC
for characterization in 2017? ___yes ____no

(new question)
3. Did your site send MRSA/MSSA isolates to CDC for
characterization in 2019? ___yes ____no

2a. If yes, how were isolates selected?

(updated question number)
3a. If yes, how were isolates selected?
(updated question number)
3b. If yes, how many isolates did you expect to be able to collect
from clinical labs?
_____ MRSA, _____ MSSA

(new question)
3c. If yes, what was the total number of isolates collected from
clinical labs?
_______ MRSA, _______ MSSA
(new question)
4. Did your site participate in MSSA surveillance in
2018? _______ yes
_______ no
(deleted)
4b. If yes, please complete the date range for which
MSSA surveillance was conducted as well as the
catchment area:
2018
Dates of MSSA
surveillance
Catchment area

(deleted)
3. How does your site complete SA case report forms
(please select all that apply)?
_______On a computer or tablet
_______With paper and pen
_______Other, please explain:
________________________________

4. How does your site complete SA case report forms (please
select all that apply)?
_______On a computer or tablet
_______With paper and pen
_______Other, please explain:
________________________________

(updated question number)
Section: Lab Participation and Case Finding
1. Please list the total number of each type of lab
1. Please list the total number of each type of lab serving your
serving your MRSA surveillance catchment area
MRSA surveillance catchment area (both inside and outside of the
(both inside and outside of the catchment area):
catchment area) and the total number of each type of lab
participating (i.e., submit test results when available) in
Inside Outsi
surveillance (both inside and outside the catchment area):
catch
de
ment
catch
Inside
Outside
area
ment
catchment
catchment
area
area
area
Hospital laboratories
Se Partic Se Partic
rve ipate rve ipate
Dialysis referral
laboratories
Hospital laboratories
Commercial/outpatient
Dialysis referral
laboratories*
laboratories
Other; please
Commercial/outpatient
specify:________________
laboratories*
_______________
Other; please
Total number (Add above
specify:_______________
together)
________________
*For the purpose of the survey, we are defining
Total number (Add above
“Commercial/Outpatient Laboratories” as any
together)
for profit laboratory, not including dialysis
*For the purpose of the survey, we are defining
referral laboratories, that serve health care
“Commercial/Outpatient Laboratories” as any for profit
facilities in a given surveillance catchment area.
laboratory, not including dialysis referral laboratories, that
Examples include LabCorp and Quest.
serve health care facilities in a given surveillance catchment
area. Examples include LabCorp and Quest.

2. Please list the total number of each type of lab

(updated question wording and response formatting)
2. If different catchment than MRSA, please list the total number

serving your MSSA surveillance catchment area if
different catchment than MRSA (both inside and
outside of the catchment area):
Inside Outsi
catch
de
ment
catch
area
ment
area
Hospital laboratories
Dialysis referral
laboratories
Commercial/outpatient
laboratories*
Other; please
specify:________________
_______________
Total number (Add above
together)
*For the purpose of the survey, we are defining
“Commercial/Outpatient Laboratories” as any
for profit laboratory, not including dialysis
referral laboratories, that serve health care
facilities in a given surveillance catchment area.
Examples include LabCorp and Quest.

of each type of lab serving your MSSA surveillance catchment
area (both inside and outside of the catchment area) and the total
number of each type of lab participating (i.e., submit test results
when available) in surveillance (both inside and outside the
catchment area)::
Inside
Outside
catchment
catchment
area
area
Se Partic Se Partic
rve ipate rve ipate
Hospital laboratories
Dialysis referral
laboratories
Commercial/outpatient
laboratories*
Other; please
specify:_______________
________________
Total number (Add above
together)
*For the purpose of the survey, we are defining
“Commercial/Outpatient Laboratories” as any for profit
laboratory, not including dialysis referral laboratories, that
serve health care facilities in a given surveillance catchment
area. Examples include LabCorp and Quest.

(updated question wording and response formatting)
Section: Data Edits
2. Did your site have any challenges completing the CRF reabstractions? _______ yes
_______ no
(new question)
2a. If yes, please describe
(new question)
Section: Ascertainment of Surveillance Area and Case Audits
3d. How many laboratories did you audit in 2019?
(new question)
4. In 2019, did your site update its inventory of facilities within
the EIP catchment area? _______ yes_______ no
(new question)
4a. If no, why not?
(new question)
4b. If yes, how many facilities serve the catchment area?

4. Does your site perform routine ascertainment* of
the surveillance area?
*“Case ascertainment” should include
ongoing attempts to identify new or
additional laboratories inside and outside of
your defined catchment area which may be

(new question)
4c. If yes, how many facilities have you identified a clinical
laboratory for?
(new question)
5. Does your site perform routine ascertainment* of the
surveillance area?
*“Case ascertainment” should include ongoing attempts
to identify new or additional laboratories inside and
outside of your defined catchment area which may be
processing specimens for surveillance area residents.

processing specimens for surveillance area
residents.
_______ yes
_______ no
a. If yes, how does your site assess case
ascertainment* methods?
(examples include: physician surveys, LTCF surveys,
outreach to new dialysis centers, etc…).

_______ yes

_______ no

a. If yes, how does your site assess case ascertainment* methods?
(examples include: physician surveys, LTCF surveys, outreach to
new dialysis centers, etc…).
b. If yes, how often is this performed? When was this last
performed?

b. If yes, how often is this performed? When was this
last performed?

(updated question number)

5. Are there specific labs that you have difficulty
obtaining line lists from?
_______ yes
_______ no
a. If yes, what types of labs?

6. Are there specific labs that you have difficulty obtaining line
lists from?
_______ yes
_______ no
a. If yes, what types of labs?

6. Does your site have checks in place to recognize
decreasing/increasing case counts or rates of MRSA
disease?
_______ yes
_______ no
a. If yes, please describe the check(s) that
you use
b. If yes, how often are the check(s) used?
c. If yes, do you plan to use these for
MSSA once more surveillance data are
available?
_______ yes
_______
no

1.

(updated question number)
7. Does your site have checks in place to recognize
decreasing/increasing case counts or rates of MRSA disease?
_______ yes
_______ no
a. If yes, please describe the check(s) that you use
b. If yes, how often are the check(s) used?
c. If yes, do you plan to use these for MSSA once
more surveillance data are available?
_______
yes
_______ no
(updated question number)

Section: CDC Responsibilities
CDC staff are responsive to
2. CDC staff are responsive to questions/concerns/emails (e.g.,
questions/concerns/emails (e.g., Valerie
Davina Campbell, Runa Gokhale, Kelly Jackson, Isaac See,
Albrecht, Kelly Jackson, Isaac See, and Shirley
and Shirley Zhang).
Zhang).
_______ Strongly agree
_______ Strongly agree
_______ Agree
_______ Agree
_______ Neutral
_______ Neutral
_______ Disagree
_______ Disagree
_______ Strongly disagree
_______ Strongly disagree
a. If you disagree or strongly disagree, please explain
and provide improvement suggestions:
a. If you disagree or strongly disagree,
please explain and provide
(Updated wording)
improvement suggestions:

21. HAIC- Laboratory Testing Practices for Candidemia Questionnaire
Questions on 2019 Survey
Title: 2019 LABORATORY TESTING
PRACTICES FOR CANDIDEMIA
QUESTIONNAIRE

Questions on 2020 Survey
Title: 2020 LABORATORY TESTING PRACTICES FOR
CANDIDEMIA QUESTIONNAIRE