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pdfHARP PM1: Clinical Laboratories
Jurisdiction
HAI/AR Response & Prevention Performance Measures 2022-2023
Page 1
__________________________________
HARP PM1: Clinical laboratories engaged to improve testing. Please answer the following
questions for the reporting period: August 1, 2022 through July 31, 2023.
This measure is due once annually: only at end of performance period (Due: August 31st,
2023)
Q1. How many clinical laboratories are in your health
department's jurisdiction?
Clinical laboratories includes any clinical,
reference, or commercial laboratories in or serving
the jurisdiction.
Q2. How many clinical laboratories did your HAI/AR
program engage to submit clinical isolates for testing
at the public health lab during this budget period?
Engagement of clinical laboratories include the
provision of technical support and/ or consultation
that facilitates the connection of the clinical
laboratories to your AR Lab Network public health lab
or regional lab for additional support.
__________________________________
(Please provide an approximate number if exact
number is not known.)
__________________________________
(Please provide an approximate number if exact
number is not known.)
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HARP PM2: nMDRO Responses
HAI/AR Response & Prevention Performance Measures 2022-2023
Page 2
HARP PM2: Novel or Targeted Multi-drug Resistant Organisms (nMDRO) Responses
Instructions: HAI/AR Response and Prevention (HARP) PM2 has been restructured to align reporting across G1,
American Rescue Plan (SHARP Project I, NH Strike Teams), and COVID-19 Supplements for Healthcare IPC activities.
Please report nMDRO investigations or consultations* conducted by either
Staff from HAI/AR Program or their designee** (regardless of funding source), or Staff partially or fully funded
through one of the following mechanisms who contributed to the response: G1 SHARP (SHARP includes project 1
through 5) Nursing Home/Other LTC Strike Team This measure is due twice annually: Mid-period (Due: January 31st
, 2023) and end of the reporting period (Due: August 31st , 2023)
Data entry instructions
Please enter one REDCap form for each nMDRO investigation or consultation that took place during the reporting
period: August 1, 2022, through December 31, 2022. To add a new response in REDCap, click "Save and Add New
Instance." For continuing responses please ensure all the data entered are cumulative irrespective of the reporting
period. The reporting form is programmed to display a subset of questions based on the answer to Question #3. An
excel-based upload tool for tracking and uploading nMDRO consultations* is available under the Bulk Upload section
of this project. Health Departments can either use this REDCap form OR the excel-based upload tool for reporting
nMDRO consultations. At this time, for reporting nMDRO investigations* the REDCap form must be used. Please do
not include SARS-CoV-2 response activities in this performance measure UNLESS the response involves mixed
infection or colonization with a target nMDRO. Mixed outbreaks involving SARS-CoV-2 and nMDROs should be
reported in PM2. Additional Resources
For information on where to enter response activities please refer to the Where to submit HAI/AR Response-Related
Activities section (Page 8) of the "ELC HAIAR Performance Measure Reporting Guide 2022-2023" For guidance on
completing nMDRO response performance measure please refer to the Additional Guidance to Complete the HARP
PM2 Reporting Form section (Page 11) of the "ELC HAIAR Performance Measure Reporting Guide 2022-2023" *Please
refer to the Where to submit HAI/AR Response-Related Activities section (Page 8) of the "ELC HAIAR Performance
Measure Reporting Guide 2022-2023" for details on key criteria for the categorization of nMDRO response activity as
nMDRO investigation vs. nMDRO consultations
**Designee includes other state health department staff, local health department staff, contractor, or other partner
supported by your program) for which your program can assure the quality of services provided.
*** Please refer to the Additional Guidance to Complete the HARP PM2 Reporting Form section (Page 11) of the "ELC
HAIAR Performance Measure Reporting Guide 2022-2023" for details on continuing response.
Note: If you have an acute outbreak, where transmission has been controlled and you are directing the facility to
conduct regular (i.e., pre-specified, prevention-focused, scheduled) PPS, those PPS entries should be entered as
prevention-based activities and data be submitted under PM4. Please add a the REDCap ID of the corresponding PM4
record to the comments section of this reporting template (PM2).
[Attachment: "ELC HAIAR Performance Measure Reporting Guide 2022-2023.pdf"]
Reported through excel-based tracking tool/Imported
into REDCap
Q1. Local outbreak/Response ID
ID for cross-referencing with your local tracking tool
as needed. May use any unique identifier.
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Yes
__________________________________
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Q2. Response Start Date
Date when the health department first made the
decision to start the investigation (to a single case
or a cluster of cases).
__________________________________
(If exact date not known, please approximate.)
Q3. Did you perform any of the following activities
for this response?
Remote Infection Prevention and Control Assessment
Onsite Infection Prevention and Control Assessment
Colonization screening
None of the above
Q3a. Did the HAI/AR program offer public health
assistance for any of the following, for any facility
involved in the consultation (check all that apply):
Remote Infection Control Assessment
Onsite Infection Control Assessment
Colonization Screening
Unknown
None of the above
Status of the investigation
Active
Monitoring
Closed
Q4. Is this a new containment response or is it a
continuing response reported during previous reporting
period (prior to Aug 1, 2021).
New response
Continuing response
[Please refer to the "nMDRO additional guidance to
complete the HARP PM2 reporting form" on how to
determine whether a group of actions should be
reported as a new or continuing response].
Please note any regional efforts that span reporting periods should be counted as a new response.
Select "new response" in Q4 of a new record. All data entered should reflect efforts during the current reporting
period. For all other continuing responses, please do not complete a new form.
Navigate to the existing record in the record status dashboard, Select "continuing response" in Q4 of the existing
record, and Update the existing record. All data entered should be cumulative to date (regardless of reporting
period).
Q5. During which reporting period did the health
department engage in activities related to this
response?
January 1, 2022 - July 31, 2022
August 1, 2022 - December 31, 2022
January 1, 2023 - July 31, 2023
[check all that apply]
Q5a. Did the Chicago Department of Public Health
assist in this response?
Yes
No
Q5a. Did the Illinois Department of Public Health
assist in this response?
Yes
No
Q5a. Did the New York City Department of Health &
Mental Hygiene assist in this response?
Yes
No
Q5a. Did the New York State Department of Health
assist in this response?
Yes
No
Q5a. Did the Pennsylvania Department of Health assist
in this response?
Yes
No
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Q5b. Did the Philadelphia Department of Pubic Health
assist in this response?
Yes
No
Q5a. Did the California Department of Pubic Health
assist in this response?
Yes
No
Q5a. Did the Los Angeles County Department of Pubic
Health assist in this response?
Yes
No
Q5a. Did the Texas Department of State Health Services
assist in this response?
Yes
No
Q5a. Did the Houston Health Department assist in this
response?
Yes
No
Q6. What was the trigger for the response?
Select the option that best describes the trigger for
initiating this response. If needed, more than one
option can be selected.
Definitions/Examples
Screening case: notification of a patient,
transferred from Hospital A and colonized with CPOs/
auris identified by admission screening at SNF A.
Regional effort: responses in multiple facilities in a
city/region to prevent the spread of an emerging
resistance, in which facilities are selected based on
their characteristics (e.g., high acuity, long length
of stay) rather than a direct epi link to a case or
outbreak Prevention-based Point Prevalence Survey
Prevention PPS, where multiple cases of a novel CPO
are identified from a facility and additional rounds
of PPS are performed in accordance with the
Containment guidance
Q6a. REDCap ID of Point Prevalence Survey
For the purposes of linking responses, please provide
the Facility ID for the Point Prevalence Survey
designated in Performance Measure 4
Q6b. Other trigger, specify:
Q7. Did more than one targeted MDRO trigger this
response?
Note: Targeted MDRO(s) [Organism/mechanism] are those
that triggered the AR containment response
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Single clinical case
Multiple clinical cases
Screening case
Regional effort*
Prevention-based Point Prevalence Survey (PPS)
Other
Unknown
(*Please note regional response activities should
be aggregated in one entry unless efforts cross
reporting periods; see attached "nMDRO additional
guidance to complete the PM2 reporting form"
document above)
__________________________________
__________________________________
Yes
No
Unknown
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Q8. Organism/mechanism that triggered the response
Please list the organism and mechanism (if applicable) that triggered the response. These
organisms will be considered "targeted MDROs" for the remainder of the questions.
Do not include other non-targeted organisms subsequently identified during the response
(e.g., through screening) in this section.
Refer to the document, "nMDRO Additional Guidance to Complete the HARP PM2 Reporting
Form" for guidance on the reporting of single and multiple response.
Organisms
[Select all the organisms and associated mechanisms
that triggered the response; If no organism prompted
the response, select “No organism identified”]
Other Organism, specify:
Acinetobacter baumannii mechanism [check all that
apply]
Acinetobacter baumannii other mechanism, specify:
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Acinetobacter baumannii
Citrobacter spp.
Enterobacter aerogenes (Klebsiella aerogenes)
Enterobacter cloacae complex
Enterobacter spp. (other E. cloacae complex)
Escherichia coli
Klebsiella oxytoca
Klebsiella pneumoniae
Klebsiella spp. (other than K. oxytoca, K.
pneumoniae, and K. aerogenes)
Morganella morganii
Proteus mirabilis
Providencia spp.
Pseudomonas aeruginosa
Pseudomonas spp. (non- aeruginosa species)
Raoultella spp.
Serratia marcescens
Candida auris
Other(s)
Unknown
No organism identified
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
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Citrobacter spp. mechanism [check all that apply]
Citrobacter spp. other mechanism, specify:
Enterobacter aerogenes (Klebsiella aerogenes)
mechanism [check all that apply]
Enterobacter aerogenes (Klebsiella aerogenes) other
mechanism, specify:
Enterobacter cloacae complex mechanism [check all that
apply]
Enterobacter cloacae complex other mechanism, specify:
04/24/2023 10:21am
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
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Escherichia coli mechanism [check all that apply]
Escherichia coli other mechanism, specify:
Klebsiella oxytoca mechanism [check all that apply]
Klebsiella oxytoca other mechanism, specify:
Klebsiella pneumoniae mechanism [check all that apply]
Klebsiella pneumoniae other mechanism, specify:
04/24/2023 10:21am
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
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Morganella morganii mechanism [check all that apply]
Morganella morganii other mechanism, specify:
Proteus mirabilis mechanism [check all that apply]
Proteus mirabilis other mechanism, specify:
Providencia spp. mechanism [check all that apply]
Providencia spp. other mechanism, specify:
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KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
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Pseudomonas aeruginosa mechanism [check all that
apply]
Pseudomonas aeruginosa other mechanism, specify:
Psuedomonas spp. (non- aerugionsa species) mechanism
[check all that apply]
Psuedomonas spp. (non- aerugionsa species) other
mechanism, specify:
Raoultella spp. mechanism [check all that apply]
Raoultella spp. other mechanism, specify:
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KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
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Serratia marcescens mechanism [check all that apply]
Serratia marcescens other mechanism, specify:
Other organism mechanism [check all that apply]
Other organism other mechanism, specify:
Unknown organism mechanism [check all that apply]
Other unknown other mechanism, specify:
04/24/2023 10:21am
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
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No organism identified- mechanism [check all that
apply]
No organism identified- other mechanism, specify:
Was this a mixed outbreak involving SARS-CoV-2 and an
nMDRO?
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
Yes
No
Facility/Setting Information
Answer the following questions for all organism/mechanism combinations involved in this
response.
Q9. Setting Type(s): Select setting types involved
(where infections identified, screenings conducted,
onsite assessments were performed, etc.).
Additionally, select the setting type that best
describes how the overall facility is licensed (e.g.,
in a SNF that cares for ventilated residents, select
vSNF.)
If the facility has more than one level of care,
select the level(s) of care relevant to the
investigation and the responses to follow up
activities should be submitted for those level(s)
where investigation was conducted.
Q9(i)a. Please select the location within the ACH, if
applicable
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Acute care hospitals
Critical access hospitals
Inpatient rehabilitation facilities
Long-term acute care hospitals
Ventilator-capable nursing home/skilled nursing
facilities (vSNF)
Nursing home/ skilled nursing facilities (SNF)
Assisted Living Facility
Other Congregate settings (e.g., group homes,
homeless shelter)
Dialysis (outpatient)
Dental Office
Ambulatory Surgical Center
Other Outpatient settings
Other healthcare settings
Unknown
Intensive care unit
Burn unit
Oncology unit
Dialysis unit
Operating room
Emergency department
Transplant unit
Labor and delivery
Medical unit
Surgical unit
Rehab unit
Other
Unknown
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Q9(i)b. Location within the facility, if other,
specify:
__________________________________
Q9(i)a. Please select the location within the LTACH,
if applicable
Intensive care unit
Non-Intensive care unit
Other
Unknown
Q9(i)a. Please select the location within the vSNF, if
applicable
Ventilator unit (or ventilated residents, if no
separate ventilator unit)
Non-ventilator unit
Other
Unknown
Q9(i)a. Please select the location within the SNF, if
applicable
Tracheostomy unit (e.g., provides tracheostomy
care but not license for ventilator services)
Short-stay unit in long-term care facility
Memory care unit
Other
Unknown
Q9(ii). Please select the types of congregate settings
Group home
Homeless shelter
Prison
School
Migrant shelter
Independent Living Facility
Emergency shelters (other than homeless shelters)
Other
Unknown
[check all that apply]
Q9(iii). Other congregate setting type, specify:
Q9(iv). Please select the other outpatient setting
type and services provided.
