Form CDC 55.122 CDC 55.122 State Health Department HAI Mandate and Validatyion Surv

Form Approved

OMB No. 0920-0666

Exp. Date: xx/xx20xx

www.cdc.gov/nhsn

State Health Department HAI Mandate and Validation Survey

Section 1: State Reporting Requirements Section

This section inquires of any state reporting requirements that were in place during the 2017 calendar year. Please indicate the HAI specific requirements and the period they were effecting. These questions will be asked for each HAI measure by location and facility type.

1. Did your state have a reporting requirement (e.g. legislative or policy including reportable conditions) for healthcare facilities to report CLABSI data to NHSN from ANY LOCATION type within the facility (e.g., ICU, Ward, NICU) at any time during 2017 for any of the following facility types (check all that apply)?

   • Acute Care Hospital (ACH)

   • Critical Access Hospital (CAH)

   • Long Term Acute Care Facility (LTAC)

   • Inpatient Rehabilitation Facility (IRF)

   • No mandate (e.g. legislative or state-required mandate) for any facility type

2. Was this CLABSI state mandate (e.g. legislative or policy including reportable conditions) for ANY LOCATION implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?

   • Acute Care Hospital (ACH)

   • Critical Access Hospital (CAH)

   • Long Term Acute Care Facility (LTAC)

   • Inpatient Rehabilitation Facility (IRF)

   • No mandate (e.g. legislative or state-required mandate) for any facility types

3. Did your state have a mandate (e.g. legislative or policy including reportable conditions) for healthcare facilities to report CLABSI data to NHSN from adult and/or pediatric ICU (critical care) locations at any time during 2017 for any of the following facility types (check all that apply)?

   • Acute Care Hospital (ACH)

   • Critical Access Hospital (CAH)

   • Long Term Acute Care Facility (LTAC)

   • No mandate (e.g. legislative or state-required mandate) for any facility types

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

Public reporting burden of this collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC, Reports Clearance Officer, 1600 Clifton Rd., MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0666).

CDC 57.122, Rev 0, v9.2

4. Was this CLABSI state mandate (e.g. legislative or policy including reportable conditions) for adult and/or pediatric ICU (critical care) locations implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?

   • Acute Care Hospital (ACH)

   • Critical Access Hospital (CAH)

   • Long Term Acute Care Facility (LTAC)

   • No mandate (e.g. legislative or state-required mandate) for any facility types

5. Did your state have a mandate (e.g. legislative or policy including reportable conditions) for healthcare facilities to report CLABSI data to NHSN from WARD locations at any time during 2017 for any of the following facility types (check all that apply)?

   • Acute Care Hospital (ACH)

   • Critical Access Hospital (CAH)

   • Long Term Acute Care Facility (LTAC)

   • Inpatient Rehabilitation Facility (IRF)

   • No mandate (e.g. legislative or state-required mandate) for any facility types

6. Was this CLABSI state mandate (e.g. legislative or policy including reportable conditions) for WARD locations implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?

   • Acute Care Hospital (ACH)

   • Critical Access Hospital (CAH)

   • Long Term Acute Care Facility (LTAC)

   • Inpatient Rehabilitation Facility (IRF)

   • No mandate (e.g. legislative or state-required mandate) for any facility types

7. Did your state have a mandate (e.g. legislative or policy including reportable conditions) for healthcare facilities to report CLABSI data to NHSN from NICU locations at any time during 2017 for any of the following facility types (check all that apply)?

   • Acute Care Hospital (ACH)

   • Critical Access Hospital (CAH)

   • No mandate (e.g. legislative or state-required mandate) for any facility types

8. Was this CLABSI state mandate (e.g. legislative or policy including reportable conditions) for NICU locations implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?

   • Acute Care Hospital (ACH)

   • Critical Access Hospital (CAH)

   • No mandate (e.g. legislative or state-required mandate) at any facility types

9. Did your state have a mandate (e.g. legislative or policy including reportable conditions) for healthcare facilities to report CAUTI data to NHSN from ANY LOCATION at any time during 2017 for any of the following facility types (check all that apply)?

