The AHRQ Safety Program for Methicillin-Resistant Staphylococcus aureus (MRSA) Prevention

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 9.5 Attachment J - Subsequent data pull for 10% of units	Form and Instruction	New	Available
Form 9.5 Attachment J - Subsequent data pull for 10% of units	Form and Instruction	New	Repair queued
Form 17 Attachment Q: Survey of Patient Safety Culture—HSOPS V.2	Form and Instruction	New	Available
Form 17 Attachment Q: Survey of Patient Safety Culture-HSOPS V.2	Form and Instruction	New	Repair queued
Form 11 Attachment L: Clinical Outcomes Data for LTC	Form and Instruction	Modified	Available
Form 11 Attachment L: Clinical Outcomes Data for LTC	Form and Instruction	Modified	Available
Form 10 Attachment K: Clinical Outcomes Data for Surgical Services	Form and Instruction	Modified	Available
Form 10 Attachment K: Clinical Outcomes Data for Surgical Services	Form and Instruction	Modified	Repair queued
Form 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction	Unchanged	Available
Form 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction	Unchanged	Repair queued
Form 11 Attachment L: Clinical Outcomes Data for LTC	Form and Instruction	Modified	Available
Form 11 Attachment L: Clinical Outcomes Data for LTC	Form and Instruction	Modified	Repair queued
Form 10 Attachment K: Clinical Outcomes Data for Surgical Services	Form and Instruction	Modified	Available
Form 10 Attachment K: Clinical Outcomes Data for Surgical Services	Form and Instruction	Modified	Available
Form 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction	Unchanged	Available
Form 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction	Unchanged	Repair queued
Form 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction	Unchanged	Available
Form 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction	Unchanged	Repair queued
Form 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction	Unchanged	Available
Form 9 Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction	Unchanged	Repair queued
Form 8 Attachment G: LTC Team Checkup Tool	Form and Instruction	Unchanged	Available
Form 8 TEAM CHECK-UP TOOL – Long-Term Care (LTC)	Form and Instruction	Unchanged	Repair queued
Form 7 Attachment F: Surgical Services Team Checkup Tool	Form and Instruction	Unchanged	Available
Form 6 Attachment E: ICU/Non-ICU Team Checkup Tool	Form and Instruction	Unchanged	Available
Form 6 Team Checkup Tool	Form and Instruction	Unchanged	Repair queued
Form 5 Attachment D: LTC Gap Analysis	Form and Instruction	Unchanged	Available
Form 4 Attachment C: Surgical Services Gap Analysis	Form and Instruction	Unchanged	Available
Form 3 Attachment B: ICU/Non-ICU Gap Analysis	Form and Instruction	Unchanged	Available
Form 3 Gap Analysis	Form and Instruction	Unchanged	Repair queued
Form 2 2,500	Form and Instruction	Unchanged	Available
Form 2 Attachment I: Survey of Patient Safety Culture – NHSOPS	Form and Instruction	Unchanged	Repair queued
Form 1 Attachment H: Survey of Patient Safety Culture – HSOPS	Form and Instruction	Modified	Available
Form 1 Attachment H: Survey of Patient Safety Culture – HSOPS	Form and Instruction	Modified	Repair queued
SSA revised highlighted changes_22.05.17 - updates to HSOPS 22.06.16_mc.docx	Supporting Statement A	Uploaded 2022-10-18	Repair queued
SSB revised highlighted changes_22.05.17 - updates to HSOPS 6.15.22_mc.docx	Supporting Statement B	Uploaded 2022-10-18	Repair queued
Att P Schedule of Evaluation Activities.docx	Supplementary Document	Uploaded 2021-07-23	Repair queued
Att O Completion Guide for LTC Clinical Outcomes Data.docx	Supplementary Document	Uploaded 2021-07-23	Repair queued