[check all that apply]
Q9(v). Other outpatient setting type, specify:
Q9(vi). Other setting type, specify:
Q9a. ZIP code of the primary outbreak facility (i.e.,
If this response activity includes facilities in more
than 1 zip code, please include the zip code of the
facility where the majority of the health department
response activity occurred)
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__________________________________
Urology
Endoscopy
Ambulatory surgery
Wound clinic
Pain clinic
Home health
Oncology
Federally Qualified Health Centers (FQHC)
Dermatology
Other
Unknown
__________________________________
__________________________________
__________________________________
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Q9b. Were any of the involved facilities a tribally
owned facility or a part of the Indian Health Service:
Yes
No
Unknown
Colonization screening and onsite assessments
Answer the following questions for each setting type.
10a. Acute-care hospitals
How many acute care hospitals (ACHs) were involved?
This includes the number of ACHs where
infected/colonized patients were identified, screening
was conducted, or onsite assessments were performed.
If more than one ACH was involved in the response, how
many ACH conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 ACH were involved in the response, but
only 2 conducted screening, enter 2.
How many screening tests were performed for all
targeted MDROs across all ACHs during this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 50 and 60
screening tests were conducted, respectively. Enter C
auris=50 NDM=60).
Please select the reason(s) for not screening patients
in ACHs [check all that apply]
Please specify other reason for not conducting any
screening.
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
If more than one ACH conducted screenings, how many
facilities had screening tests positive for the
targeted mechanism(s)/organism(s)?
__________________________________
For example, if 2 ACHs conducted screening but only 1
facility detected the targeted
mechanism(s)/organism(s), then enter 1.
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How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all ACHs during this response?
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 5 tests
detected Candida auris and 10 detected NDM. Enter C
auris=5 NDM=10).
Did your health department or a designee conduct any
of the following?
In general, the initial onsite IC assessment should
include not only a review of policies, but also
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
__________________________________
(If none, enter 0. If exact number screened not
known, please approximate.)
__________________________________
Onsite infection control assessment
Remote infection control assessment
No assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
tele-ICAR tool or similar state/locally developed
tool.
Provision of onsite assistance may be done directly by
the recipient or through the support of a local health
department, academic partner, contractor, consultant,
or other entity (designee) for which the recipient can
assure the quality of services provided
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across all ACHs during this response?
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
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__________________________________
(If no onsite assessments performed, enter 0.)
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How many remote infection control assessments were
conducted across all ACHs during this response?
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
__________________________________
(If no remote assessments performed, enter 0.)
Telephone
Video (i.e, Skype, Zoom)
10b. Critical Access Hospitals
How many critical access hospitals (CAHs) were
involved?
This includes the number of CAHs where
infected/colonized patients were identified, screening
was conducted, or onsite assessments were performed.
If more than one CAH was involved in the response, how
many CAH conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 CAHs were involved in the response, but
only 2 conducted screening, enter 2.
How many screening tests were performed for all
targeted MDROs across all CAHs during this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 50 and 60
screening tests were conducted, respectively. Enter C
auris=50 NDM=60).
Please select the reason(s) for not screening patients
in CAHs [check all that apply]
Please specify other reason for not conducting any
screening.
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
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If more than one CAH conducted screenings, how many
facilities had screening tests positive for the
targeted mechanism(s)/organism(s)?
__________________________________
For example, if 2 CAHs conducted screening but only 1
facility detected the targeted
mechanism(s)/organism(s), then enter 1.
How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all CAHs during this response?
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 5 tests
detected Candida auris and 10 detected NDM. Enter C
auris=5 NDM=10).
Did your health department or a designee conduct any
of the following?
In general, the initial onsite IC assessment should
include not only a review of policies, but also
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
__________________________________
(If none, enter 0. If exact number screened not
known, please approximate.)
__________________________________
Onsite infection control assessment
Remote infection control assessment
No assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
tele-ICAR tool or similar state/locally developed
tool.
Provision of onsite assistance may be done directly by
the recipient or through the support of a local health
department, academic partner, contractor, consultant,
or other entity (designee) for which the recipient can
assure the quality of services provided
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
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How many onsite infection control assessments were
conducted across all CAHs during this response?
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
How many remote infection control assessments were
conducted across all CAHs during this response?
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
__________________________________
(If no onsite assessments performed, enter 0.)
__________________________________
(If no remote assessments performed, enter 0.)
Telephone
Video (i.e, Skype, Zoom)
10c. Inpatient rehabilitation facilities
How many inpatient rehabilitation facilities were
involved?
This includes the number of inpatient rehabilitation
facilities where infected/colonized patients were
identified, screening was conducted, or onsite
assessments were performed.
If more than one inpatient rehab facility was involved
in the response, how many inpatient rehab facilities
conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 inpatient rehab facilities were involved
in the response, but only 2 conducted screening, enter
2.
How many screening tests were performed for all
targeted MDROs across all inpatient rehabilitation
facilities during this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 50 and 60
screening tests were conducted, respectively. Enter C
auris=50 NDM=60).
04/24/2023 10:21am
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
projectredcap.org
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Please select the reason(s) for not screening patients
in inpatient rehabilitation facilities [check all that
apply]
Please specify other reason for not conducting any
screening.
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
If more than one inpatient rehabilitation facility
conducted screenings, how many facilities had
screening tests positive for the targeted
mechanism(s)/organism(s)?
__________________________________
For example, if 2 inpatient rehabilitation facilities
conducted screening but only 1 facility detected the
targeted mechanism(s)/organism(s), then enter 1.
How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all inpatient rehabilitation
facilities during this response?
__________________________________
(If none, enter 0. If exact number not known,
please approximate.)
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 5 tests
detected Candida auris and 10 detected NDM. Enter C
auris=5 NDM=10).
04/24/2023 10:21am
__________________________________
projectredcap.org
Page 19
Did your health department or a designee conduct any
of the following?
In general, the initial onsite IC assessment should
include not only a review of policies, but also
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
Onsite infection control assessment
Remote infection control assessment
No assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
tele-ICAR tool or similar state/locally developed
tool.
Provision of onsite assistance may be done directly by
the recipient or through the support of a local health
department, academic partner, contractor, consultant,
or other entity (designee) for which the recipient can
assure the quality of services provided
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across all Inpatient rehabilitation
facilities during this response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
How many remote infection control assessments were
conducted across all Inpatient rehabilitation
facilities during this response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
04/24/2023 10:21am
Telephone
Video (i.e, Skype, Zoom)
projectredcap.org
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10d. Long-term acute care hospitals
How many long-term acute care hospitals (LTACHs) were
involved?
This includes the number of long-term acute care
hospitals where infected/colonized patients were
identified, screening was conducted, or onsite
assessments were performed.
If more than one LTACH was involved in the response,
how many LTACHs conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 LTACHs were involved in the response,
but only 2 conducted screening, enter 2.
How many screening tests were performed for all
targeted MDROs across all LTACHs during this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 50 and 60
screening tests were conducted, respectively. Enter C
auris=50 NDM=60).
Please select the reason(s) for not screening patients
in LTACHs [check all that apply]
Please specify other reason for not conducting any
screening.
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
If more than one LTACH conducted screenings, how many
facilities had screening tests positive for the
targeted mechanism(s)/organism(s)?
__________________________________
For example, if 2 LTACHs conducted screening but only
1 facility detected the targeted
mechanism(s)/organism(s), then enter 1.
How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all LTACHs during this response?
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
04/24/2023 10:21am
__________________________________
(If none, enter 0. If exact number not known,
please approximate.)
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If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 5 tests
detected Candida auris and 10 detected NDM. Enter C
auris=5 NDM=10).
Did your health department or a designee conduct any
of the following?
In general, the initial onsite IC assessment should
include not only a review of policies, but also
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
__________________________________
Onsite infection control assessment
Remote infection control assessment
No assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
tele-ICAR tool or similar state/locally developed
tool.
Provision of onsite assistance may be done directly by
the recipient or through the support of a local health
department, academic partner, contractor, consultant,
or other entity (designee) for which the recipient can
assure the quality of services provided
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across all LTACHs during this response?
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
How many remote infection control assessments were
conducted across all LTACHs during this response?
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
04/24/2023 10:21am
__________________________________
(If no onsite assessments performed, enter 0.)
__________________________________
(If no remote assessments performed, enter 0.)
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Please select the method in which the remote
assessment was conducted
Telephone
Video (i.e, Skype, Zoom)
10e. Ventilator capable nursing home/ skilled nursing facilities (vSNFs)
How many ventilator capable skilled nursing facilities
(vSNFs) were involved?
This includes the number of vSNF where
infected/colonized patients were identified, screening
was conducted, or onsite assessments were performed.
If more than one vSNF was involved in the response,
how many vSNFs conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 vSNFs were involved in the response, but
only 2 conducted screening, enter 2.
How many screening tests were performed for all
targeted MDROs across all vSNFs during this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 50 and 60
screening tests were conducted, respectively. Enter C
auris=50 NDM=60).
Please select the reason(s) for not screening patients
in vSNFs. [check all that apply]
Please specify other reason for not conducting any
screening.
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
If more than one vSNF conducted screenings, how many
facilities had screening tests positive for the
targeted mechanism(s)/organism(s)?
__________________________________
For example, if 2 vSNFs conducted screening but only 1
facility detected the targeted
mechanism(s)/organism(s), then enter 1.
04/24/2023 10:21am
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How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all vSNFs during this response?
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 5 tests
detected Candida auris and 10 detected NDM. Enter C
auris=5 NDM=10).
Did your health department or a designee conduct any
of the following?
In general, the initial onsite IC assessment should
include not only a review of policies, but also
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
__________________________________
(If none, enter 0. If exact number not known,
please approximate.)
__________________________________
Onsite infection control assessment
Remote infection control assessment
No assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
tele-ICAR tool or similar state/locally developed
tool.
Provision of onsite assistance may be done directly by
the recipient or through the support of a local health
department, academic partner, contractor, consultant,
or other entity (designee) for which the recipient can
assure the quality of services provided
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across all vSNFs during this response?
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
04/24/2023 10:21am
__________________________________
(If no onsite assessments performed, enter 0.)
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How many remote infection control assessments were
conducted across all vSNFs during this response?
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
__________________________________
(If no remote assessments performed, enter 0.)
Telephone
Video (i.e, Skype, Zoom)
10f. Nursing homes/ Skilled nursing facilities (non-ventilator capable)
How many NHs/SNFs were involved?
This includes the number of NH/SNF where
infected/colonized patients were identified, screening
was conducted, or onsite assessments were performed.
If more than one SNF was involved in the response, how
many SNFs conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 SNFs were involved in the response, but
only 2 conducted screening, enter 2.
How many screening tests were performed for all
targeted MDROs across all NH/SNFs during this
response?
__________________________________
(If no patients were screened, please enter 0)
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times. If exact number
screened not known, please approximate.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 50 and 60
screening tests were conducted, respectively. Enter C
auris=50 NDM=60).
Please select the reason(s) for not screening patients
in NH/SNFs [check all that apply]
Please specify other reason(s) for not conducting any
screening.
__________________________________
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
04/24/2023 10:21am
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Page 25
If more than one SNF conducted screenings, how many
facilities had screening tests positive for the
targeted mechanism(s)/organism(s)?
__________________________________
For example, if 2 SNFs conducted screening but only 1
facility detected the targeted
mechanism(s)/organism(s), then enter 1.
How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all NH/SNFs during this response?
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 5 tests
detected Candida auris and 10 detected NDM. Enter C
auris=5 NDM=10).
Did your health department or a designee conduct any
of the following?
In general, the initial onsite IC assessment should
include not only a review of policies, but also
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
__________________________________
(If none, enter 0. If exact number not known,
please approximate.)
__________________________________
Onsite infection control assessment
Remote infection control assessment
No assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
tele-ICAR tool or similar state/locally developed
tool.
Provision of onsite assistance may be done directly by
the recipient or through the support of a local health
department, academic partner, contractor, consultant,
or other entity (designee) for which the recipient can
assure the quality of services provided
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
04/24/2023 10:21am
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How many onsite infection control assessments were
conducted across all NH/SNFs during this response?
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
How many remote infection control assessments were
conducted across all NH/SNFs during this response?
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
__________________________________
(If no onsite assessments performed, enter 0.)
__________________________________
(If no remote assessments performed, enter 0.)
Telephone
Video (i.e, Skype, Zoom)
10g. Assisted Living Facility
How many assisted living facilities were involved?
This includes the number of intermediate care
facilities (ALFs) where infected/colonized patients
were identified, screening was conducted, or onsite
assessments were performed.
If more than one ALF was involved in the response, how
many ALFs conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 ALFs were involved in the response, but
only 2 conducted screening, enter 2.