   • Acute Care Hospital (ACH)

   • Critical Access Hospital (CAH)

   • Long Term Acute Care Facility (LTAC)

   • Inpatient Rehabilitation Facility (IRF)

   • No mandate (e.g. legislative or state-required mandate) at any facility types

10. Was this CAUTI state mandate (e.g. legislative or policy including reportable conditions) for ANY LOCATION implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?

    • Acute Care Hospital (ACH)

    • Critical Access Hospital (CAH)

    • Long Term Acute Care Facility (LTAC)

    • Inpatient Rehabilitation Facility (IRF)

    • No mandate (e.g. legislative or state-required mandate) at any facility types

11. Did your state have a mandate (e.g. legislative or policy including reportable conditions) for healthcare facilities to report CAUTI data to NHSN from adult and/or pediatric ICU (critical care) locations at any time during 2017 for any of the following facility types (check all that apply)?

    • Acute Care Hospital (ACH)

    • Critical Access Hospital (CAH)

    • Long Term Acute Care Facility (LTAC)

    • No mandate (e.g. legislative or state-required mandate) at any facility types

12. Was this CAUTI state mandate (e.g. legislative or policy including reportable conditions) for adult and/or pediatric ICU (critical care) locations implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?

    • Acute Care Hospital (ACH)

    • Critical Access Hospital (CAH)

    • Long Term Acute Care Facility (LTAC)

    • No mandate (e.g. legislative or state-required mandate) at any facility types

13. Did your state have a mandate (e.g. legislative or policy including reportable conditions) for healthcare facilities to report CAUTI data to NHSN from WARD locations at any time during 2017 for any of the following facility types (check all that apply)?

    • Acute Care Hospital (ACH)

    • Critical Access Hospital (CAH)

    • Long Term Acute Care Facility (LTAC)

    • Inpatient Rehabilitation Facility (IRF)

    • No mandate (e.g. legislative or state-required mandate) at any facility types

14. Was this CAUTI state mandate (e.g. legislative or policy including reportable conditions) for WARD locations implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?

    • Acute Care Hospital (ACH)

    • Critical Access Hospital (CAH)

    • Long Term Acute Care Facility (LTAC)

    • Inpatient Rehabilitation Facility (IRF)

    • No mandate (e.g. legislative or state-required mandate) at any facility types

15. Did your state have a mandate (e.g. legislative or policy including reportable conditions) for healthcare facilities to report VAE data to NHSN from ANY LOCATION at any time during 2017 for any of the following facility types (check all that apply)?

    • Acute Care Hospital (ACH)

    • Critical Access Hospital (CAH)

    • Long Term Acute Care Facility (LTAC)

    • Inpatient Rehabilitation Facility (IRF)

    • No mandate (e.g. legislative or state-required mandate) at any facility types

16. Was this VAE state mandate (e.g. legislative or policy including reportable conditions) for ANY LOCATION implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?

    • Acute Care Hospital (ACH)

    • Critical Access Hospital (CAH)

    • Long Term Acute Care Facility (LTAC)

    • Inpatient Rehabilitation Facility (IRF)

    • No mandate (e.g. legislative or state-required mandate) at any facility types

17. Did your state have a mandate (e.g. legislative or policy including reportable conditions) for healthcare facilities to report VAE data to NHSN from adult and/or pediatric ICU (critical care) locations at any time during 2017 for any of the following facility types (check all that apply)?

    • Acute Care Hospital (ACH)

    • Critical Access Hospital (CAH)

    • Long Term Acute Care Facility (LTAC)

    • No mandate (e.g. legislative or state-required mandate) at any facility types

18. Was this VAE state mandate (e.g. legislative or policy including reportable conditions) for adult and/or pediatric ICU (critical care) locations implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?

    • Acute Care Hospital (ACH)

    • Critical Access Hospital (CAH)

    • Long Term Acute Care Facility (LTAC)

    • No mandate (e.g. legislative or state-required mandate) at any facility types

19. Did your state have a mandate (e.g. legislative or policy including reportable conditions) for healthcare facilities to report VAE data to NHSN from WARD locations at any time during 2017 for any of the following facility types (check all that apply)?

