Form
Approved
OMB No. 0920-0666
Exp. Date: xx/xx20xx
www.cdc.gov/nhsn
State Health Department HAI Mandate and Validation Survey
Section 1: State Reporting Requirements Section
This section inquires of any state reporting requirements that were in place during the 2017 calendar year. Please indicate the HAI specific requirements and the period they were effecting. These questions will be asked for each HAI measure by location and facility type.
Did your state have a reporting requirement (e.g. legislative or policy including reportable conditions) for healthcare facilities to report CLABSI data to NHSN from ANY LOCATION type within the facility (e.g., ICU, Ward, NICU) at any time during 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
Inpatient Rehabilitation Facility (IRF)
No mandate (e.g. legislative or state-required mandate) for any facility type
Was this CLABSI state mandate (e.g. legislative or policy including reportable conditions) for ANY LOCATION implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
Inpatient Rehabilitation Facility (IRF)
No mandate (e.g. legislative or state-required mandate) for any facility types
Did your state have a mandate (e.g. legislative or policy including reportable conditions) for healthcare facilities to report CLABSI data to NHSN from adult and/or pediatric ICU (critical care) locations at any time during 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
No mandate (e.g. legislative or state-required mandate) for any facility types
Assurance of Confidentiality: The voluntarily provided information obtained in this surveillance system that would permit identification of any individual or institution is collected with a guarantee that it will be held in strict confidence, will be used only for the purposes stated, and will not otherwise be disclosed or released without the consent of the individual, or the institution in accordance with Sections 304, 306 and 308(d) of the Public Health Service Act (42 USC 242b, 242k, and 242m(d)).
Public reporting burden of this collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC, Reports Clearance Officer, 1600 Clifton Rd., MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0666).
CDC 57.122, Rev 0, v9.2
Was this CLABSI state mandate (e.g. legislative or policy including reportable conditions) for adult and/or pediatric ICU (critical care) locations implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
No mandate (e.g. legislative or state-required mandate) for any facility types
Did your state have a mandate (e.g. legislative or policy including reportable conditions) for healthcare facilities to report CLABSI data to NHSN from WARD locations at any time during 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
Inpatient Rehabilitation Facility (IRF)
No mandate (e.g. legislative or state-required mandate) for any facility types
Was this CLABSI state mandate (e.g. legislative or policy including reportable conditions) for WARD locations implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
Inpatient Rehabilitation Facility (IRF)
No mandate (e.g. legislative or state-required mandate) for any facility types
Did your state have a mandate (e.g. legislative or policy including reportable conditions) for healthcare facilities to report CLABSI data to NHSN from NICU locations at any time during 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
No mandate (e.g. legislative or state-required mandate) for any facility types
Was this CLABSI state mandate (e.g. legislative or policy including reportable conditions) for NICU locations implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
No mandate (e.g. legislative or state-required mandate) at any facility types
Did your state have a mandate (e.g. legislative or policy including reportable conditions) for healthcare facilities to report CAUTI data to NHSN from ANY LOCATION at any time during 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
Inpatient Rehabilitation Facility (IRF)
No mandate (e.g. legislative or state-required mandate) at any facility types
Was this CAUTI state mandate (e.g. legislative or policy including reportable conditions) for ANY LOCATION implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
Inpatient Rehabilitation Facility (IRF)
No mandate (e.g. legislative or state-required mandate) at any facility types
Did your state have a mandate (e.g. legislative or policy including reportable conditions) for healthcare facilities to report CAUTI data to NHSN from adult and/or pediatric ICU (critical care) locations at any time during 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
No mandate (e.g. legislative or state-required mandate) at any facility types
Was this CAUTI state mandate (e.g. legislative or policy including reportable conditions) for adult and/or pediatric ICU (critical care) locations implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
No mandate (e.g. legislative or state-required mandate) at any facility types
Did your state have a mandate (e.g. legislative or policy including reportable conditions) for healthcare facilities to report CAUTI data to NHSN from WARD locations at any time during 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
Inpatient Rehabilitation Facility (IRF)
No mandate (e.g. legislative or state-required mandate) at any facility types
Was this CAUTI state mandate (e.g. legislative or policy including reportable conditions) for WARD locations implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
Inpatient Rehabilitation Facility (IRF)
No mandate (e.g. legislative or state-required mandate) at any facility types
Did your state have a mandate (e.g. legislative or policy including reportable conditions) for healthcare facilities to report VAE data to NHSN from ANY LOCATION at any time during 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
Inpatient Rehabilitation Facility (IRF)
No mandate (e.g. legislative or state-required mandate) at any facility types
Was this VAE state mandate (e.g. legislative or policy including reportable conditions) for ANY LOCATION implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
Inpatient Rehabilitation Facility (IRF)
No mandate (e.g. legislative or state-required mandate) at any facility types
Did your state have a mandate (e.g. legislative or policy including reportable conditions) for healthcare facilities to report VAE data to NHSN from adult and/or pediatric ICU (critical care) locations at any time during 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
No mandate (e.g. legislative or state-required mandate) at any facility types
Was this VAE state mandate (e.g. legislative or policy including reportable conditions) for adult and/or pediatric ICU (critical care) locations implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
No mandate (e.g. legislative or state-required mandate) at any facility types
Did your state have a mandate (e.g. legislative or policy including reportable conditions) for healthcare facilities to report VAE data to NHSN from WARD locations at any time during 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
Inpatient Rehabilitation Facility (IRF)
No mandate (e.g. legislative or state-required mandate) at any facility types
Was this VAE state mandate (e.g. legislative or policy including reportable conditions) for WARD locations implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
Inpatient Rehabilitation Facility (IRF)
No mandate (e.g. legislative or state-required mandate) at any facility types
Did your state have a mandate (e.g. legislative or policy including reportable conditions) for acute care hospitals (ACH) to report SSI data to NHSN from any of the following procedure types at any time during 2017 (check all that apply)?