How many screening tests were performed for all
targeted MDROs across all assisted living facilities
during this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 50 and 60
screening tests were conducted, respectively. Enter C
auris=50 NDM=60).
04/24/2023 10:21am
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
projectredcap.org
Page 27
Please select the reason(s) for not screening patients
in assisted living facilities [check all that apply]
Please specify other reason(s) for not conducting any
screening.
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
If more than one ALF conducted screenings, how many
facilities had screening tests positive for the
targeted mechanism(s)/organism(s)?
__________________________________
For example, if 2 ALFs conducted screening but only 1
facility detected the targeted
mechanism(s)/organism(s), then enter 1.
How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across allassisted living facilities during
this response?
__________________________________
(If none, enter 0. If exact number not known,
please approximate.)
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 5 tests
detected Candida auris and 10 detected NDM. Enter C
auris=5 NDM=10).
04/24/2023 10:21am
__________________________________
projectredcap.org
Page 28
Did your health department or a designee conduct any
of the following?
In general, the initial onsite IC assessment should
include not only a review of policies, but also
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
Onsite infection control assessment
Remote infection control assessment
No assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
tele-ICAR tool or similar state/locally developed
tool.
Provision of onsite assistance may be done directly by
the recipient or through the support of a local health
department, academic partner, contractor, consultant,
or other entity (designee) for which the recipient can
assure the quality of services provided
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across allassisted living facilities during
this response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
How many remote infection control assessments were
conducted across all assisted living facilities during
this response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
04/24/2023 10:21am
Telephone
Video (i.e, Skype, Zoom)
projectredcap.org
Page 29
10h. Other Congregate settings
How many congregate facilities
([pm2_congregate_type:checked]) were involved?
This includes the number of congregate facilities
where infected/colonized patients were identified,
screening was conducted, or onsite assessments were
performed.
If more than one congregate setting was involved in
the response, how many facilities conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 congregate settings were involved in the
response, but only 2 conducted screening, enter 2.
How many screening tests were performed for all
targeted MDROs across all congregate facilities during
this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 50 and 60
screening tests were conducted, respectively. Enter C
auris=50 NDM=60).
Please select the reason(s) for not screening patients
in other congregate facilities [check all that apply]
Please specify other reason(s) for not conducting any
screening.
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
If more than one congregate setting conducted
screenings, how many facilities had screening tests
positive for the targeted mechanism(s)/organism(s)?
__________________________________
For example, if 2 congregate settings conducted
screening but only 1 facility detected the targeted
mechanism(s)/organism(s), then enter 1.
04/24/2023 10:21am
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How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all congregate facilities during this
response?
__________________________________
(If none, enter 0. If exact number screened not
known, please approximate.)
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 5 tests
detected Candida auris and 10 detected NDM. Enter C
auris=5 NDM=10).
Did your health department or a designee conduct any
of the following?
In general, the initial onsite IC assessment should
include not only a review of policies, but also
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
__________________________________
Onsite infection control assessment
Remote infection control assessment
No assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
tele-ICAR tool or similar state/locally developed
tool.
Provision of onsite assistance may be done directly by
the recipient or through the support of a local health
department, academic partner, contractor, consultant,
or other entity (designee) for which the recipient can
assure the quality of services provided
Please specify reason for not conducting an online or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across all congregate settings during this
response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
04/24/2023 10:21am
projectredcap.org
Page 31
How many remote infection control assessments were
conducted across all congregate settings during this
response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
Telephone
Video (i.e, Skype, Zoom)
10i. Dialysis (Outpatient) Setting
How many dialysis (outpatient) facilities were
involved?
This includes the number of outpatient facilities
where infected/colonized patients were identified,
screening was conducted, or onsite assessments were
performed.
If more than one dialysis (outpatient) facility was
involved in the response, how many dialysis facilities
conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 outpatient dialysis facilities were
involved in the response, but only 2 conducted
screening, enter 2.
How many screening tests were performed for all
targeted MDROs accross all dialysis (outpatient)
facilities during this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 50 and 60
screening tests were conducted, respectively. Enter C
auris=50 NDM=60).
Please select the reason(s) for not screening patients
in dialysis (outpatient) facilities [check all that
apply]
Please specify other reason(s) for not conducting any
screening.
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
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If more than one outpatient dialysis facility
conducted screenings, how many facilities had
screening tests positive for the targeted
mechanism(s)/organism(s)?
__________________________________
For example, if 2 outpatient dialysis facilities
conducted screening but only 1 facility detected the
targeted mechanism(s)/organism(s), then enter 1.
How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all dialysis (outpatient) facilities
during this response?
__________________________________
(If none, enter 0. If exact number not known,
please approximate.)
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 5 tests
detected Candida auris and 10 detected NDM. Enter C
auris=5 NDM=10).
Did your health department or a designee conduct any
of the following?
In general, the initial onsite IC assessment should
include not only a review of policies, but also
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
__________________________________
Onsite infection control assessment
Remote infection control assessment
No assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
tele-ICAR tool or similar state/locally developed
tool.
Provision of onsite assistance may be done directly by
the recipient or through the support of a local health
department, academic partner, contractor, consultant,
or other entity (designee) for which the recipient can
assure the quality of services provided.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
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How many onsite infection control assessments were
conducted across all dialysis (outpatient) facilities
during this response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
How many remote infection control assessments were
conducted across all dialysis (outpatient) facilities
during this response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
Telephone
Video (i.e, Skype, Zoom)
10j. Dental Offices
How many dental offices were involved?
This includes the number of other facilities where
infected/colonized patients were identified, screening
was conducted, or onsite assessments were performed.
If more than one dental office was involved in the
response, how many dental facilities conducted
screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 dental offices were involved in the
response, but only 2 conducted screening, enter 2.
How many screening tests were performed for all
targeted MDROs accross all dental offices during this
response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 50 and 60
screening tests were conducted, respectively. Enter C
auris=50 NDM=60).
04/24/2023 10:21am
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
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Please select the reason(s) for not screening patients
in dental offices [check all that apply]
Please specify other reason(s) for not conducting any
screening.
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
If more than one dental office conducted screenings,
how many facilities had screening tests positive for
the targeted mechanism(s)/organism(s)?
__________________________________
For example, if 2 dental offices conducted screening
but only 1 facility detected the targeted
mechanism(s)/organism(s), then enter 1.
How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all dental offices during this
response?
__________________________________
(If none, enter 0. If exact number not known,
please approximate.)
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 5 tests
detected Candida auris and 10 detected NDM. Enter C
auris=5 NDM=10).
04/24/2023 10:21am
__________________________________
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Did your health department or a designee conduct any
of the following?
In general, the initial onsite IC assessment should
include not only a review of policies, but also
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
Onsite infection control assessment
Remote infection control assessment
No assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
tele-ICAR tool or similar state/locally developed
tool.
Provision of onsite assistance may be done directly by
the recipient or through the support of a local health
department, academic partner, contractor, consultant,
or other entity (designee) for which the recipient can
assure the quality of services provided
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across all dental offices during this
response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
How many remote infection control assessments were
conducted across all dental offices during this
response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
04/24/2023 10:21am
Telephone
Video (i.e, Skype, Zoom)
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Page 36
10k. Ambulatory Surgical Centers
How many ambulatory surgical centers were involved?
This includes the number of other facilities where
infected/colonized patients were identified, screening
was conducted, or onsite assessments were performed.
If more than one ambulatory surgical center was
involved in the response, how many dental facilities
conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 ambulatory surgical centers were
involved in the response, but only 2 conducted
screening, enter 2.
How many screening tests were performed for all
targeted MDROs accross all ambulatory surgical centers
during this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 50 and 60
screening tests were conducted, respectively. Enter C
auris=50 NDM=60).
Please select the reason(s) for not screening patients
at ambulatory surgical center(s) [check all that
apply]
Please specify other reason(s) for not conducting any
screening.
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
If more than one ambulatory surgical center conducted
screenings, how many facilities had screening tests
positive for the targeted mechanism(s)/organism(s)?
__________________________________
For example, if 2 ambulatory surgical centers
conducted screening but only 1 facility detected the
targeted mechanism(s)/organism(s), then enter 1.
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How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all other outpatient settings during
this response?
__________________________________
(If none, enter 0. If exact number not known,
please approximate.)
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 5 tests
detected Candida auris and 10 detected NDM. Enter C
auris=5 NDM=10).
Did your health department or a designee conduct any
of the following?
In general, the initial onsite IC assessment should
include not only a review of policies, but also
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
__________________________________
Onsite infection control assessment
Remote infection control assessment
No assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
tele-ICAR tool or similar state/locally developed
tool.
Provision of onsite assistance may be done directly by
the recipient or through the support of a local health
department, academic partner, contractor, consultant,
or other entity (designee) for which the recipient can
assure the quality of services provided
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across all ambulatory surgical centers
during this response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
04/24/2023 10:21am
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How many remote infection control assessments were
conducted across all ambulatory surgical centers
during this response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
Telephone
Video (i.e, Skype, Zoom)
10l. Other Outpatient settings
How many other outpatient settings were involved?
This includes the number of other facilities where
infected/colonized patients were identified, screening
was conducted, or onsite assessments were performed.
If more than one other outpatient settings was
involved in the response, how many outpatient
facilities conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 other outpatient settings were involved
in the response, but only 2 conducted screening, enter
2.
How many screening tests were performed for all
targeted MDROs accross all other outpatient settings
during this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 50 and 60
screening tests were conducted, respectively. Enter C
auris=50 NDM=60).
Please select the reason(s) for not screening patients
in other outpatient settings [check all that apply]
Please specify other reason(s) for not conducting any
screening.
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
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Page 39
If more than one other outpatient setting conducted
screenings, how many facilities had screening tests
positive for the targeted mechanism(s)/organism(s)?
__________________________________
For example, if 2 other outpatient settings conducted
screening but only 1 facility detected the targeted
mechanism(s)/organism(s), then enter 1.
How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all other outpatient settings during
this response?
__________________________________
(If none, enter 0. If exact number not known,
please approximate.)
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 5 tests
detected Candida auris and 10 detected NDM. Enter C
auris=5 NDM=10).
Did your health department or a designee conduct any
of the following?
In general, the initial onsite IC assessment should
include not only a review of policies, but also
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
__________________________________
Onsite infection control assessment
Remote infection control assessment
No assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
tele-ICAR tool or similar state/locally developed
tool.
Provision of onsite assistance may be done directly by
the recipient or through the support of a local health
department, academic partner, contractor, consultant,
or other entity (designee) for which the recipient can
assure the quality of services provided
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
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How many onsite infection control assessments were
conducted across all other outpatient settings during
this response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
How many remote infection control assessments were
conducted across all other outpatient settings during
this response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
Telephone
Video (i.e, Skype, Zoom)
10m. Other Settings
How many other facilities were involved?
This includes the number of other facilities where
infected/colonized patients were identified, screening
was conducted, or onsite assessments were performed.
If more than one other facility was involved in the
response, how many other facilities conducted
screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 other facilities were involved in the
response, but only 2 conducted screening, enter 2.
How many screening tests were performed for all
targeted MDROs accross all other facilities during
this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 50 and 60
screening tests were conducted, respectively. Enter C
auris=50 NDM=60).
04/24/2023 10:21am
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
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Please select the reason(s) for not screening patients
in other facilities [check all that apply]
Please specify other reason(s) for not conducting any
screening.
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
If more than one other facility conducted screenings,
how many facilities had screening tests positive for
the targeted mechanism(s)/organism(s)?
__________________________________
For example, if 2 ALFs conducted screening but only 1
facility detected the targeted
mechanism(s)/organism(s), then enter 1.
How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all other facilities during this
response?
__________________________________
(If none, enter 0. If exact number not known,
please approximate.)
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and NDM E. coli for which 5 tests
detected Candida auris and 10 detected NDM. Enter C
auris=5 NDM=10).
04/24/2023 10:21am
__________________________________
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Page 42
Did your health department or a designee conduct any
of the following?
In general, the initial onsite IC assessment should
include not only a review of policies, but also
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
Onsite infection control assessment
Remote infection control assessment
No assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
tele-ICAR tool or similar state/locally developed
tool.
Provision of onsite assistance may be done directly by
the recipient or through the support of a local health
department, academic partner, contractor, consultant,
or other entity (designee) for which the recipient can
assure the quality of services provided
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across all other facilities during this
response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
How many remote infection control assessments were
conducted across all other facilities during this
response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
04/24/2023 10:21am
Telephone
Video (i.e, Skype, Zoom)
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Page 43
Total case count
Q11. How many total patients with the target
mechanisms (for CPOs) or organisms (for C. auris) were
identified during this response? Include index
patients, those identified through colonization
screening, and any other patients identified on
prospective or retrospective surveillance
Q11a. If more than one targeted MDRO triggered the
response, specify the number of patients identified
for each organism/mechanism (e.g., targeted MDROs
included Candida auris and NDM E. coli for which 5 and
7 patients were identified, respectively. Enter C
auris=5; NDM=7).
Q11b. In which of the following age groups was
colonization or infection identified?
