Form 0920-0978 CDC’s Healthcare-Associated Infections Community Interfa

CDC’s Healthcare-Associated Infections Community Interface (HAIC) Staphylococcus
aureus Laboratory Survey

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

Date Survey Completed: _________________ EIP Site: __________ Completed by: ______________________________
Hospital/Lab ID: ________________________ Lab contact to complete the survey (name/title): ______________________

□ Lab did not respond – END SURVEY
1. Type of laboratory

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

2. During the past year, has your lab changed testing methods used to detect any of the following pathogens:
MRSA only
All Staphylococcus aureus

Yes

No

□
□

□
□

Not applicable/
no surveillance

□
□

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

Staphylococcus aureus (methicillin-sensitive and methicillin-resistant)
3. Do you routinely set up culture for sterile sites (blood, CSF, bone, etc.) on site (in-house) at your laboratory?

□ Yes

- GO TO Q4

□ No – GO TO Q3a

3a. [If no] To which laboratory do you send sterile specimens for culture/identification?

____________________________________

Question 4 asks about methods for identifying S. aureus or MRSA from a positive sterile site (blood, CSF,
bone, etc.) culture.
4.

If a sterile site culture is positive, is sub-culturing to obtain an isolate always performed?

□ Yes – GO TO Q4b

□ No

4a. [If no] explain/specify reason: __________________________________________________

4b. If a sterile site culture is positive, how do you identify it as S. aureus? This includes identifying both
on-site (in-house) or at another lab. (Check all that apply)
Public reporting burden of this collection of information is estimated to average 8 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to a collection of information unless it displays a current valid OMB control number. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Rd NE, MS D-74, Atlanta, Georgia 30329;
ATTN: PRA (xxxx-xxxx)

–IMPORTANT – PLEASE COMPLETE THE BACK OF THIS FORM –

□ MALDI-TOF – GO TO 4f
□ Biochemical tests (e.g., catalase, coagulase) – GO TO 4f
□ Molecular test – GO TO 4c
□ Other, specify: _____________________ – GO TO 4f
□ Do not identify as S. aureus– GO TO Q5
4c. [If molecular test(s) used] Where is molecular testing from a positive sterile site culture completed?
□ On-site

□ Send out, please specify lab __________________ - GO TO Q4e

4d. Which molecular tests do you use (cultures from 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__________
□ 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 ________________
□ BioFire Blood Culture Identification 2 (BCID2) Panel… Date started ________________
□ Other, Lab Developed molecular Test (detects MRSA or SA)… Date started ____________________
□ Other commercial molecular test, Specify_______...Date started__________

4e. Are positive molecular tests from sterile site cultures appearing in the S. aureus surveillance
laboratory line lists?
□ Yes – GO TO Q5

□ No – GO TO Q5

□ Unknown – GO TO Q5

4f. [If not using molecular tests from sterile site cultures on-site] Do you plan to start offering any
molecular tests for detection of S. aureus or MRSA from a positive sterile source culture within the next
year?
□ Yes

□ No – GO TO Q5

4g. When do you plan to start offering molecular tests?
Month/Year: ____/____
4h. Where do you plan to have molecular tests performed?
□ On-site

□ Send out, please specify lab __________________ - GO TO Q5

CDC’s Healthcare-Associated Infections Community Interface (HAIC) Staphylococcus aureus
Laboratory Survey
Question 5 asks about testing performed directly on sterile site specimens (a positive blood culture
is not required to perform these tests).
5. Do you routinely run any tests on site (in-house) or at another lab that detect of S. aureus directly from a
sterile source (e.g., blood, CSF) without a culture?

□ Yes

□ No - GO TO Q5e

5a. [If yes] Where is this testing completed?
□ On-site

□ Send out, please specify lab __________________ - GO TO Q5e

5b. Which tests do you use to detect S. aureus directly from a sterile site source without culture? (sterile
site sources only, i.e. blood, CSF, pleural fluid, bone, etc.)? Please check all that apply.

□ T2Bacteria® Panel…Date started__________
□ Karius TestTM…Date started__________
□ Other, Lab Developed Test (detects MRSA or SA)… Date started ____________________
□ Other commercial test, Specify_______...Date started__________

5c. Are all positive tests directly from sterile sources appearing in the S. aureus surveillance laboratory
line lists?
□ Yes

□ No

□ Unknown

5d. Do you still obtain an isolate for S. aureus or MRSA if these tests are used?
□ Yes – END SURVEY
□ No – END SURVEY
5e. [If no] Do you plan to start offering any tests for detection of S. aureus or MRSA directly from a
sterile source within the next year?
□ Yes
□ No – END SURVEY
5f. When do you plan to start offering these tests?
Month/Year: ____/____
5g. Where do you plan to have these tests performed?
□ On-site
□ Send out, please specify lab __________________ - END SURVEY

Comments:

END SURVEY

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