    • Acute Care Hospital (ACH)

    • Critical Access Hospital (CAH)

    • Long Term Acute Care Facility (LTAC)

    • Inpatient Rehabilitation Facility (IRF)

    • No mandate (e.g. legislative or state-required mandate) at any facility types

20. Was this VAE state mandate (e.g. legislative or policy including reportable conditions) for WARD locations implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?

    • Acute Care Hospital (ACH)

    • Critical Access Hospital (CAH)

    • Long Term Acute Care Facility (LTAC)

    • Inpatient Rehabilitation Facility (IRF)

    • No mandate (e.g. legislative or state-required mandate) at any facility types

21. Did your state have a mandate (e.g. legislative or policy including reportable conditions) for acute care hospitals (ACH) to report SSI data to NHSN from any of the following procedure types at any time during 2017 (check all that apply)?

    Procedure			Was this reporting mandate in place at any time during 2017?		Was this reporting mandate in effect on January 1, 2017?
    No reporting mandates for any procedure in place		Yes No			Yes No
    AAA		Yes No			Yes No
    APPY		Yes No			Yes No
    CARD		Yes No			Yes No
    CBGB/CBGC		Yes No			Yes No
    COLO		Yes No			Yes No
    CSEC		Yes No			Yes No
    FUSN		Yes No			Yes No
    HPRO		Yes No			Yes No
    HYST		Yes No			Yes No
    KPRO		Yes No			Yes No
    LAM		Yes No			Yes No
    PVBY		Yes No			Yes No
    REC		Yes No			Yes No
    VHYS		Yes No			Yes No
    XLAP		Yes No			Yes No

22. Did your state have a mandate (e.g. legislative or state-required mandate) for critical access hospitals (CAH) to report inpatient SSI data to NHSN from any of the following procedure types at any time during 2017 (check all that apply)?

Procedure		Was this reporting mandate in place at any time during 2017?	Was this reporting mandate in effect on January 1, 2017?
No reporting mandates for any procedure in place	Yes No		Yes No
AAA	Yes No		Yes No
APPY	Yes No		Yes No
CARD	Yes No		Yes No
CBGB/CBGC	Yes No		Yes No
COLO	Yes No		Yes No
CSEC	Yes No		Yes No
FUSN	Yes No		Yes No
HPRO	Yes No		Yes No
HYST	Yes No		Yes No
KPRO	Yes No		Yes No
LAM	Yes No		Yes No
PVBY	Yes No		Yes No
REC	Yes No		Yes No
VHYS	Yes No		Yes No
XLAP	Yes No		Yes No

23. Did your state have a mandate (e.g. legislative or state-required mandate) for healthcare facilities to report MRSA Bacteremia Laboratory-identified (LabID) Events to NHSN from Facility-wide inpatient locations (FacWideIN) at any time during 2017 for any of the following facility types (check all that apply)?

    • Acute Care Hospital (ACH)

    • Critical Access Hospital (CAH)

    • Long Term Acute Care Facility (LTAC)

    • Inpatient Rehabilitation Facility (IRF)

    • No mandate (e.g. legislative or state-required mandate) for any facility type

24. Was this MRSA Bacteremia LabID Event state mandate (e.g. legislative or state-required mandate) for FacWideIN locations implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?

    • Acute Care Hospital (ACH)

    • Critical Access Hospital (CAH)

    • Long Term Acute Care Facility (LTAC)

    • Inpatient Rehabilitation Facility (IRF)

• No mandate (e.g. legislative or state-required mandate)

25. Did your state have a mandate (e.g. legislative or state-required mandate) for healthcare facilities to report C. difficile Laboratory-identified (LabID) Events to NHSN from Facility-wide inpatient locations (FacWideIN)  at any time during 2017 for any of the following facility types (check all that apply)?

    • Acute Care Hospital (ACH)

    • Critical Access Hospital (CAH)

    • Long Term Acute Care Facility (LTAC)

    • Inpatient Rehabilitation Facility (IRF)

    • No mandate (e.g. legislative or state-required mandate) at any facility types

26. Was this CDI LabID Event state mandate (e.g. legislative or state-required mandate) for FacWideIN locations implemented and in effect on January 1, 2017 for any of the following facility types (check all that apply)?