Procedure |
Was this reporting mandate in place at any time during 2017? |
Was this reporting mandate in effect on January 1, 2017? |
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No reporting mandates for any procedure in place |
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AAA |
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APPY |
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CARD |
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CBGB/CBGC |
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COLO |
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CSEC |
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FUSN |
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HPRO |
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HYST |
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KPRO |
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LAM |
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PVBY |
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REC |
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VHYS |
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XLAP |
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Did your state have a mandate (e.g. legislative or state-required mandate) for critical access hospitals (CAH) to report inpatient SSI data to NHSN from any of the following procedure types at any time during 2017 (check all that apply)?
Procedure |
Was this reporting mandate in place at any time during 2017? |
Was this reporting mandate in effect on January 1, 2017? |
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No reporting mandates for any procedure in place |
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AAA |
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APPY |
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CARD |
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CBGB/CBGC |
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COLO |
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CSEC |
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FUSN |
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HPRO |
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HYST |
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KPRO |
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LAM |
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PVBY |
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REC |
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VHYS |
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XLAP |
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Did your state have a mandate (e.g. legislative or state-required mandate) for healthcare facilities to report MRSA Bacteremia Laboratory-identified (LabID) Events to NHSN from Facility-wide inpatient locations (FacWideIN) at any time during 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
Inpatient Rehabilitation Facility (IRF)
No mandate (e.g. legislative or state-required mandate) for any facility type
Was this MRSA Bacteremia LabID Event state mandate (e.g. legislative or state-required mandate) for FacWideIN locations implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
Inpatient Rehabilitation Facility (IRF)
No mandate (e.g. legislative or state-required mandate)
Did your state have a mandate (e.g. legislative or state-required mandate) for healthcare facilities to report C. difficile Laboratory-identified (LabID) Events to NHSN from Facility-wide inpatient locations (FacWideIN) at any time during 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
Inpatient Rehabilitation Facility (IRF)
No mandate (e.g. legislative or state-required mandate) at any facility types
Was this CDI LabID Event state mandate (e.g. legislative or state-required mandate) for FacWideIN locations implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Long Term Acute Care Facility (LTAC)
Inpatient Rehabilitation Facility (IRF)
No mandate (e.g. legislative or state-required mandate
Section 2: Data Validation
This section asks about any validation activities that were conducted during the 2017 calendar year. Please let us know if your validation activities and the period they were effective. These questions will be asked for each HAI measure stratified by facility type.
Select the appropriate HAIs and facility types for which you (state health department) or a partner organization have access to 2017 data via NHSN. (Please select a response for each HAI listed below)
No Access to any of the data listed |
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CLABSI |
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CAUTI |
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SSI-COLO |
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SSI-HYST |
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MRSA Bacteremia LabID Event |
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CDI LabID Event |
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VAE |
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Has your state health department or partner organization performed data quality checks on at least 6 months of 2017 NHSN data from any of the following HAIs within any healthcare facility types prior to August 1, 2018? This includes an assessment of outliers, data entry errors, trends, data completeness, etc. (Please select a response for each HAI listed below)
No data quality checks performed with any of the data listed |
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CLABSI |
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CAUTI |
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SSI-COLO |
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SSI-HYST |
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MRSA Bacteremia LabID Event |
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CDI LabID Event |
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VAE |
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Does your state health department or partner organization contact hospitals if outliers, errors, missing data, or incomplete data are found?
Yes
No
Has your state health department completed an external audit (medical record review of any HAI, or a review of laboratory records for MRSA or C.difficile LabID Events) of 2017 NHSN data from any of the following healthcare facility types prior to August 1, 2018?
Yes
No
Which HAIs and facility types were validated during the external audit? (Please answer all fields)
CLABSI |
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CAUTI |
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SSI-COLO |
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SSI-HYST |
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MRSA Bacteremia LabID Event |
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CDI LabID Event |
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VAE |
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Does your state have a mandate (e.g. legislation or policy) to conduct an annual external audit (medical record review of any HAI either onsite or via remote desktop electronic review) of NHSN data for any facility types (ACH, CAH, LTACH, or IRF)?
Yes, there is a state mandate to conduct annual external audits
No mandate, the state conducts external audits on an ad hoc basis
No mandate and no external audits are performed on HAI data
33. Please select the HAIs for each facility that had a state mandate (e.g. legislation or policy) to conduct an external audit of NHSN data during 2017. (Please answer all fields)
CLABSI |
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CAUTI |
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SSI-COLO |
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SSI-HYST |
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MRSA Bacteremia LabID Event |
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CDI LabID Event |
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VAE |
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Decker, Scott Gregory (CDC/OID/NCEZID) (CTR) |
File Modified | 0000-00-00 |
File Created | 2023-12-24 |