Att N Completion Guide for Surgical Services Clinical Outcomes Data.docx	Supplementary Document	Uploaded 2021-07-23	Available
Att M Completion Guide for ICU-Non-ICU Clinical Outcomes Data.docx	Supplementary Document	Uploaded 2021-07-23	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
256475	Attachment J - Subsequent data pull for 10% of units	Form and Instruction	New	Attachment J - Subsequent data pull for 10% of units
256475	Attachment J - Subsequent data pull for 10% of units	Form and Instruction	New
256469	Attachment Q: Survey of Patient Safety Culture-HSOPS V.2	Form and Instruction	New	Attachment Q: Survey of Patient Safety Culture—HSOPS V.2
256469	Attachment Q: Survey of Patient Safety Culture-HSOPS V.2	Form and Instruction	New
248521	Attachment L: Clinical Outcomes Data for LTC	Form and Instruction	Modified	Attachment L: Clinical Outcomes Data for LTC
248521	Attachment L: Clinical Outcomes Data for LTC	Form and Instruction	Modified
248520	Attachment K: Clinical Outcomes Data for Surgical Services	Form and Instruction	Modified	Attachment K: Clinical Outcomes Data for Surgical Services
248520	Attachment K: Clinical Outcomes Data for Surgical Services	Form and Instruction	Modified
248519	Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction	Unchanged	Attachment J: Clinical Outcomes Data for ICU/Non-ICU
248519	Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction	Unchanged
248518	Attachment L: Clinical Outcomes Data for LTC	Form and Instruction	Modified	Attachment L: Clinical Outcomes Data for LTC
248518	Attachment L: Clinical Outcomes Data for LTC	Form and Instruction	Modified
248517	Attachment K: Clinical Outcomes Data for Surgical Services	Form and Instruction	Modified	Attachment K: Clinical Outcomes Data for Surgical Services
248517	Attachment K: Clinical Outcomes Data for Surgical Services	Form and Instruction	Modified
248516	Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction	Unchanged	Attachment J: Clinical Outcomes Data for ICU/Non-ICU
248516	Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction	Unchanged
248515	Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction	Unchanged	Attachment J: Clinical Outcomes Data for ICU/Non-ICU
248515	Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction	Unchanged
248507	Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction	Unchanged	Attachment J: Clinical Outcomes Data for ICU/Non-ICU
248507	Attachment J: Clinical Outcomes Data for ICU/Non-ICU	Form and Instruction	Unchanged
248495	TEAM CHECK-UP TOOL – Long-Term Care (LTC)	Form and Instruction	Unchanged	Attachment G: LTC Team Checkup Tool
248495	TEAM CHECK-UP TOOL – Long-Term Care (LTC)	Form and Instruction	Unchanged
248492	Team Checkup Tool	Form and Instruction	Unchanged	Attachment F: Surgical Services Team Checkup Tool
248492	Team Checkup Tool	Form and Instruction	Unchanged	Attachment E: ICU/Non-ICU Team Checkup Tool
248492	Team Checkup Tool	Form and Instruction	Unchanged
248491	Gap Analysis	Form and Instruction	Unchanged	Attachment D: LTC Gap Analysis
248491	Gap Analysis	Form and Instruction	Unchanged	Attachment C: Surgical Services Gap Analysis
248491	Gap Analysis	Form and Instruction	Unchanged	Attachment B: ICU/Non-ICU Gap Analysis
248491	Gap Analysis	Form and Instruction	Unchanged
248489	Attachment I: Survey of Patient Safety Culture – NHSOPS	Form and Instruction	Unchanged	2,500
248489	Attachment I: Survey of Patient Safety Culture – NHSOPS	Form and Instruction	Unchanged
248486	Attachment H: Survey of Patient Safety Culture – HSOPS	Form and Instruction	Modified	Attachment H: Survey of Patient Safety Culture – HSOPS
248486	Attachment H: Survey of Patient Safety Culture – HSOPS	Form and Instruction	Modified