Note: This question does not ask the health
departments to collect any additional information or
perform colonization testing for HC personnel but to
report this information on healthcare personnel if it
is known
__________________________________
__________________________________
Patients/residents - Infant (0-2 years)
Patients/residents - Pediatric (3-17 years)
Patients/residents - Adults (18-64 years)
Patients/residents - Older adults (65+ years)
No colonization or infection were identified among
patients or residents
Unknown
Q11c. Was colonization or infection identified among any of the following groups during this investigation?
Note: This question does not ask the health departments to collect any additional information or perform
colonization testing for HC personnel but to report this information on healthcare personnel if it is known
Definitions
Direct care personnel -Care Providers Direct care personnel-Ancilliary Indirect care personnel Visitors
Physician Nurse Practitioners/Physician Assistants Registered Nurse Licensed Practical Nurse Certified Nursing
Assistants Respiratory therapist Physical/Occupation therapist Speech Therapist Dietary personnel Radiology
technicians Phlebotomists Registrars Volunteers Environmental Services Personnel Sterile Processing Department
Pharmacists Supply chain Patient/resident family members Hospice care providers Chaplains Resident personal
services (e.g., hair/nails)
Direct care personnel - care providers
Direct care personnel - ancillary
Indirect care personnel
Visitors
Other
None of the above
Unknown
Q11c (i). Specify the type of care provider:
04/24/2023 10:21am
Physician
Nurse Practitioners/Physician Assistants
Registered Nurse
Licensed Practical Nurse
Certified Nursing Assistants
Other
None of the above
Unknown
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Q11c (ii). Specify the type of ancilliary care
personnel:
Respiratory therapist
Physical/Occupation therapist
Speech Therapist
Dietary personnel
Radiology technicians
Phlebotomists
Registrars
Volunteers
Other
None of the above
Unknown
Q11c (iii). Specify the type of indirect care
personnel:
Environmental Services Personnel
Sterile Processing Department
Pharmacists
Supply chain
Others
None of the above
Unknown
Q11c (iv). Specify the type of Visitors/Contracted
Personnel:
Patient/resident family members
Hospice care providers
Chaplains
Resident personal services (e.g., hair/nails)
Others
None of the above
Unknown
Q11c (V). Please specify the "other" group in which
colonization or infection identified:
Q12. Was transmission within the healthcare facility
or facilities suspected in this investigation?
Q13. How many patients with other (i.e. non-targeted)
MDROs were identified during this investigation?
__________________________________
Yes
No
Unknown
__________________________________
This includes colonization or infection. Specify
organisms/mechanisms and number (e.g. if you
identified an additional 5 patients with infections or
colonization with VIM and 3 with C. auris, please
write: VIM=5; C. auris=3)
Q13b. In which of the following age groups was
colonization or infection identified?
Note: This question does not ask the health
departments to collect any additional information or
perform colonization testing for HC personnel but to
report this information on healthcare personnel if it
is known
04/24/2023 10:21am
Patients/residents - Infant (0-2 years)
Patients/residents - Pediatric (3-17 years)
Patients/residents - Adults (18-64 years)
Patients/residents - Older adults (65+ years)
No colonization or infection were identified among
patients or residents
Unknown
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Page 45
Q13c. Was colonization or infection identified among any of the following groups during this investigation?
Note: This question does not ask the health departments to collect any additional information or perform
colonization testing for HC personnel but to report this information on healthcare personnel if it is known
Definitions
Direct care personnel -Care Providers Direct care personnel-Ancilliary Indirect care personnel Visitors
Physician Nurse Practitioners/Physician Assistants Registered Nurse Licensed Practical Nurse Certified Nursing
Assistants Respiratory therapist Physical/Occupation therapist Speech Therapist Dietary personnel Radiology
technicians Phlebotomists Registrars Volunteers Environmental Services Personnel Sterile Processing Department
Pharmacists Supply chain Patient/resident family members Hospice care providers Chaplains Resident personal
services (e.g., hair/nails)
Direct care personnel - care providers
Direct care personnel - ancillary
Indirect care personnel
Visitors
Other
None of the above
Unknown
Q14. Were any of the isolates identified in this
response as pan-non-susceptible based on testing by
CDC or ARLN regional lab?
Yes
No
Unknown
For CRE, CRPA, and CRAB, this is defined as
non-susceptible to all available antibiotics based on
testing by CDC or ARLN regional lab.
For C. auris, this is defined as non-susceptible to
all available antifungals based on testing by CDC lab.
Q14a. If yes, please specify which organism and
mechanism combination was pan-non-susceptible.
__________________________________
Public health programs involved in investigation
Answer the following questions at the response level (i.e., for any setting affected and any
organism/mechanism combination).
Q15. Which public health programs contributed to the
response?
[check all that apply]
State/territorial health department HAI/AR program
HAI/AR program (Epi or Lab)
Local health department
Regional public health office
Regional public health staff (e.g., regional
office staff, remote staff strategically assigned
or placed to serve a designated geographic region
within the jurisdiction)
Other
Unknown
Q15a. Which entity had the responsibility of leading the overall AR containment response?
[Please ONLY select one option]
______
______
______
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04/24/2023
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______
______
Q15b. Other, specify:
Q16. Were other states involved in this response?
__________________________________
Yes
No
Don't know
Q16a. Please list other states involved:
__________________________________________
Q17. Were other jurisdictions such as other local
health departments/ state health department involved
in the response?
Yes
No
Unknown
Q17a. Please list other jurisdictions involved:
__________________________________________
Notifications
Q18. Notification types:
[check all that apply]
Patient notification: Patients were informed of
investigation or advised of potential exposure or
risk.
Patient notification
Provider notification
Public disclosure
None
Unknown
Provider notification: Providers were informed of the
investigation or advised of potential exposure or
risk.
Public disclosure: Members of the public were made
aware of the investigation through media reports or
other communication to the public.
Q18a. Approximate number of patients notified
[Optional]
__________________________________
Other investigation details
Q19. State lab specimen ID of index case
If specimen or isolate was tested at a Public Health
Laboratory, please enter the state laboratory
accession number. If multiple index cases triggered
the response, include at least one state laboratory
accession number. If the specimen was tested at a
regional lab, please include that ID. If isolate was
not tested at the Public Health Laboratory, please
input N/A
__________________________________
Page 47
Q20. Date of specimen collection of index case
If multiple index cases triggered the response,
include the first one.
Q21. Date target mechanism (for CPOs) or organism (for
C.auris) was identified
If multiple index cases triggered the response,
include the first one.
Q22. Were any of the staff contributing to this
investigation/consultation partially or fully funded
through the following funding mechanism:
[Select all that apply]
Q23. Additional notes/comments to CDC (any other
information that the HD would like to share about this
particular event)
04/24/2023 10:21am
__________________________________
(If exact date not known, please provide
approximate.)
__________________________________
(If exact date not known, please provide
approximate.)
G1
SHARP (SHARP includes Project 1 through 5)
Nursing Home/Other LTC Strike Team
Enhancing Detection Expansion/CARES
None of the above
Unknown
__________________________________________
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HAI/AR Response & Prevention Performance Measures 2022-2023
Page 48
HARP PM3: HAI (Non-nMDRO) And COVID-19 Responses
HARP PM3: HAI (non-nMDRO) and COVID-19 Responses
(This PM now includes COVID-19 responses in healthcare settings [Formerly reported in E.25])
HAI/AR Response and Prevention (HARP) PM3 has been restructured to align reporting across G1, American Rescue
Plan (SHARP Project I, NH Strike Teams), and COVID-19 Supplements for Healthcare IPC activities.
Please report HAI (non-MDRO) investigations or consultations conducted by either
Staff from HAI/AR Program or their designee* (regardless of funding source), or Staff partially or fully funded
through one of the following mechanisms who contributed to the response. G1 SHARP (SHARP includes project 1
through 5) Nursing Home/Other LTC Strike Team This measure is due twice annually: Mid-period (Due: January 31st
, 2023) and end of the reporting period (Due: August 31st , 2023)
Data entry instructions
Please enter one REDCap form for each HAI response including that took place during the reporting period: August
1, 2022, through December 31, 2022. To add a new response in REDCap, click "Save and Add New Instance." For
continuing responses please ensure all the data entered are cumulative irrespective of the reporting period. The
reporting form is programmed to display a subset of questions based on the answer to Question #3 and Question #4
An excel-based upload tool for tracking and uploading HAI consultations* and COVID-19 responses is available under
the Bulk Upload section of this project. Health departments can either use this REDCap form OR the excel-based
upload tool for reporting HAI consultations and SARS-CoV-2 responses. At this time, for reporting HAI investigations*
the REDCap form must be used. Mixed outbreaks involving SARS-CoV-2 and nMDROs should be reported in PM2.
Additional Resources
For information on where to enter response activities please refer to the Where to submit HAI/AR Response-Related
Activities section (Page 8) of the "ELC HAIAR Performance Measure Reporting Guide 2022-2023" For guidance on
completing HAI and COVID-19 response performance measure please refer to the Additional Guidance to Complete
the HARP PM3 Reporting Form section (Page 18) of the "ELC HAIAR Performance Measure Reporting Guide
2022-2023" * Designee includes personnel employed by or contracted by the recipient at the state, or regional, or
local levels.
[Attachment: "ELC HAIAR Performance Measure Reporting Guide 2022-2023.pdf"]
Reported through excel-based tracking tool/Imported
into REDCap
Yes
HARP PM3: HAI (non-nMDRO) and COVID-19 Responses. Please enter one REDCap form for
each HAI (non-nMDRO) response that took place during the reporting period: August 1, 2022 December 31, 2022.
Q1. Local response/outbreak ID
ID for cross-referencing with your local tracking tool
as needed. May use any unique identifier.
Q2. Response Start Date
Date when the health department first made the
decision to start the investigation.
04/24/2023 10:21am
__________________________________
__________________________________
(If exact date not known, please approximate.)
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Q3. Did you perform (or provide significant technical
assistance with) any of the following activities for
this response?
Note: When considering whether substantial assistance
was provided, judgment can be applied (refer to Page 8
of the PM reporting guide for more information)
Q4. Is this a response to a COVID-19 outbreak in a
health care setting (i.e. A COVID-19 outbreak is
defined as any event that met the CSTE/CORHA or other
jurisdiction-specific threshold for an outbreak).
Onsite for any reason
Remote IPC assessment
Patient notification
Environmental sampling
Screening/ testing
None of the above
Yes
No
Unknown
Please refer to the following link for more
information regarding the CSTE/CORHA outbreak
threshold: CSTE/CORHA HC Outbreak Definition
Q5. Is this a new response or is it a continuing
response reported during previous reporting period
(prior to Aug 1, 2021)?
New response
Continuing response
For continuing responses, please do not complete a new form.
Navigate to the existing record in the record status dashboard, Select "continuing response" in Q0 of the existing
record, and Update the existing record. All data entered should be cumulative to date (regardless of reporting
period).
Q6. During which reporting period did the health
department engage in activities related to this
response?
January 1, 2022 - July 31, 2022
August 1, 2022 - December 31, 2022
January 1, 2023 - July 31, 2023
[check all that apply]
Epidemiological investigation
Q7. Did this response involve any of the following
issues:
[Check all that apply]
Q7a. Type of medical device:
[Optional]
Q7b. Type of product:
[Optional]
04/24/2023 10:21am
Injection safety breach (other than drug diversion)
Drug diversion
Medical device reprocessing breach
Medical product contamination other than device,
extrinsic (facility)
Medical product or device contamination, intrinsic
(pre-facility)
Environmental cleaning and disinfection issue
Facility water issue
Foodborne illness
Other
None of the above
Unknown
__________________________________
__________________________________
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Q7c. Type of product:
[Optional]
Q7d. Other, specify:
Q8. In this response, were there any
outbreak-associated patient or healthcare personnel
colonization or infections identified (this includes
confirmed or probable cases)
Q8a. Number of cases (include confirmed and probable
cases)
Q8b. In which of the following age groups was
colonization or infection identified?
Note: This question does not ask the health
departments to collect any additional information or
perform colonization testing for HC personnel but to
report this information on healthcare personnel if it
is known
__________________________________
__________________________________
Yes
No
Unknown
__________________________________
(If not known, please approximate and use the
comments field to explain further, as needed.
Please enter 0 if no cases identified.)
Patients/residents - Infant (0-2 years)
Patients/residents - Pediatric (3-17 years)
Patients/residents - Adults (18-64 years)
Patients/residents - Older adults (65+ years)
No colonization or infection were identified among
patients or residents
Unknown
Q8c. Was colonization or infection identified among any of the following groups during this investigation?
