0920-1282 Form 3 - HAI/AR Performance Measures (SHARP Project IV;

HAI/AR Performance Measures (SHARP Project IV; NHSN), 2021-2022
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SHARP PM IV.1 NHSN technical assistance (TA) requests
fulfilled, documented by TA category and setting
Recipient

__________________________________

SHARP PM IV.1: NHSN technical assistance (TA) requests fulfilled, documented by TA category and setting Rationale:
To inform CDC of the demand for TA, types of TA requested and provided, and facility setting types requesting
assistance. CDC will use this information to improve NHSN user support and NHSN helpdesk experience. TA provided
to facilities will strengthen the accuracy and timeliness of data reported in NHSN, thereby leading to actionable data
for infection prevention activities.
Instructions: Complete the form below. Once complete mark as 'Complete' and select 'Save & Go to Next Form' from
the drop down below.

NHSN Coordination Lead
Q1. Does your program have an NHSN Coordination Lead?

A. Please provide status update or challenges
encountered in identify or hiring an NHSN Coordination
Lead

Yes
No

__________________________________________

Response to Q1 A is required if you have not hired an NHSN Coordination Lead.
B. Staffing Directory is updated with required
information for all staff leading and supporting NHSN
activities

Yes
No

C. Please update the HAI/AR Program Staffing Directory.

Technical Assistance (TA) Request
Q2. Please answer the TA questions for the current reporting period January 1, 2022--July 31, 2022.
A. Total number of TA requests received
Provide the total number of TA requests received by
your health department. A TA request refers to any one
interaction (email, phone call, etc.), and may include
more than one topic.

__________________________________

For example, one TA request comprised of three topics
is reported as one TA request received.

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B. Total number of TA requests completed
Provide the total number of TA requests completed by
your health department. A TA request is considered
complete if all topics were fully resolved.

__________________________________

For example, one TA request comprised of three topics
with only two of three topics fully resolved is not
reported as completed. One TA request comprised of
three topics with three of three topics fully resolved
is reported as one TA request completed.
C. Percentage of Completed Requests (%)

__________________________________

TA Requests by Topic
Q3. List the topics of the NHSN TA requests. Provide the number of TA requests received and completed for each
topic.
Topic
Number of TA requests received
Number of TA requests completed
______ ______ ______
______ ______ ______
______ ______ ______
______ ______ ______
______ ______ ______
______ ______ ______
______
______ ______
______ ______ ______
______ ______ ______
______ ______ ______
______ ______ ______
______ ______ ______
______ ______ ______
______ ______ ______
______ ______ ______
______ ______ ______
______ ______ ______
______ ______ ______
______ ______ ______
______ ______ ______
Response to Q3 is required.

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Number of facilities requesting TA, categorized by setting type and zip code.
Q4. Provide the number of facilities requesting technical assistance, categorized by setting type.
Number of facilities requesting TA by setting type
Acute Care Hospitals ______
Critical Access Hospitals ______
Ambulatory Surgery Centers ______
Long-term acute care hospitals ______
Inpatient rehabilitation facilities ______
Inpatient psychiatric facilities ______
Dialysis facilities ______
Assisted living facilities ______
Skilled nursing facilities ______
Home dialysis centers ______
LTCF for developmentally disabled ______
Other (please describe): ______ ______
Response to Q4 is required.
Q5. Use the table to summarize the number of the facilities that requested TA by zip code. If zip code data are not
available, explain why in the comment field.
Zip codes with 1-5 facilities requesting TA Zip codes with 6-10 facilities requesting TA Zip codes with >10
facilities requesting TA
______
______ ______
Response to Q5 is required.
A. Comments:
__________________________________________

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The NHSN project team plans to develop a technical assistance tracking tool for optional use.
This tool includes the required data fields used for performance measures reporting, and the
intent is to reduce the burden when entering data into REDCap.
Do you have a technical assistance tracking tool in
place?

Yes
No

Would you like CDC to provide a technical assistance
tracking tool for optional use?

Yes
No

Date of Submission

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HAI/AR Performance Measures (SHARP Project IV; NHSN), 2021-2022
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SHARP PM IV.2 NHSN data use agreements (DUAs)
established or updated

SHARP PM IV.2: NHSN data use agreements (DUAs) established or updated Rationale: To inform CDC of DUAs
between jurisdictions and healthcare facilities. Established DUAs serve as an indicator of improved data information
sharing and data-driven prevention. DUAs document a jurisdiction's access to NHSN data beyond data subject to
reporting mandates. CDC can improve and modify the NHSN application based on knowledge of how jurisdictions are
using data they access via DUAs, and provide examples for other jurisdictions.
Instructions: Complete the form below. Once complete mark as 'Complete' and select 'Save & Go to Next Form' from
the drop down below.
Note: This PM is only applicable to recipients participating in NHSN Activity 2

Data Use Agreements
Q1. Does your jurisdiction currently have an
established or updated DUA with healthcare facilities?

Yes
No

A. How is the accessed data being used?
__________________________________________
Response to Q1 A is required.
B. Why has your jurisdiction not established or
updated a DUA with healthcare facilities?

__________________________________________

Response to Q1 B is required.
Date of Submission

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NHSN PM Data Close Out

HAI/AR Performance Measures (SHARP Project IV; NHSN), 2021-2022
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NHSN Data Closeout
Instructions:
The following form contains information regarding items that have been flagged during our
data closeout of the Budget Period 3 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.

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.
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:
SHARP PM IV.1 NHSN technical assistance (TA) requests fulfilled, documented by TA category and setting
______ ______ ______
SHARP PM IV.2 NHSN data use agreements (DUAs) established or updated
______ ______ ______
Notes/comments to CDC:

Thank you for submitting your NHSN Performance Measures. No items have been flagged for follow-up.

If you have any questions, concerns, or issues with the items indicated above please contact [email protected]
with "NHSN Performance Measures - Data Closeout" in the subject line.

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