CDC 57.504 Prevention Process Measures Monthly Monitoring for Dialy

[NCEZID] The National Healthcare Safety Network (NHSN)

57.504_DIALProcessMeasureSummary_BLANK

OMB: 0920-0666

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Form Approved

OMB No. 0920-0666

Exp. Date: 01/31/2021

www.cdc.gov/nhsn




Prevention Process Measures

Monthly Monitoring for Dialysis

Page 1 of 1

*required for saving

**Each process measure is conditionally required based upon monitoring selection in Monthly Reporting Plan

Facility ID #:_____________ *Month: _____________ *Year: ____________ *Location Code: ______________

Prevention Process Measures**

Observation Type

# Successful Observations

Total # Observations

  1. Hand Hygiene



  1. Hemodialysis Catheter Connection/Disconnection



  1. Hemodialysis Catheter Exit Site Care



  1. Arteriovenous Fistula and Graft Cannulation/Decannulation



  1. Dialysis Station Routine Disinfection



  1. Injection Safety – Medication Preparation



  1. Injection Safety – Medication Administration



Custom Fields

Label

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Data

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Comments









Assurance of Confidentiality: The voluntarily provided information obtained in this surveillance system that would permit identification of any individual or institution is collected with a guarantee that it will be held in strict confidence, will be used only for the purposes stated, and will not otherwise be disclosed or released without the consent of the individual, or the institution in accordance with Sections 304, 306 and 308(d) of the Public Health Service Act (42 USC 242b, 242k, and 242m(d)).


Public reporting burden of this collection of information is estimated to average 1.25 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC, Reports Clearance Officer, 1600 Clifton Rd., MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0666).


CDC 57.504 Rev 4, v8.8



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File Title57.504
AuthorCDC/NCZEID/DHQP
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