Att D-4 _Rev of Est Annual Cost Burden

National Healthcare Safety Network (NHSN)

OMB Control No. 0920-0666

Revision Request 07/02/2018

Revision of Estimated Annual Cost Burden*

		Total Estimated Burden (Hours)		Estimated Hourly Wage of Respondent		Total Estimated Annual Cost Burden		Change in Estimated Annual Cost Burden
Form Number	Form Name	04/2017	04/2018	04/2017	04/2018	04/2017	04/2018
57.100	NHSN Registration Form	167	167	$39.66	$39.66	$6,610	$6,610	0
57.101	Facility Contact Information	333	333	$39.66	$39.66	$13,220	$13,220	0
57.103	Patient Safety Component--Annual Hospital Survey	5,000	7,500	$39.66	$39.66	$198,300	$297,450	$99,150
57.105	Group Contact Information	83	83	$39.66	$39.66	$3,305	$3,305	0
57.106	Patient Safety Monthly Reporting Plan	18,000	18,000	$39.66	$39.66	$713,880	$713,880	0
57.108	Primary Bloodstream Infection (BSI)	145,200	145,200	$39.66	$39.66	$5,758,632	$5,758,632	0
57.111	Pneumonia (PNEU)	64,800	64,800	$39.66	$39.66	$2,569,968	$2,569,968	0
57.112	Ventilator-Associated Event	403,200	377,328	$39.66	$39.66	$15,990,912	$14,964,828	$1,026,084
57.113	Pediatric Ventilator-Associated Event (PedVAE)	6,000	6,000	$39.66	$39.66	$237,960	$237,960	0
57.114	Urinary Tract Infection (UTI)	80,000	80,000	$39.66	$39.66	$3,172,800	$3,172,800	0
57.115	Custom Event	106,167	31,850	$39.66	$39.66	$4,210,570	$1,263,171	0
57.116	Denominators for Neonatal Intensive Care Unit (NICU)	288,000	288,000	$32.45	$32.45	$9,345,600	$9,345,600	0
57.117	Denominators for Specialty Care Area (SCA)/Oncology (ONC)	271,080	90,600	$32.45	$32.45	$8,796,546	$2,939,970	$5,856,576
57.118	Denominators for Intensive Care Unit (ICU)/Other locations (not NICU or SCA)	1,807,200	1,812,000	$32.45	$32.45	$58,643,640	$58,799,400	0
57.120	Surgical Site Infection (SSI)	126,000	126,000	$39.66	$39.66	$4,997,160	$4,997,160	0
57.121	Denominator for Procedure	540,000	540,000	$32.45	$32.45	$17,523,000	$17,523,000	0
57.122	HAI Progress Report State Health Department Survey	-	41	$39.66	$39.66	-	$1,636	$1,636
57.123	Antimicrobial Use and Resistance (AUR)-Microbiology Data Electronic Upload Specification Tables	350	1,000	$18.73	$18.73	$6,556	$18,730	$12,175
57.124	Antimicrobial Use and Resistance (AUR)-Pharmacy Data Electronic Upload Specification Tables	800	2,000	$58.41	$58.41	$46,728	$116,820	$70,092
57.125	Central Line Insertion Practices Adherence Monitoring	4,167	4,167	$39.66	$39.66	$165,250	$165,250	0
57.126	MDRO or CDI Infection Form	216,000	216,000	$39.66	$39.66	$8,566,560	$8,566,560	0
57.127	MDRO and CDI Prevention Process and Outcome Measures Monthly Monitoring	36,000	29,580	$39.66	$39.66	$1,427,760	$1,173,143	$254,617
57.128	Laboratory-identified MDRO or CDI Event	480,000	394,400	$39.66	$39.66	$19,036,800	$15,641,904	$3,394,896
57.129	Adult Sepsis	5,208	5,208	$39.66	$39.66	$206,563	$206,563	0
57.137	Long-Term Care Facility Component – Annual Facility Survey	5,200	5,200	$39.66	$39.66	$206,232	$206,232	0
57.138	Laboratory-identified MDRO or CDI Event for LTCF	10,400	10,400	$39.66	$39.66	$412,464	$412,464	0
57.139	MDRO and CDI LabID Event Reporting Monthly Summary Data for LTCF	5,200	10,400	$39.66	$39.66	$206,232	$412,464	$206,232
57.140	Urinary Tract Infection (UTI) for LTCF	21,233	18,200	$39.66	$39.66	$842,114	$721,812	0
57.141	Monthly Reporting Plan for LTCF	2,600	2,600	$39.66	$39.66	$103,116	$103,116	0
57.142	Denominators for LTCF Locations	124,800	130,000	$39.66	$39.66	$4,949,568	$5,155,800	$206,232
57.143	Prevention Process Measures Monthly Monitoring for LTCF	2,600	2,600	$39.66	$39.66	$103,116	$103,116	0
57.150	LTAC Annual Survey	400	583	$39.66	$39.66	$15,864	$23,135	$7,271
57.151	Rehab Annual Survey	1000	1,400	$39.66	$39.66	$39,660	$55,524	$15,864
57.200	Healthcare Personnel Safety Component Annual Facility Survey	400	400	$33.75	$33.75	$13,500	$13,500	0
57.203	Healthcare Personnel Safety Monthly Reporting Plan	1,417	0	$33.75	$33.75	$47,813	$0	$47,813