Note: This question does not ask the health departments to collect any additional information or perform
colonization testing for HC personnel but to report this information on healthcare personnel if it is known
Definitions
Direct care personnel-Care Providers Direct care personnel-Ancilliary Indirect care personnel Visitors
Physician Nurse Practitioners/Physician Assistants Registered Nurse Licensed Practical Nurse Certified Nursing
Assistants Respiratory therapist Physical/Occupation therapist Speech Therapist Dietary personnel Radiology
technicians Phlebotomists Registrars Volunteers Environmental Services Personnel Sterile Processing Department
Pharmacists Supply chain Patient/resident family members Hospice care providers Chaplains Resident personal
services (e.g., hair/nails)
Direct care personnel - Care Providers
Direct care personnel - Ancillary
Indirect care personnel
Visitors
Other
None of the above
Unknown
Q8c (i). Specify the type of care provider:
04/24/2023 10:21am
Physician
Nurse Practitioners/Physician Assistants
Registered Nurse
Licensed Practical Nurse
Certified Nursing Assistants
Other
None of the above
Unknown
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Q8c (ii). Specify the type of ancilliary care
personnel:
Respiratory therapist
Physical/Occupation therapist
Speech Therapist
Dietary personnel
Radiology technicians
Phlebotomists
Registrars
Volunteers
Other
None of the above
Unknown
Q8c (iii). Specify the type of indirect care
personnel:
Environmental Services Personnel
Sterile Processing Department
Pharmacists
Supply chain
Others
None of the above
Unknown
Q8c (iv). Specify the type of Visitors/Contracted
Personnel:
Patient/resident family members
Hospice care providers
Chaplains
Resident personal services (e.g., hair/nails)
Others
None of the above
Unknown
Q8c (v). Please specify the "other" group in which
colonization or infection identified:
Q9. Infection type(s):
[Check all that apply]
Q9a. Other, please specify:
[Optional]
__________________________________
No infection identified
Gastrointestinal
Respiratory tract
Blood stream
Surgical site
Skin/soft tissue
Eye
Urinary tract
Neurological
Other
Unknown
__________________________________
Q10. Number of potentially exposed patients:
Please provide an approximate number, if unknown please select the "unknown" checkbox option
*must provide value
______
______
04/24/2023 10:21am
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Q11. Was transmission within a healthcare facility
suspected in this investigation (including
colonization or infection)?
Yes
No
Unknown/unclear
Q12. Did this outbreak (of non-COVID
pathogens/infections) occur at the same time as a
COVID-19 outbreak in the same unit/facility?
Yes
No
Unknown
04/24/2023 10:21am
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Q13. Primary organism identified
Select the most common organism identified. Choose the
most specific choice available.
04/24/2023 10:21am
Achromobacter spp.
Acinetobacter spp.
Adenovirus
Aspergillus spp.
Bacillus spp.
Burkholderia Spp.
Candida auris
Candida spp. (not including Candida auris)
Citrobacter spp.
Creutzfeldt-Jakob disease (CJD)
Clostridioides difficile
Clostridioides perfringens
Clostridioides sordelli
Clostridioides spp. (not including Clostridioides
difficile)
Cytomegalo virus
Cryptococcus neoformans
Ebola virus
Elizabethkingia spp.
Enterobacter sakazakii
Enterobacter spp.
Enterococcus spp.
Enterovirus spp.
Escherichia coli
Escherichia spp. (not including E. coli)
Hepatitis A
Hepatitis B
Hepatitis C
Human immunodeficiency virus (HIV)
Influenza virus
Klebsiella spp.
Legionella spp.
Listeria spp.
Measles virus
Middle East respiratory syndrome-coronavirus
(MERS-Cov)
Monkeypox virus
Mucor spp.
Mycobacterium tuberculosis
Nontuberculous Mycobacteria (NTM)
Norovirus
Pantoea spp.
Propionibacterium spp.
Proteus spp.
Providencia spp.
Pseudomonas spp.
Ralstonia spp.
Respiratory Syncytial virus
Rhodococcus spp.
Salmonella spp.
SARS-CoV-2
Serratia spp.
Staphylococcus aureus (methicillin resistant) MRSA
Staphylococcus aureus (methicillin susceptible) MSSA
Staphylococcus aureus (methicillin resistance
unknown)
Staphylococcus spp. (not including Staphylococcus
aureus)
Stenotrophomonas spp.
Streptococcus pyogenes (Group A strep)
Streptococcus agalactiae (Group B strep)
Streptococcus spp. (not including Streptococcus
pyogenes or Streptococcus agalactiae)
Zika virus
Other
No organism identified
Not applicable projectredcap.org
Unknown
Q13a. Other organism(s) identified:
[Optional]
13b. Is this organism a novel or targeted MDRO
(nMDRO)?
__________________________________
(Please list up to 3 other organisms identified in
the response. Each organism name should be
separated by a semicolon. )
Yes
No
Unknown
If this is an nMDRO investigation, please report in PM2 instead of PM3
Facility/Setting Information
Q14. Setting Type(s): Select settings affected (where
infections identified, screening conducted, onsite
assessments were performed, etc.).
[Check all that apply]
Q14a. Location within the facility, if applicable
[Optional, Check all that apply]
Q14a (i). Intensive care unit type:
[Optional, Check all that apply]
Q13a(ii). Location within the facility, if other,
specify:
Acute care hospital
Critical access hospital
Inpatient rehabilitation facility
Long-term acute care hospital
Nursing home/skilled nursing facility
Ventilator-capable nursing home/skilled nursing
facility (vSNF)
Assisted living facility
Other Congregate settings (e.g., group homes,
homeless shelter)
Dialysis (outpatient)
Dental office
Ambulatory Surgical Center
Other outpatient setting
Other healthcare settings
Unknown
Intensive care unit
Burn unit
Oncology unit
Dialysis unit
Operating room
Emergency department
Transplant unit
Labor and delivery
Medical unit
Surgical unit
Rehab unit
Unknown
Other
General
Medical care
Surgical
Neuro
Neonatal intensive care unit (NICU)
Pediatric intensive care unit (PICU)
Other, specify
__________________________________
Page 55
Q14b. Please select the types of congregate settings
[check all that apply]
Q14c. Please select the other outpatient setting type
and services provided.
[check all that apply]
Q14d. Other setting, specify:
[Optional]
Q15a. ZIP code of the primary outbreak facility (i.e.,
If this response activity includes facilities in more
than 1 zip code, please include the zip code of the
facility where the majority of the health department
response activity occurred)
Q15b. Were any of the involved facilities a tribally
owned facility or a part of the Indian Health Service:
Group home
Homeless shelter
Prison
School
Migrant shelter
Independent Living Facility
Emergency shelters (other than homeless shelters)
Other
Urology
Endoscopy
Ambulatory surgery
Wound clinic
Pain clinic
Home health
Oncology
Federally Qualified Health Centers (FQHC)
Dermatology
Other
__________________________________
__________________________________
Yes
No
Unknown
Infection Control Assessment
Please note provision of onsite or remote assistance to assess infection control issues may be
done directly by the Recipient or through the support of a local health department, academic
partner, contractor, consultant, or other entity (designee) for which the Recipient can assure
the quality of services provided.
Acute Care Hospitals
Q16. How many acute care hospitals (ACHs) were
involved?
04/24/2023 10:21am
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
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Q16a. Did your health department or a designee provide
onsite assistance (meeting with healthcare facility
leadership, observing infection control practices,
reviewing infection control policies and procedures
manual, discuss control measures, etc.) ?
Yes
No
Unknown
Note: Provision of onsite assistance may be done
directly by the recipient or through the support of a
local health department, academic partner, contractor,
consultant, or other entity (designee) for which the
recipient can assure the quality of services provided
Q16a. Did your health department or a designee provide
an onsite infection control assessment ?
Q16a(i). How many onsite visits included infection
control assessments?
In general, the initial IC assessment should include
not only a review of policies, but also observations
of key IC practices such as hand hygiene, PPE use,
environmental cleaning and disinfection, sink hygiene,
and inter-facility communication process.
Yes
No
Unknown
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
Q16b. Did your health department or a designee provide
remote assistance (meeting remotely with healthcare
facility leadership, reviewing infection control
policies and procedures manual, discuss control
measures, etc.) ?
Yes
No
Unknown
Q16b. Did your health department or a designee provide
a remote infection control assessment?
Yes
No
Unknown
Q16b(i). How many remote visits included infection
control assessments?
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
04/24/2023 10:21am
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Infection Control Assessment
Please note provision of onsite or remote assistance to assess infection control issues may be
done directly by the Recipient or through the support of a local health department, academic
partner, contractor, consultant, or other entity (designee) for which the Recipient can assure
the quality of services provided.
Critical Access Hospital
Q16. How many critical access hospitals were involved?
Q16a. Did your health department or a designee provide
onsite assistance (meeting with healthcare facility
leadership, observing infection control practices,
reviewing infection control policies and procedures
manual, discuss control measures, etc.) ?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Yes
No
Unknown
Note: Provision of onsite assistance may be done
directly by the recipient or through the support of a
local health department, academic partner, contractor,
consultant, or other entity (designee) for which the
recipient can assure the quality of services provided
Q16a. Did your health department or a designee provide
an onsite infection control assessment ?
Q16a(i). How many onsite visits included infection
control assessments?
In general, the initial IC assessment should include
not only a review of policies, but also observations
of key IC practices such as hand hygiene, PPE use,
environmental cleaning and disinfection, sink hygiene,
and inter-facility communication process.
Yes
No
Unknown
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
Q16b. Did your health department or a designee provide
remote assistance (meeting remotely with healthcare
facility leadership, reviewing infection control
policies and procedures manual, discuss control
measures, etc.) ?
04/24/2023 10:21am
Yes
No
Unknown
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Q16b. Did your health department or a designee provide
a remote infection control assessment?
Q16b(i). How many remote visits included infection
control assessments?
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
Yes
No
Unknown
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Infection Control Assessment
Please note provision of onsite or remote assistance to assess infection control issues may be
done directly by the Recipient or through the support of a local health department, academic
partner, contractor, consultant, or other entity (designee) for which the Recipient can assure
the quality of services provided.
Inpatient Rehabilitation Facilities
Q16. How many Inpatient rehabilitation facilities
(IRFs) were involved?
Q16a. Did your health department or a designee provide
onsite assistance (meeting with healthcare facility
leadership, observing infection control practices,
reviewing infection control policies and procedures
manual, discuss control measures, etc.) ?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Yes
No
Unknown
Note: Provision of onsite assistance may be done
directly by the recipient or through the support of a
local health department, academic partner, contractor,
consultant, or other entity (designee) for which the
recipient can assure the quality of services provided
Q16a. Did your health department or a designee provide
an onsite infection control assessment ?
04/24/2023 10:21am
Yes
No
Unknown
projectredcap.org
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Q16a(i). How many onsite visits included infection
control assessments?
In general, the initial IC assessment should include
not only a review of policies, but also observations
of key IC practices such as hand hygiene, PPE use,
environmental cleaning and disinfection, sink hygiene,
and inter-facility communication process.
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
Q16b. Did your health department or a designee provide
remote assistance (meeting remotely with healthcare
facility leadership, reviewing infection control
policies and procedures manual, discuss control
measures, etc.) ?
Yes
No
Unknown
Q16b. Did your health department or a designee provide
a remote infection control assessment?
Yes
No
Unknown
Q16b(i). How many remote visits included infection
control assessments?
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Infection Control Assessment
Please note provision of onsite or remote assistance to assess infection control issues may be
done directly by the Recipient or through the support of a local health department, academic
partner, contractor, consultant, or other entity (designee) for which the Recipient can assure
the quality of services provided.
Long-term acute care hospitals
04/24/2023 10:21am
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Q16. How many long-term acute care hospitals (LTACHs)
were involved?
Q16a(i). How many onsite visits included infection
control assessments?
In general, the initial IC assessment should include
not only a review of policies, but also observations
of key IC practices such as hand hygiene, PPE use,
environmental cleaning and disinfection, sink hygiene,
and inter-facility communication process.
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
Q16a. Did your health department or a designee provide
onsite assistance (meeting with healthcare facility
leadership, observing infection control practices,
reviewing infection control policies and procedures
manual, discuss control measures, etc.) ?
Yes
No
Unknown
Note: Provision of onsite assistance may be done
directly by the recipient or through the support of a
local health department, academic partner, contractor,
consultant, or other entity (designee) for which the
recipient can assure the quality of services provided
Q16b. Did your health department or a designee provide
remote assistance (meeting remotely with healthcare
facility leadership, reviewing infection control
policies and procedures manual, discuss control
measures, etc.) ?
Yes
No
Unknown
Q16a. Did your health department or a designee provide
an onsite infection control assessment ?
Yes
No
Unknown
Q16b. Did your health department or a designee provide
a remote infection control assessment?
Yes
No
Unknown
04/24/2023 10:21am
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Q16b(i). How many remote visits included infection
control assessments?
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Infection Control Assessment
Please note provision of onsite or remote assistance to assess infection control issues may be
done directly by the Recipient or through the support of a local health department, academic
partner, contractor, consultant, or other entity (designee) for which the Recipient can assure
the quality of services provided.
Nursing home/skilled nursing facilities
Q16. How many nursing home/skilled nursing facilities
(SNFs) were involved?
Q16a. Did your health department or a designee provide
onsite assistance (meeting with healthcare facility
leadership, observing infection control practices,
reviewing infection control policies and procedures
manual, discuss control measures, etc.) ?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Yes
No
Unknown
Note: Provision of onsite assistance may be done
directly by the recipient or through the support of a
local health department, academic partner, contractor,
consultant, or other entity (designee) for which the
recipient can assure the quality of services provided
Q16a. Did your health department or a designee provide
an onsite infection control assessment?
