NH Survey

Form Approved

OMB Control No. 0920-1071

Expiration Date: 05/31/2024

Survey Number: _________

1. Please indicate your role(s) at this nursing home: (check all that apply)

   1. Infection preventionist

   2. Administrator

   3. Nursing manager

   4. Senior nurse (not nursing manager)

   5. Other (please specify: ____________)

2. In your position, are you involved in monitoring Healthcare Associated Infections (HAIs) at this nursing home?

   1. Yes

   2. No

3. Please indicate which best describes this nursing home’s affiliation: (check one)

   1. Independent, free-standing

   2. Independent, part of a continuing care retirement community

   3. Multi-facility organization (chain, including corporate owned)

   4. Hospital system, free-standing

   5. Hospital system, attached

4. What company created the electronic health record (EHR) system that is used for most clinical activities at your nursing home?

MARK ALL THAT APPLY
__American Data __American HealthTech __Cerner/Oracle __Eldermark __Epic __MatrixCare	__Netsmart __PointClickCare __RTZ Systems __Storiicare __WellSky (formerly ADS data systems) __Yardi
__Other (please specify: ____________________________)
__ We do not have an EHR system

5. Does your nursing home have a system for tracking HAIs, including Clostridiodes difficile (C difficile) infections:

   1. Yes (proceed to question 6)

   2. No (proceed to question 8)

6. If Yes, who makes this system?

   1. It’s created internally, e.g., use of an excel spreadsheet

   2. It’s part of your EHR system, created by the following company:

      MARK ALL THAT APPLY
      __American Data __American HealthTech __Cerner/Oracle __Eldermark __Epic __MatrixCare	__Netsmart __PointClickCare __RTZ Systems __Storiicare __WellSky (formerly ADS data systems) __Yardi
      __Other (please specify: ____________________________)

7. For your infection control tracking system, please indicate the following:

1. Ease of entering infection-related information into the infection tracking system?

1. Easy

2. Neither easy or difficult

3. Difficult

2. Ease of accessing infection-related information as part of routine care of your nursing home residents?

1. Easy

2. Neither easy or difficult

3. Difficult

3. Ease of generating an HAI monitoring report through your infection tracking system?

1. Easy

2. Neither easy or difficult

3. Difficult

4. Overall, how satisfied are you with your infection tracking system?

1. Satisfied

2. Neither satisfied or dissatisfied

3. Dissatisfied

8. Does your facility have its own laboratory that performs microbiology/antimicrobial susceptibility testing (e.g., for C difficile infection testing)?

   1. Yes (proceed to question 10)

   2. No (proceed to question 9)

9. If No, where is your facility’s antimicrobial susceptibility testing performed? (check one)

   1. Affiliated medical center, within same health system

   2. Non-affiliated Medical center, contracted locally

   3. Commercial referral laboratory

10. What is the primary testing method for C difficile by the laboratory where your facility’s testing is usually performed? (check one)

    1. Enzyme immunoassay (EIA) for toxin

    2. Nucleic acid amplification test (NAAT) (e.g., PCR, LAMP)

    3. Enzyme immunoassay (EIA) and nucleic acid amplification test (e.g., PCR, LAMP)

    4. Glutamate dehydrogenase (GDH) antigen plus EIA for toxin

    5. Glutamate dehydrogenase (GDH) antigen plus nucleic acid amplification test (e.g., PCR, LAMP)

    6. Cell cytotoxicity neutralization assay

    7. Other (please specify: ____________)

    8. Unknown

11. On average, how quickly does your nursing home get C difficile test results back from the lab that usually measures C difficile? (check one)

    1. within 6 hours

    2. about 12 hours

    3. about 1 day

    4. about 2 days

    5. usually takes longer than 2 days

12. Are C difficile test results usually entered or transferred into your nursing home’s EHR system?

    1. Yes (proceed to question 13)

    2. No (proceed to question 16)

    3. We do not have an EHR system (proceed to question 16)

13. If Yes, how are C difficile testing results usually entered or transferred into your nursing home’s EHR system when coming from your usual lab:

    1. Manually, in which a staff member types C difficile test results into the EHR system (proceed to question 14)

    2. Automatically captured by your nursing home’s EHR system by some process so manual entry is not needed (proceed to question 18)

14. If manually entered, please indicate the ease of learning how to enter C difficile infections into your EHR system?

    1. Very easy to learn

    2. Moderately easy to learn

    3. Difficult to learn

    4. Very difficult to learn

15. If manually entered, please indicate how time-consuming it is to enter C difficile infections into your EHR system.

    1. A little time consuming (proceed to question 18)

    2. Moderately time consuming (proceed to question 18)

    3. Very time consuming (proceed to question 18)

16. If C difficile test results are NOT entered or transferred into your nursing home’s EHR system, are C difficile test results entered into an infection-related tracking sheet that is separate from your EHR system?