• Acute Care Hospital (ACH)

• Critical Access Hospital (CAH)

• Long Term Acute Care Facility (LTAC)

• Inpatient Rehabilitation Facility (IRF)

• No mandate (e.g. legislative or state-required mandate

Section 2: Data Validation

This section asks about any validation activities that were conducted during the 2017 calendar year. Please let us know if your validation activities and the period they were effective. These questions will be asked for each HAI measure stratified by facility type.

27. Select the appropriate HAIs and facility types for which you (state health department) or a partner organization have access to 2017 data via NHSN. (Please select a response for each HAI listed below)

No Access to any of the data listed	Yes
CLABSI
No Data Access	ACH	CAH	LTAC	IRF
CAUTI
No Data Access	ACH	CAH	LTAC	IRF
SSI-COLO
No Data Access	ACH	CAH	LTAC	IRF
SSI-HYST
No Data Access	ACH	CAH	LTAC	IRF
MRSA Bacteremia LabID Event
No Data Access	ACH	CAH	LTAC	IRF
CDI LabID Event
No Data Access	ACH	CAH	LTAC	IRF
VAE
No Data Access	ACH	CAH	LTAC	IRF

28. Has your state health department or partner organization performed data quality checks on at least 6 months of 2017 NHSN data from any of the following HAIs within any healthcare facility types prior to August 1, 2018? This includes an assessment of outliers, data entry errors, trends, data completeness, etc. (Please select a response for each HAI listed below)

No data quality checks performed with any of the data listed	Yes
CLABSI
No data quality checks performed	ACH	CAH	LTAC	IRF
CAUTI
No data quality checks performed	ACH	CAH	LTAC	IRF
SSI-COLO
No data quality checks performed	ACH	CAH	LTAC	IRF
SSI-HYST
No data quality checks performed	ACH	CAH	LTAC	IRF
MRSA Bacteremia LabID Event
No data quality checks performed	ACH	CAH	LTAC	IRF
CDI LabID Event
No data quality checks performed	ACH	CAH	LTAC	IRF
VAE
No data quality checks performed	ACH	CAH	LTAC	IRF

29. Does your state health department or partner organization contact hospitals if outliers, errors, missing data, or incomplete data are found?

• Yes

• No

30. Has your state health department completed an external audit (medical record review of any HAI, or a review of laboratory records for MRSA or C.difficile LabID Events) of 2017 NHSN data from any of the following healthcare facility types prior to August 1, 2018?

    • Yes

    • No

31. Which HAIs and facility types were validated during the external audit? (Please answer all fields)

CLABSI
ACH	CAH		LTAC	IRF
CAUTI
ACH	CAH		LTAC	IRF
SSI-COLO
ACH	CAH		LTAC	IRF
SSI-HYST
ACH	CAH		LTAC	IRF
MRSA Bacteremia LabID Event
ACH	CAH		LTAC	IRF
CDI LabID Event
ACH	CAH		LTAC	IRF
VAE
ACH	CAH		LTAC	IRF

32. Does your state have a mandate (e.g. legislation or policy) to conduct an annual external audit (medical record review of any HAI either onsite or via remote desktop electronic review) of NHSN data for any facility types (ACH, CAH, LTACH, or IRF)?

• Yes, there is a state mandate to conduct annual external audits

• No mandate, the state conducts external audits on an ad hoc basis

• No mandate and no external audits are performed on HAI data

33. Please select the HAIs for each facility that had a state mandate (e.g. legislation or policy) to conduct an external audit of NHSN data during 2017. (Please answer all fields)

CLABSI
ACH	CAH		LTAC	IRF
CAUTI
ACH	CAH		LTAC	IRF
SSI-COLO
ACH	CAH		LTAC	IRF
SSI-HYST
ACH	CAH		LTAC	IRF
MRSA Bacteremia LabID Event
ACH	CAH		LTAC	IRF
CDI LabID Event
ACH	CAH		LTAC	IRF
VAE
ACH	CAH		LTAC	IRF

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