04/24/2023 10:21am
Yes
No
Unknown
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Q16a(i). How many onsite visits included infection
control assessments?
In general, the initial IC assessment should include
not only a review of policies, but also observations
of key IC practices such as hand hygiene, PPE use,
environmental cleaning and disinfection, sink hygiene,
and inter-facility communication process.
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
Q16b. Did your health department or a designee provide
remote assistance (meeting remotely with healthcare
facility leadership, reviewing infection control
policies and procedures manual, discuss control
measures, etc.) ?
Yes
No
Unknown
Q16b. Did your health department or a designee provide
a remote infection control assessment?
Yes
No
Unknown
Q16b(i). How many remote visits included infection
control assessments?
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Infection Control Assessment
Please note provision of onsite or remote assistance to assess infection control issues may be
done directly by the Recipient or through the support of a local health department, academic
partner, contractor, consultant, or other entity (designee) for which the Recipient can assure
the quality of services provided.
Ventilator-capable nursing home/skilled nursing facilities (vSNFs)
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Page 63
Q16. How many ventilator-capable nursing home/skilled
nursing facility (vSNFs) were involved?
Q16a. Did your health department or a designee provide
onsite assistance (meeting with healthcare facility
leadership, observing infection control practices,
reviewing infection control policies and procedures
manual, discuss control measures, etc.) ?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Yes
No
Unknown
Note: Provision of onsite assistance may be done
directly by the recipient or through the support of a
local health department, academic partner, contractor,
consultant, or other entity (designee) for which the
recipient can assure the quality of services provided
Q16a. Did your health department or a designee provide
an onsite infection control assessment?
Q16a(i). How many onsite visits included infection
control assessments?
In general, the initial IC assessment should include
not only a review of policies, but also observations
of key IC practices such as hand hygiene, PPE use,
environmental cleaning and disinfection, sink hygiene,
and inter-facility communication process.
Yes
No
Unknown
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
Q16b. Did your health department or a designee provide
remote assistance (meeting remotely with healthcare
facility leadership, reviewing infection control
policies and procedures manual, discuss control
measures, etc.) ?
Yes
No
Unknown
Q16b. Did your health department or a designee provide
a remote infection control assessment?
Yes
No
Unknown
04/24/2023 10:21am
projectredcap.org
Page 64
Q16b(i). How many remote visits included infection
control assessments?
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Infection Control Assessment
Please note provision of onsite or remote assistance to assess infection control issues may be
done directly by the Recipient or through the support of a local health department, academic
partner, contractor, consultant, or other entity (designee) for which the Recipient can assure
the quality of services provided.
Assisted Living Facilities
Q16. How many assisted living facilities were
involved?
Q16a. Did your health department or a designee provide
onsite assistance (meeting with healthcare facility
leadership, observing infection control practices,
reviewing infection control policies and procedures
manual, discuss control measures, etc.) ?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Yes
No
Unknown
Note: Provision of onsite assistance may be done
directly by the recipient or through the support of a
local health department, academic partner, contractor,
consultant, or other entity (designee) for which the
recipient can assure the quality of services provided
Q16a. Did your health department or a designee provide
an onsite infection control assessment?
04/24/2023 10:21am
Yes
No
Unknown
projectredcap.org
Page 65
Q16a(i). How many onsite visits included infection
control assessments?
In general, the initial IC assessment should include
not only a review of policies, but also observations
of key IC practices such as hand hygiene, PPE use,
environmental cleaning and disinfection, sink hygiene,
and inter-facility communication process.
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
Q16b. Did your health department or a designee provide
remote assistance (meeting remotely with healthcare
facility leadership, reviewing infection control
policies and procedures manual, discuss control
measures, etc.) ?
Yes
No
Unknown
Q16b. Did your health department or a designee provide
a remote infection control assessment?
Yes
No
Unknown
Q16b(i). How many remote visits included infection
control assessments?
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Infection Control Assessment
Please note provision of onsite or remote assistance to assess infection control issues may be
done directly by the Recipient or through the support of a local health department, academic
partner, contractor, consultant, or other entity (designee) for which the Recipient can assure
the quality of services provided.
Other Congregate settings (e.g., group homes, homeless shelter, prison, school)
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Q16. How many other Congregate settings (e.g., group
homes, homeless shelter, prison, school) were
involved?
Q16a. Did your health department or a designee provide
onsite assistance (meeting with healthcare facility
leadership, observing infection control practices,
reviewing infection control policies and procedures
manual, discuss control measures, etc.) ?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Yes
No
Unknown
Note: Provision of onsite assistance may be done
directly by the recipient or through the support of a
local health department, academic partner, contractor,
consultant, or other entity (designee) for which the
recipient can assure the quality of services provided
Q16a. Did your health department or a designee provide
an onsite infection control assessment?
Q16a(i). How many onsite visits included infection
control assessments?
In general, the initial IC assessment should include
not only a review of policies, but also observations
of key IC practices such as hand hygiene, PPE use,
environmental cleaning and disinfection, sink hygiene,
and inter-facility communication process.
Yes
No
Unknown
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
Q16b. Did your health department or a designee provide
remote assistance (meeting remotely with healthcare
facility leadership, reviewing infection control
policies and procedures manual, discuss control
measures, etc.) ?
Yes
No
Unknown
Q16b. Did your health department or a designee provide
a remote infection control assessment?
Yes
No
Unknown
04/24/2023 10:21am
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Page 67
Q16b(i). How many remote visits included infection
control assessments?
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Infection Control Assessment
Please note provision of onsite or remote assistance to assess infection control issues may be
done directly by the Recipient or through the support of a local health department, academic
partner, contractor, consultant, or other entity (designee) for which the Recipient can assure
the quality of services provided.
Dialysis (outpatient)
Q16. How many outpatient dialysis facilities were
involved?
Q16a. Did your health department or a designee provide
onsite assistance (meeting with healthcare facility
leadership, observing infection control practices,
reviewing infection control policies and procedures
manual, discuss control measures, etc.) ?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Yes
No
Unknown
Note: Provision of onsite assistance may be done
directly by the recipient or through the support of a
local health department, academic partner, contractor,
consultant, or other entity (designee) for which the
recipient can assure the quality of services provided
Q16a. Did your health department or a designee provide
an onsite infection control assessment?
04/24/2023 10:21am
Yes
No
Unknown
projectredcap.org
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Q16a(i). How many onsite visits included infection
control assessments?
In general, the initial IC assessment should include
not only a review of policies, but also observations
of key IC practices such as hand hygiene, PPE use,
environmental cleaning and disinfection, sink hygiene,
and inter-facility communication process.
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
Q16b. Did your health department or a designee provide
remote assistance (meeting remotely with healthcare
facility leadership, reviewing infection control
policies and procedures manual, discuss control
measures, etc.) ?
Yes
No
Unknown
Q16b. Did your health department or a designee provide
a remote infection control assessment?
Yes
No
Unknown
Q16b(i). How many remote visits included infection
control assessments?
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Infection Control Assessment
Please note provision of onsite or remote assistance to assess infection control issues may be
done directly by the Recipient or through the support of a local health department, academic
partner, contractor, consultant, or other entity (designee) for which the Recipient can assure
the quality of services provided.
Dental Offices
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Q16. How many dental offices were involved?
Q16a. Did your health department or a designee provide
onsite assistance (meeting with healthcare facility
leadership, observing infection control practices,
reviewing infection control policies and procedures
manual, discuss control measures, etc.) ?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Yes
No
Unknown
Note: Provision of onsite assistance may be done
directly by the recipient or through the support of a
local health department, academic partner, contractor,
consultant, or other entity (designee) for which the
recipient can assure the quality of services provided
Q16a. Did your health department or a designee provide
an onsite infection control assessment?
Q16a(i). How many onsite visits included infection
control assessments?
In general, the initial IC assessment should include
not only a review of policies, but also observations
of key IC practices such as hand hygiene, PPE use,
environmental cleaning and disinfection, sink hygiene,
and inter-facility communication process.
Yes
No
Unknown
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
Q16b. Did your health department or a designee provide
remote assistance (meeting remotely with healthcare
facility leadership, reviewing infection control
policies and procedures manual, discuss control
measures, etc.) ?
Yes
No
Unknown
Q16b. Did your health department or a designee provide
a remote infection control assessment?
Yes
No
Unknown
04/24/2023 10:21am
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Page 70
Q16b(i). How many remote visits included infection
control assessments?
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Infection Control Assessment
Please note provision of onsite or remote assistance to assess infection control issues may be
done directly by the Recipient or through the support of a local health department, academic
partner, contractor, consultant, or other entity (designee) for which the Recipient can assure
the quality of services provided.
Ambulatory Surgical Centers
Q16. How many ambulatory surgical centers were
involved?
Q16a. Did your health department or a designee provide
onsite assistance (meeting with healthcare facility
leadership, observing infection control practices,
reviewing infection control policies and procedures
manual, discuss control measures, etc.) ?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Yes
No
Unknown
Note: Provision of onsite assistance may be done
directly by the recipient or through the support of a
local health department, academic partner, contractor,
consultant, or other entity (designee) for which the
recipient can assure the quality of services provided
Q16a. Did your health department or a designee provide
an onsite infection control assessment?
04/24/2023 10:21am
Yes
No
Unknown
projectredcap.org
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Q16a(i). How many onsite visits included infection
control assessments?
In general, the initial IC assessment should include
not only a review of policies, but also observations
of key IC practices such as hand hygiene, PPE use,
environmental cleaning and disinfection, sink hygiene,
and inter-facility communication process.
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
Q16b. Did your health department or a designee provide
remote assistance (meeting remotely with healthcare
facility leadership, reviewing infection control
policies and procedures manual, discuss control
measures, etc.) ?
Yes
No
Unknown
Q16b. Did your health department or a designee provide
a remote infection control assessment?
Yes
No
Unknown
Q16b(i). How many remote visits included infection
control assessments?
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Infection Control Assessment
Please note provision of onsite or remote assistance to assess infection control issues may be
done directly by the Recipient or through the support of a local health department, academic
partner, contractor, consultant, or other entity (designee) for which the Recipient can assure
the quality of services provided.
Other outpatient settings
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Q16. How many other outpatient facilities were
involved?
Q16a. Did your health department or a designee provide
onsite assistance (meeting with healthcare facility
leadership, observing infection control practices,
reviewing infection control policies and procedures
manual, discuss control measures, etc.) ?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Yes
No
Unknown
Note: Provision of onsite assistance may be done
directly by the recipient or through the support of a
local health department, academic partner, contractor,
consultant, or other entity (designee) for which the
recipient can assure the quality of services provided
Q16a. Did your health department or a designee provide
an onsite infection control assessment?
Q16a(i). How many onsite visits included infection
control assessments?
In general, the initial IC assessment should include
not only a review of policies, but also observations
of key IC practices such as hand hygiene, PPE use,
environmental cleaning and disinfection, sink hygiene,
and inter-facility communication process.
Yes
No
Unknown
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
Q16b. Did your health department or a designee provide
remote assistance (meeting remotely with healthcare
facility leadership, reviewing infection control
policies and procedures manual, discuss control
measures, etc.) ?
Yes
No
Unknown
Q16b. Did your health department or a designee provide
a remote infection control assessment?
Yes
No
Unknown
04/24/2023 10:21am
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Q16b(i). How many remote visits included infection
control assessments?
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Infection Control Assessment
Please note provision of onsite or remote assistance to assess infection control issues may be
done directly by the Recipient or through the support of a local health department, academic
partner, contractor, consultant, or other entity (designee) for which the Recipient can assure
the quality of services provided.
Other settings
Q16. How many Other facilities were involved?
Q16a. Did your health department or a designee provide
onsite assistance (meeting with healthcare facility
leadership, observing infection control practices,
reviewing infection control policies and procedures
manual, discuss control measures, etc.) ?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Yes
No
Unknown
Note: Provision of onsite assistance may be done
directly by the recipient or through the support of a
local health department, academic partner, contractor,
consultant, or other entity (designee) for which the
recipient can assure the quality of services provided
Q16a. Did your health department or a designee provide
an onsite infection control assessment?
04/24/2023 10:21am
Yes
No
Unknown
projectredcap.org
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Q16a(i). How many onsite visits included infection
control assessments?
In general, the initial IC assessment should include
not only a review of policies, but also observations
of key IC practices such as hand hygiene, PPE use,
environmental cleaning and disinfection, sink hygiene,
and inter-facility communication process.
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat on-site visits as long
as some form of IC practice assessment occurs during
that visit (e.g., not just an update about case
counts). In some instances, both remote and on-site
visits may have occurred with a facility, and this
should be reflected accordingly among the different
assessment types.
Q16b. Did your health department or a designee provide
remote assistance (meeting remotely with healthcare
facility leadership, reviewing infection control
policies and procedures manual, discuss control
measures, etc.) ?
Yes
No
Unknown
Q16b. Did your health department or a designee provide
a remote infection control assessment?
Yes
No
Unknown
Q16b(i). How many remote visits included infection
control assessments?
In general, the initial remote IC assessment should
include a review of key IC policies and practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and on-site visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Public Health Programs Involved in Investigation
Q17. Which public health programs contributed to the
response?