ICR Details

OMB Control No: 0935-0260	ICR Reference No: 202209-0935-004
Status: Historical Active	Previous ICR Reference No: 202107-0935-003
Agency/Subagency: HHS/AHRQ	Agency Tracking No:
Title: The AHRQ Safety Program for Methicillin-Resistant Staphylococcus aureus (MRSA) Prevention
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/22/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/19/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2025	36 Months From Approved	08/31/2024
Responses	36,928	0	36,637
Time Burden (Hours)	12,052	0	11,552
Cost Burden (Dollars)	0	0	0

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Abstract: The Agency for Healthcare Research and Quality (AHRQ) requests to revise the currently approved AHRQ Safety Program for Methicillin-Resistant Staphylococcus aureus (MRSA) Prevention. The AHRQ Safety Program for MRSA Prevention’s purpose is to reduce the incidence and prevalence of infections caused by MRSA in a variety of settings. The revision for the AHRQ Safety Program for MRSA Prevention includes the following modifications: 1. ICU/Non-ICU cohort: The optional point prevalence data will be collected at baseline (pre-intervention) and every six months throughout the 18-month implementation period rather than only at baseline. 2. Surgical Services cohort: After a discussion with the program’s Technical Expert Panel (TEP), it was decided to collect surgical site infection (SSI) outcome data on a different subset of surgical procedures performed within the cardiac surgery, orthopedic surgery, and neurosurgery specialty areas. 3. Long-Term Care (LTC) cohort: The LTC cohort will now also submit the Minimum Data Set (MDS) 3.0 M Skin Conditions data elements.

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Authorizing Statute(s): US Code: 42 USC 299 Name of Law: Agency for Healthcare Research and Quality Act of 1999
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 43521	07/21/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 61323	10/09/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 15

table that charts list of burden

IC Title	Form No.	Form Name
Attachment H: Survey of Patient Safety Culture – HSOPS	1	Attachment H: Survey of Patient Safety Culture – HSOPS
Attachment I: Survey of Patient Safety Culture – NHSOPS	2	2,500
Attachment J - Subsequent data pull for 10% of units	9.5	Attachment J - Subsequent data pull for 10% of units
Attachment J: Clinical Outcomes Data for ICU/Non-ICU	9	Attachment J: Clinical Outcomes Data for ICU/Non-ICU
Attachment J: Clinical Outcomes Data for ICU/Non-ICU	9	Attachment J: Clinical Outcomes Data for ICU/Non-ICU
Attachment J: Clinical Outcomes Data for ICU/Non-ICU	9	Attachment J: Clinical Outcomes Data for ICU/Non-ICU
Attachment J: Clinical Outcomes Data for ICU/Non-ICU	9	Attachment J: Clinical Outcomes Data for ICU/Non-ICU
Attachment K: Clinical Outcomes Data for Surgical Services	10	Attachment K: Clinical Outcomes Data for Surgical Services
Attachment K: Clinical Outcomes Data for Surgical Services	10	Attachment K: Clinical Outcomes Data for Surgical Services
Attachment L: Clinical Outcomes Data for LTC	11	Attachment L: Clinical Outcomes Data for LTC
Attachment L: Clinical Outcomes Data for LTC	11	Attachment L: Clinical Outcomes Data for LTC
Attachment Q: Survey of Patient Safety Culture-HSOPS V.2	17	Attachment Q: Survey of Patient Safety Culture—HSOPS V.2
Gap Analysis	3, 4, 5	Attachment B: ICU/Non-ICU Gap Analysis ,   Attachment C: Surgical Services Gap Analysis ,   Attachment D: LTC Gap Analysis
TEAM CHECK-UP TOOL – Long-Term Care (LTC)	8	Attachment G: LTC Team Checkup Tool
Team Checkup Tool	6, 7	Attachment E: ICU/Non-ICU Team Checkup Tool ,   Attachment F: Surgical Services Team Checkup Tool

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	36,928	36,637	0	291	0	0
Annual Time Burden (Hours)	12,052	11,552	0	500	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: There is a reduction in burden from 15 minutes to 12.5 minutes per survey for the HSOPS 2.0 due to the shorter length of the instrument compared to Version 1.0.

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Annual Cost to Federal Government: $1,977,501

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 10/19/2022

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