    1. Yes (proceed to question 17)

    2. No (proceed to question 18)

17. If Yes, how are these C difficile test results entered or transferred into the infection-related tracking sheet that is not part of the EHR system

    1. manually

    2. entered automatically by some process so manual entry is not needed

18. When one of your nursing home residents is tested for a C difficile infection in an emergency room, outpatient clinic, or hospital:

1. For what % of those cases does your nursing home usually receive those results?

1. < = 25%

2. 26-50%

3. 51-75%

4. 76-100%

Question 18 continued: When one of your nursing home residents is tested for a C difficile infection in an emergency room, outpatient clinic, or hospital:

2. How do you usually receive those results?

1. automatically loaded into your EHR system receive results by phone or fax

2. receive results by email

3. receive results by regular mail

4. paper discharge report in the possession of the resident or a staff member transferring the resident

5. Other (please specify: __________________)

3. How do you typically enter or transfer those C difficile results into your C difficile tracking system or EHR system?

1. manually

2. entered automatically by some process so manual entry is not needed

3. not transferred or stored in our EHR or C difficile tracking system

19. How many C difficile cases has your nursing home had in the prior 12 months: _______

[Number of C difficile cases in past 12 months in which the resident tested positive while residing in your nursing home or the resident was tested positive for C difficile during an emergency room or outpatient clinic visit but the resident returned to your nursing home within 2 days of having gone to the ER or outpatient clinic]

20. Which answer below best describes approximately how often trends (patterns of occurrence) are monitored regarding the number of residents who’ve had a C difficile infection in your nursing home?

    1. Monthly or more frequently than monthly

    2. Every 2 months

    3. Every 3 - 4 months

    4. 2 times per year

    5. 1 time per year

    6. Less often than 1 time per year

    7. We do not monitor trends in C difficile infections in our nursing home

21. Are the monitoring of trends (patterns of occurrence) of C difficile/HAIs mainly generated through your EHR system or through a manual tracking system?

    1. Yes, through our EHR system

    2. Yes, through a manual tracking system

    3. No

    4. Other (please specify: ____________)

22. How much importance/emphasis does your nursing home’s administration place on monitoring C difficile infections in your nursing home?

    1. High importance and strong emphasis

    2. Moderate amount of emphasis

    3. A little emphasis

    4. Not emphasized at all

23. Does your nursing home typically test a resident for C difficile infection in the following situations:

1. Resident has been experiencing substantial abdominal pain, vomiting, diarrhea, or has had a significant change in bowel movements (frequency, consistency, texture, odor):

1. Always

2. Almost always

3. Sometimes but not usually

4. Rarely

5. Never

2. Soon after a resident returns from being hospitalized for several days or longer?

1. Always

2. Almost always

3. Sometimes but not usually

4. Rarely

5. Never

3. Soon after a new resident transfers into your facility from another care facility?

1. Always

2. Almost always

3. Sometimes but not usually

4. Rarely

5. Never

24. Please rate the ease to determine the following using your EHR system:

1. Whether a particular resident currently has a C difficile infection:

1. very easy and fast

2. quite good

3. fair

4. not very good

5. not able to

6. We do not have an EHR system

2. Whether a particular resident had a prior C difficile infection at your facility, and when it occurred:

1. very easy and fast

2. quite good

3. fair

4. not very good

5. not able to

6. We do not have an EHR system

3. For a resident who had a prior C difficile infection at your facility, what antibiotic was prescribed for that infection:

1. very easy and fast

2. quite good

3. fair

4. not very good

5. not able to

6. We do not have an EHR system

25. Does your facility’s EHR system have the capability to flag when a resident is on contact precautions for C difficile infection?

    1. Yes

    2. No

    3. We do not have an EHR system

26. How well or to what level are the following infections captured within your EHR system:

(circle one choice per HAI type, select N/A if you do not have an EHR system)

Infection Type	Scale
Urinary tract infections	Excellent	quite good	fair	not very well	not at all	N/A
COVID-19 infection	Excellent	quite good	fair	not very well	not at all	N/A
Influenza	Excellent	quite good	fair	not very well	not at all	N/A
C difficile infection	Excellent	quite good	fair	not very well	not at all	N/A
Multi-drug resistant organism (MDRO)-related infections	Excellent	quite good	fair	not very well	not at all	N/A

27. Who typically makes the determination if a resident has a C difficile infection based on available lab results and patient symptoms? (check all that apply)

    1. Doctor

    2. Nurse Practitioner or Physician’s Assistant

    3. Infection Preventionist

    4. Senior Nurse (none of the above)

    5. Administrator

    6. Other (please specify: ____________)

28. Indicate which of the following are typically available in the electronic health record for residents at your nursing home: (check all that apply)

    1. Laboratory test results for possible infection

    2. Antibiotic prescription orders

    3. Antibiotic administration record

    4. None of the above

29. Does your facility currently report healthcare associated infections (HAIs) into the NHSN Long Term Care Component, or plan to do so in the near future?

    1. Yes, we currently report HAIs to NHSN

    2. We don’t currently report HAIs to NHSN but hope to in the near future

    3. We don’t report HAIs to NHSN and currently do not have any plans for reporting these HAIs to NHSN in the foreseeable future

Thank you for completing the survey!

Public reporting burden of this collection of information is estimated to average 20 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/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS H21-8, Atlanta, Georgia 30333; ATTN: PRA 0920-1071.

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