[Check all that apply]
State/Territorial health department HAI/AR program
HAI/AR program (Epi or Lab)
Local health department
Regional public health office
Regional public health staff (e.g., regional
office staff, remote staff strategically assigned
or placed to serve a designated geographic region
within the jurisdiction)
Other
Unknown
Q17(i). Which entity had the responsibility of leading the overall HAI/AR response?
[Please ONLY select one option]
______
______
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______
______
______
______
______
Q18c. Other, specify:
[Optional]
Q18. Were other states involved in this response?
__________________________________
Yes
No
Unknown
Q18a. Other states involved, additional comments:
[Optional]
Q18. Were other jurisdictions such as other local
health departments/ state health department involved
in the response?
__________________________________________
Yes
No
Unknown
Q18a. Please list other jurisdictions involved:
[Optional]
__________________________________________
Notifications
Q19. Notification types:
[check all that apply]
Patient notification: Patients were informed of
investigation or advised of potential exposure or
risk.
Patient notification
Provider notification
Public disclosure
None
Unknown
Provider notification: Providers were informed of the
investigation or advised of potential exposure or
risk.
Public disclosure: Members of the public were made
aware of the investigation through media reports or
other communication to the public.
Q19a. Approximate number of patients notified
[Optional]
__________________________________
Page 76
Q20. State lab specimen ID of index case.
If specimen or isolate was tested at a Public Health
Laboratory, please enter the state laboratory
accession number. If multiple index cases triggered
the response, include at least one state laboratory
accession number. If the specimen was tested at a
regional lab, please include that ID. If isolate was
not tested at the Public Health Laboratory, please
input N/A
Q21. Were any of the staff contributing to this
investigation/consultation partially or fully funded
through the following funding mechanism:
[Select all that apply]
__________________________________
G1
SHARP (SHARP includes Project 1 through 5)
Nursing Home/Other LTC Strike Team
Enhancing Detection Expansion/CARES
None of the above
Unknown
Additional comments
Q22. Additional notes/comments to CDC (any other
information that the HD would like to share about this
particular event):
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__________________________________________
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HAI/AR Response & Prevention Performance Measures 2022-2023
Page 77
HARP PM3b: COVID-19 Outbreaks Reported in Healthcare
Settings
HARP PM3b: COVID-19 Outbreaks - Number of COVID-19 Outbreaks in Healthcare Settings
Instructions: Please report the number of COVID-19 outbreaks that occurred in healthcare
settings from August 1, 2022 through July 31, 2023 by setting type. We prefer that health
departments use the setting-specific CSTE/CORHA document for the investigation threshold
and outbreak definitions described in this guidance, however, it is acceptable if your health
department is using a different threshold specific to your jurisdiction.
Number of COVID-19 outbreaks (i.e., those that met the setting-specific CSTE/CORHA COVID-19 outbreak definition or
jurisdiction-specific COVID-19 outbreak definition) by setting type:
Acute care hospital:
Please specify the COVID-19 outbreak definition
utilized for Acute Care Hospitals in your
jurisdiction:
If you are not using the CSTE/CORHA COVID-19 outbreak
definition, please describe your jurisdiction-specific
COVID-19 outbreak definition:
Critical access hospital:
Inpatient rehabilitation facility:
Assisted Living Facilities:
Long-term acute care hospital:
Dialysis (outpatient):
Nursing home/skilled nursing facility:
04/24/2023 10:21am
__________________________________
CORHA/CSTE outbreak definition
Jurisdiction-specific outbreak definition
__________________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
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Please specify the COVID-19 outbreak definition
utilized for nursing homes/skilled nursinf facilities
in your jurisdiction:
If you are not using the CSTE/CORHA COVID-19 outbreak
definition, please describe your jurisdiction-specific
COVID-19 outbreak definition:
Dental office:
Ventilator-capable nursing home/skilled nursing
facility (vSNF):
Please specify the COVID-19 outbreak definition
utilized for vSNFs in your jurisdiction:
If you are not using the CSTE/CORHA COVID-19 outbreak
definition, please describe your jurisdiction-specific
COVID-19 outbreak definition:
Ambulatory Surgical Center:
Other outpatient setting:
Other healthcare settings:
CORHA/CSTE outbreak definition
Jurisdiction-specific outbreak definition
__________________________________________
__________________________________
__________________________________
CORHA/CSTE outbreak definition
Jurisdiction-specific outbreak definition
__________________________________________
__________________________________
__________________________________
__________________________________
Additional notes/comments to CDC:
__________________________________________
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HAI/AR Response & Prevention Performance Measures 2022-2023
Page 79
HARP PM4: Prevention-based Activities
HARP PM4: Prevention-based Infection Control Assessments and Proactive Point Prevalence
Surveys (PPS)
(This PM now includes Prevention-based Healthcare Infection Control Assessments for
COVID-19 [Formerly reported in E.24])
HAI/AR Response and Prevention (HARP) PM4 has been restructured to align reporting across
G1, American Rescue Plan (SHARP Project I, NH Strike Teams), and COVID-19 Supplements for
Healthcare IPC activities. We now ask health departments to submit one form for each facility
in which a prevention-based activity took place during the reporting period.
Proactive infection control assessments are distinct from response-driven assessments.
Prevention-based infection control assessments are intended to provide feedback on infection
control policies and practices before a problem is identified and require direct observation
(either in person or via video) using a structured form for data collection. These typically are
focused on facility types with characteristics associated with increased risk of HAI/AR threats
(e.g., MDRO transmission, COVID-19 prevention, or other HAI threats).
Provision of onsite assistance to assess infection control issues may be done directly by the
recipient or through the support of a local health department, academic partner, contractor,
consultant, or other entity (designee) for which the recipient can assure the quality of
services provided.
Proactive PPSs are colonization screenings conducted at a healthcare facility at a
predetermined frequency (e.g., every four to six months) and are not triggered by
identification of a case. Proactive PPSs are a way to improve surveillance and identify those
who require infection control actions to prevent further transmission. These PPSs can occur
prior to a facility's identification of both novel and targeted MDRO cases, may involve only a
subset of patients/residents (such as a single high acuity unit), and are distinct from PPSs
performed in response to a single case or suspected transmission.
Please report prevention-based activities (Infection Control Assessments and/or Point
Prevalence Surveys) conducted by either
Staff from HAI/AR Program or their designee* (regardless of funding source), or Staff
partially or fully funded through one of the following mechanisms contributed to the response,
including staff at state/territorial, regional, local, or other funded entities.
G1 SHARP
(SHARP includes project 1 through 5) Nursing Home/Other LTC Strike Team
This measure is
due twice annually: Mid-period (Due: January 31st, 2023) and end reporting period (Due:
August 31st, 2023)
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projectredcap.org
Data entry instructions
Please enter one REDCap form for each facility in which a prevention-based activity (infection
control assessment and/or point prevalence survey) that took place during the reporting
period: August 1, 2022, through December 31, 2022. If multiple point prevalence surveys were
conducted at a single facility, please enter each instance in the same form by selecting “Yes”
to Q5b (v) if a second PPS was conducted or Q5b (viii) if a third PPS was conducted. To add a
new response in REDCap, click "Save and Add New Instance." Excel-based upload tools for
tracking and uploading Prevention-based Infection Control Assessments and Point Prevalence
Survey are available under the Bulk Upload Processing section of this project. Health
departments can either use this REDCap form OR the excel-based upload tool for reporting
Prevention-based Infection Control Assessments and Point Prevalence Surveys. Please not
that there are separate forms for tracking Prevention-based Infection Control Assessments
and Point Prevalence Surveys. Please refer to the “Excel-Based Tracking and Bulk Upload
Process” section of the “ELC HAIAR Performance Measure Reporting Guide 2022-2023” PDF
available in the Bulk Upload Process section of this project for further details and instructions
on entering data using these tools. Instructions on entering multiple PPS at a single facility
can be found in “Section II: Entering Data Using the Excel Based Bulk Data Entry Tools”
*Designee includes personnel employed by or contracted by the recipient at the state, or
regional, or local levels.
Note: If a facility is conducting admission or discharge screening as part of a prevention
initiative, these should be included in prevention PPS data tracking using the following
procedures. All admission screens for the reporting period should be entered as a PPS at the
end of the reporting period. Please enter the date of first admission screening under Q5b (i),
and make a note in the comment section that this prevention activity is admission screening.
Follow the same approach for discharge screenings: enter all discharge screens as PPS at the
end of the reporting periods and make a note in the comments that this activity is prevention
screening.
Reported through excel-based tracking tool/Imported
into REDCap
Yes
Reported through excel-based tracking tool/Imported
into REDCap
Yes
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Facility Level Information
Q1. Facility ID:
______
Please assign a unique identifier for cross-referencing with your local tracking tool as needed. May use any unique
identifier.
Q2. Setting Type:
______
______
______
______
______
Q3. Facility ZIP Code:
______
Q4. Was this facility a tribally owned facility or a
part of Indian Health Service:
Yes
No
Unknown
Q5. Please indicate the type of prevention-based
activity conducted:
Infection Control Assessment
Point Prevalence Survey
[Select all that apply]
Infection Control Assessments
Q5a (i). Type of Assessment Performed
(Select all that apply)
Onsite
Remote
Q5a (ii).Total number of onsite infection control
assessments:
__________________________________
Q5a (iii).Total number of remote infection control
assessments:
__________________________________
Q5a (iv). Reason for Infection Control Assessment
(Select all that apply)
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MDRO prevention
COVID-19 prevention
Health Equity goal
General HAI prevention (general non-MDRO or
request from facility, etc.)
None of the above
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Point Prevalence Survey
Q5b (i).Date of PPS:
Q5b (ii). Indicate which target(s) screened and number
of screenings performed:
__________________________________
C.auris
KPC, VIM, IMP, OXA-48-like, NDM
CRAB with OXA-23, -24/40, 58, 235
Other
C.auris
Total Screened Total Positive
______ ______
Total Screened Mechanism Total Positive Associated Organism
KPC, VIM, IMP, OXA-48-like, NDM ______ KPC ______ ______
VIM ______ ______
IMP ______ ______
OXA-48-like ______ ______
NDM ______ ______
Total Screened Mechanism Total Positive Associated Organism
CRAB with OXA-23, -24/40, 58, 235 ______ OXA-23 ______ ______
OXA-24/40 ______ ______
OXA-58 ______ ______
OXA-235 ______ ______
Other
Please specify target and/or mechanism
______
Total Screened Total Positive
______ ______
Q5b (iii). Was there a public health investigation
conducted as a result of this PPS/screening activity?
Q5b (iv). Containment Response ID:
[The Containment Response ID should match the Local
outbreak/Response ID associated with the record
submited in HARP PM2]
Q5b (v). Was there additional round of colonization
screen conducted during this reporting period:
Q5b (vi). Date of PPS (Round 2):
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Yes
No
__________________________________
Yes
No
__________________________________
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Q5b (vii). Indicate target(s) screened:
C.auris
KPC, VIM, IMP, OXA-48-like, NDM
CRAB with OXA-23, -24/40, 58, 235
Other
C.auris
Total Screened Total Positive
______ ______
Total Screened Mechanism Total Positive Associated Organism
KPC, VIM, IMP, OXA-48-like, NDM ______ KPC ______ ______
VIM ______ ______
IMP ______ ______
OXA-48-like ______ ______
NDM ______ ______
Total Screened Mechanism Total Positive Associated Organism
CRAB with OXA-23, -24/40, 58, 235 ______ OXA-23 ______ ______
OXA-24/40 ______ ______
OXA-58 ______ ______
OXA-235 ______ ______
Other
Please specify target and/or mechanism
______
Total Screened Total Positive
______ ______
Q5b (viii). Was there additional round of colonization
screen conducted during this reporting period:
Q5b (ix). Date of PPS (Round 3):
Q5b (vii). Indicate target(s) screened:
Yes
No
__________________________________
C.auris
KPC, VIM, IMP, OXA-48-like, NDM
CRAB with OXA-23, -24/40, 58, 235
Other
C.auris
Total Screened Total Positive
______ ______
Total Screened Mechanism Total Positive Associated Organism
KPC, VIM, IMP, OXA-48-like, NDM ______ KPC ______ ______
VIM ______ ______
IMP ______ ______
OXA-48-like ______ ______
NDM ______ ______
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Total Screened Mechanism Total Positive Associated Organism
CRAB with OXA-23, -24/40, 58, 235 ______ OXA-23 ______ ______
OXA-24/40 ______ ______
OXA-58 ______ ______
OXA-235 ______ ______
Other
Please specify target and/or mechanism
______
Total Screened Total Positive
______ ______
Q6a. Were any of the staff contributing to this
infection control assessment partially or fully funded
through the following funding mechanism:
[Select all that apply]
Q6b. Were any of the staff contributing to this point
prevalence survey partially or fully funded through
the following funding mechanism:
[Select all that apply]
Additional notes/comments to CDC (any other
information that the HD would like to share about this
particular event):
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G1
SHARP (SHARP includes Project 1 through 5)
Nursing Home/Other LTC Strike Team
Enhancing Detection Expansion/CARES
None of the above
Unknown
G1
SHARP (SHARP includes Project 1 through 5)
Nursing Home/Other LTC Strike Team
Enhancing Detection Expansion/CARES
None of the above
Unknown
__________________________________________
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HAI/AR Response & Prevention Performance Measures 2022-2023
Page 85
HARP PM5: Status of Required Tasks (SHARP PM I.1, I.2,
Strike PM2)
Instructions: Developing and maintaining HAI/AR expertise is critical to build capacity for
prevention and response strategies described in SHARP Project I. The required roles described
in SHARP Project I enhance the HAI/AR Program's ability to maintain response and prevention
expertise. Characterizing SHARP Project I staffing allows CDC to understand the workforce
required to meet goals.
Completion of MDRO prevention needs assessment tool and MDRO Prevention Workplan are
required under Project 1 Strategy B.
Completion of landscape analysis of outpatient dialysis services locations is required under
Project I Strategy D. This will provide information on where outpatient dialysis services are
happening.
Q1. Does the HAI/AR Staffing Directory include updated staffing information for staff involved in HAI/AR Response and
Prevention activities:
Link to HAI/AR Staffing Directory: HAI/AR Program Staffing Directory
Q1a. HAI/AR Program Staff regardless of funding
source:
Yes
No
Don't Know
Q1b. Staff fully or partially funded through SHARP
Project I including state/territorial, regional,
local, or other funded entity (designee):
Yes
No
Don't Know
Q2. Have you met with CDC to discuss your plans for
expansion of HAI/AR expertise across your
jurisdiction. Deadline for completing this task is Dec
15, 2022. More information on how to schedule a
meeting is forthcoming.
Yes
No
Meeting scheduled
Q3. Status of MDRO prevention needs assessment tool:
Completed
Underway
Not started
Q4. Status of MDRO prevention workplan:
Completed
Underway
Not started
Q5. Status of landscape analysis of outpatient
dialysis services location:
Completed
Underway
Not started
Q6. Status of the Nursing Home and LTCF Strike Teams
and Infrastructure Project success stories:
Submitted
Underway
Not started
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Additional notes/comments to CDC:
__________________________________________
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HAI/AR Response & Prevention Performance Measures 2022-2023
Page 87
HARP PM6: NH Strike Teams (Strike PM1)
Strike PM1: Approach and implementation plan adopted by the health department to support
and sustain facility capacity to detect and respond to infectious diseases and improve patient
care practices in long-term care facilities
Types of Approach(es): Strategies or activities adopted by health departments to support and
sustain facility capacity to detect and respond to COVID-19 and other infectious diseases and
improve resident safety and care in long-term care facilities
Instructions: Health departments should report progress on all strategies and activities fully
or partially funded by NH/LTC Strike Team. Only select the approach(es) that are applicable to
your jurisdiction.
For the purpose of reporting for this performance measure:
Skilled nursing facility (SNF) refers to all Centers for Medicare and Medicaid (CMS)-certified
nursing homes Other long-term care facilities (LTCF) include assisted living and residential
care communities, intermediate care facilities for individuals with developmental disabilities
(ICF), group homes, or other settings providing care to frail and older adults and children. This
does not include activities in non-LTC congregate settings such as correctional facilities or
homeless shelters.
For each selected approach, provide a brief description of the
support/activity, and summarize progress to date. Where applicable, please highlight any
unique activities that are specifically as a result of the NH Strike Team funds.
Note that some of the approaches listed in this performance measure (PM) are also reported
as part of performance measures for other ELC funded programs. For example, COVID-19
response activities are also reported by Healthcare Associated Infection/Antimicrobial
Resistance (HAI/AR) Prevention Programs as part of Performance Measures for ELC Core G1
Activities. We ask HAI/AR Programs to report number of COVID-19 consultations provided for
possible COVID-19 outbreaks by setting types (PM E25) ) and number of COVID-19
prevention-based assessments (PM E24).
For the purposes of the NH/LTC Strike Team PM listed below, we ask you to estimate the
number of nursing homes and other LTCFs that received COVID-19 response or prevention
consultations involving staff who are partially or fully funded by NH Strike Team.
For health departments in the early phase of implementing an approach and have not begun
providing this support to facilities, we understand there may not yet be quantitative numbers
of facilities to report. In those situations, please enter "0" in the numeric field and use the
"summarize"
text box to describe the progress made to date.
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projectredcap.org
Q1. Types of approach(es):
Please select all that apply to your jurisdiction
COVID-19 outbreak response activities
COVID-19 prevention-based onsite assessments
COVID-19 educational support e.g., webinar, training, learning collaborative
Provision of clinical staff (to address staffing shortages)
Provision of specific clinical services ( administration of COVID-19 therapeutics or vaccine)
Direct financial support (e.g., grants or incentives) to support facility IPC activities
Activity to recruit and support new individuals to enter LTC workforce (e.g., scholarships or incentives to
obtain CNA training/certification)
Activity to support existing LTC workforce (e.g., incentives, retention bonus, professional development
opportunity)
Optional activity: Purchasing of supplies (e.g., test kits, PPE)
Optional activity: Conducting environmental assessments, providing infrastructure support (e.g., offering
fit-testing for all staff)
Other activity not reflected in options above, please specify
COVID-19 outbreak support response activities
COVID-19 response efforts may take the form of consultation regarding IPC activities, remote
or onsite infection control assessments, or other IPC technical assistance to facilities with
COVID-19 infections among residents/patients or HCP.
(The numbers reported here can be a subset of covid-19 consultations reported in HARP PM3)
Q2a. Briefly summarize your approach:
Q2a (i). Number of SNF that received support:
Q2a (ii). Number of other-LTCF that received support:
__________________________________
__________________________________
COVID-19 prevention-based onsite assessments
To be counted, prevention-based assessments require use of a structured form for data
collection, such as CDC Tele-ICAR tool (or similar state/local developed tool).
(The number reported here can be a subset of prevention-based COVID-19 IPC assessment
reported in HARP PM4)
Page 89
Q2b. Briefly summarize your approach:
Q2b (i). Number of SNFs that received support (Please
provide an estimate):
__________________________________
Q2b (ii). Number of other-LTCF that received support
(Please provide an estimate):
__________________________________
COVID-19 educational support (e.g., webinar, training, learning collaborative)
Q2c. Briefly summarize your approach:
Q2c (i). Number of SNFs that received support:
Q2c (ii). Number of other-LTCFs that received support:
__________________________________
__________________________________
Provision of clinical staff (to address staffing shortages)
Q2d. Briefly summarize your approach:
Q2d (i). Number of SNFs that received support:
Q2d (ii). Number of other-LTCFs that received support:
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__________________________________
__________________________________
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Provision of specific clinical services ( administration of COVID-19 therapeutics or vaccine)
Q2e. Briefly summarize your approach:
Q2e (i). Number of SNFs that received support:
Q2e (ii). Number of other-LTCFs that received support:
__________________________________
__________________________________
Direct financial support (e.g., grants or incentives) to support facility IPC activities
Q2f. Briefly summarize your approach:
Q2f (i). Number of SNFs that received support:
Q2f (ii). Number of other-LTCFs that received support:
__________________________________
__________________________________
Activity to recruit and support new individuals to enter LTC workforce (e.g., scholarships or
incentives to obtain CNA training/certification)
Q2g. Briefly summarize your approach:
Q2g (i). Number of SNFs that received support:
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__________________________________
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Page 91
Q2g (ii). Number of other-LTCFs that received support:
Q2g (iii). Number of individuals participating in
program:
__________________________________
__________________________________
Activity to support existing LTC workforce (e.g., incentives, retention bonus, professional
development opportunity)
Q2h. Briefly summarize your approach:
Q2h (i). Number of SNFs that received support:
Q2h (ii). Number of other-LTCFs that received support:
Q2h (iii). Cumulative number of LTC staff supported:
__________________________________
__________________________________
__________________________________
(If not applicable, enter n/a ; if not available
enter 0)
Optional activity: Purchasing of supplies (e.g., test kits, PPE)
Q2i. Briefly summarize your approach:
Q2i (i). Number of SNFs that received support:
Q2i (ii). Number of other-LTCFs that received support:
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__________________________________
__________________________________
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Optional activity: Conducting environmental assessments, providing infrastructure support
(e.g., offering fit-testing for all staff)
Q2j. Briefly summarize your approach:
Q2j (i). Number of SNFs that received support:
Q2j (ii). Number of other-LTCFs that received support:
__________________________________
__________________________________
Other activity not reflected in options above, please specify
Q2k. Briefly summarize your approach:
Q2k (i). Number of SNFs that received support:
Q2k (ii). Number of other-LTCFs that received support:
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__________________________________
__________________________________
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HAI/AR Response & Prevention Performance Measures 2022-2023
Page 93
HARP Bulk Upload Processing (HARP PM2, PM3 and PM4)
Bulk Data Upload Instructions
This section provides unique Excel-based data entry tools for bulk upload of the following
HAI/AR Response & Prevention Performance Measures:
HARP PM2: nMDRO Consultations HARP PM3: HAI (non-nMDRO) Consultations HARP PM3:
COVID-19 Responses HARP PM4: Prevention-based IPC Assessments HARP PM4: Point
Prevalence Survey Tracking HAI/AR Programs interested in using Excel-based tools for bulk
data entry should have attended the Excel-based Tracking and Bulk Data Upload Process
Orientation Session or should watch the recording of the session before accessing this
feature. The orientation session recoding can be accessed through the following link: Session
Recording
[Attachment: "ELC HAIAR Performance Measure Reporting Guide 2022-2023.pdf"]
Please acknowledge that you have attended the
Excel-based Tracking and Bulk Data Upload Process
Orientation Session or watched the recording of the
session (Session recording).
Yes
nMDRO Consultations
[Attachment: "nMDRO Consultations.xlsx"]
Please upload a completed version of the nMDRO
Consultations Excel Form:
Note: Responses that meet the criteria of an nMDRO
Investigations should be entered directly in REDCap
under HARP PM2.
HAI (non-nMDRO) Consultations
[Attachment: "HAI (non-nMDRO) Consultations.xlsx"]
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Please upload a completed version of the HAI
(non-nMDRO) Consultations Excel Form:
Note:
Responses that meet the criteria of an HAI
(non-nMDRO) Investigation should be entered directly
in REDCap under HARP PM3.. Responses to COVID-19
should not be entered in this form.
COVID-19 Responses
[Attachment: "COVID-19 Responses.xlsx"]
Please upload a completed version of the COVID-19
Responses Excel Form:
Note: Consultations for other HAI
(non-nMDRO/non-COVID-19) responses should not be
entered in this form.
Prevention-based Infection Control Assessments
[Attachment: "Prevention-based IPC Assessments.xlsx"]
Please upload the completed version of the
Prevention-Based Activities Tracking Excel File:
Point Prevalence Survey Tracking
[Attachment: "Point Prevalence Survey Tracking.xlsx"]
Please upload the completed version of the Point
Prevalence Survey Tracking Excel File:
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HARP Mid-Period Data Closeout
HAI/AR Response & Prevention Performance Measures 2022-2023
Page 95
HAI/AR Response & Prevention Performance Measures
Instructions:
The following form contains information regarding items that have been flagged during our
data closeout of the Budget Period 4 HAI/AR Response & Prevention Performance Measures
(PM). Each PM that has been flagged includes a summary of the issue. The summary of the
issue is avaliable in column (b). Once the flagged items have been addressed and data has
been updated directly in REDCap, select "Yes" in column (c). We kindly ask that you only
select "Yes" once the data has been corrected directly in REDCap. Additionally, once all items
have been addressed we ask that you please scroll down to the bottom of the page, change
the form status to "Complete" and click the "Save & Exit Form" button. If you have any
comments or questions related to any of the items that have been flagged, you may provide
those comments/questions in the comment box provided below. Alternatively, you may reach
out to [email protected] directly.
Errors identified during submission:
Yes
No
Performance Measure a) Flagged for Follow-up b) Summary of Issues c) Please confirm that the issue has been
addressed:
HARP PM2: nMDRO Responses
* Flagged items do not require immediate update
______ ______ ______
HARP PM3: HAI (Non-nMDRO) And COVID-19 Responses
* Flagged items do not require immediate update
______ ______ ______
HARP PM3b: COVID-19 Outbreaks Reported in Healthcare Settings
* Flagged items do not require immediate update
______ ______ ______
HARP PM4: Prevention-based Activities
* Flagged items do not require immediate update
______ ______ ______
HARP PM5: Status of Required Tasks (SHARP PM I.1, I.2, Strike PM2)
* Flagged items do not require immediate update
______ ______ ______
HARP PM6: NH Strike Team
* Flagged items do not require immediate update
______ ______
______
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HAI/AR Staffing Directory
(E.23 related variables)
** Flagged items require update by 04-04-2023
______ ______ ______
Please submit any questions, concerns, or issues in the comment box below:
Thank you for submitting your HAI/AR Response & Prevention Performance Measures. No items have been flagged for
follow-up.
| File Type | application/pdf |
| File Modified | 2023-04-24 |
| File Created | 2023-04-24 |