57.204	Healthcare Worker Demographic Data	3,333	3,333	$33.75	$33.75	$112,500	$112,500	0
57.205	Exposure to Blood/Body Fluids	2,500	2,500	$33.75	$33.75	$84,375	$84,375	0
57.206	Healthcare Worker Prophylaxis/Treatment	375	375	$33.75	$33.75	$12,656	$12,656	0
57.207	Follow-Up Laboratory Testing	625	625	$18.73	$18.73	$11,706	$11,706	0
57.210	Healthcare Worker Prophylaxis/Treatment-Influenza	417	417	$33.75	$33.75	$14,063	$14,063	0
57.300	Hemovigilance Module Annual Survey – Acute Care Facility	1,000	708	$34.99	$34.99	$34,990	$24,785	$10,205
57.301	Hemovigilance Module Monthly Reporting Plan	100	100	$34.99	$34.99	$3,499	$3,499	0
57.303	Hemovigilance Module Monthly Reporting Denominators	7,020	7,000	$34.99	$34.99	$245,630	$244,930	0
57.305	Hemovigilance Incident	833	833	$34.99	$58.41	$29,158	$29,158	0
57.306	Hemovigilance Module Annual Survey - Non-Acute Care Facility	117	117	$34.99	$34.99	$4,082	$4,082	0
57.307	Hemovigilance Adverse Reaction - Acute Hemolytic Transfusion Reaction	667	667	$34.99	$34.99	$23,327	$23,327	0
57.308	Hemovigilance Adverse Reaction - Allergic Transfusion Reaction	667	667	$34.99	$34.99	$23,327	$23,327	0
57.309	Hemovigilance Adverse Reaction - Delayed Hemolytic Transfusion Reaction	167	167	$34.99	$34.99	$5,832	$5,832	0
57.310	Hemovigilance Adverse Reaction - Delayed Serologic Transfusion Reaction	333	333	$34.99	$34.99	$11,663	$11,663	0
57.311	Hemovigilance Adverse Reaction - Febrile Non-hemolytic Transfusion Reaction	667	667	$34.99	$34.99	$23,327	$23,327	0
57.312	Hemovigilance Adverse Reaction - Hypotensive Transfusion Reaction	167	167	$34.99	$34.99	$5,832	$5,832	0
57.313	Hemovigilance Adverse Reaction - Infection	167	167	$34.99	$34.99	$5,832	$5,832	0
57.314	Hemovigilance Adverse Reaction - Post Transfusion Purpura	167	167	$34.99	$34.99	$5,832	$5,832	0
57.315	Hemovigilance Adverse Reaction - Transfusion Associated Dyspnea	167	167	$34.99	$34.99	$5,832	$5,832	0
57.316	Hemovigilance Adverse Reaction - Transfusion Associated Graft vs. Host Disease	167	167	$34.99	$34.99	$5,832	$5,832	0
57.317	Hemovigilance Adverse Reaction - Transfusion Related Acute Lung Injury	167	167	$34.99	$34.99	$5,832	$5,832	0
57.318	Hemovigilance Adverse Reaction - Transfusion Associated Circulatory Overload	333	333	$34.99	$34.99	$11,663	$11,663	0
57.319	Hemovigilance Adverse Reaction - Unknown Transfusion Reaction	167	167	$34.99	$34.99	$5,832	$5,832	0
57.320	Hemovigilance Adverse Reaction - Other Transfusion Reaction	167	167	$34.99	$34.99	$5,832	$5,832	0
57.400	Outpatient Procedure Component—Annual Facility Survey	833	417	$32.45	$32.45	$27,042	$13,532	0
57.401	Outpatient Procedure Component - Monthly Reporting Plan	20,000	15,000	$32.45	$32.45	$649,000	$486,750	0
57.402	Outpatient Procedure Component Same Day Outcome Measures	20,000	20,000	$32.45	$32.45	$649,000	$649,000	0
57.403	Outpatient Procedure Component - Monthly Denominators for Same Day Outcome Measures	9,600	9,600	$32.45	$32.45	$311,520	$311,520	0
57.404	OPC- SSI Denominator	450,000	450,000	$32.45	$32.45	$14,602,500	$14,602,500	0
57.405	OPC Surgical Site Infection (SSI) Event	105,000	105,000	$39.66	$39.66	$4,164,300	$3,407,250	0
57.500	Outpatient Dialysis Center Practices Survey	14,350	28,233	$39.66	$39.66	$569,121	$587,629	$121,972
57.501	Dialysis Monthly Reporting Plan	7,000	7,000	$32.45	$32.45	$227,150	$227,150	0
57.502	Dialysis Event	175,000	175,000	$32.45	$32.45	$5,678,750	$5,678,750	0
57.503	Denominator for Outpatient Dialysis	14,000	14,000	$32.45	$32.45	$454,300	$454,300	0
57.504	Prevention Process Measures Monthly Monitoring for Dialysis	30,000	17,000	$32.45	$32.45	$973,500	$551,650	$421,850
57.505	Dialysis Patient Influenza Vaccination	4,063	4,063	$32.45	$32.45	$131,828	$131,828	0
57.506	Dialysis Patient Influenza Vaccination Denominator	271	271	$32.45	$32.45	$8,789	$8,789	0
57.507	Home Dialysis Center Practices Survey	175	175	$39.66	$39.66	$6,941	$6,941	0
Total Estimated Annual Cost Burden						$197,482,719	$183,509,861	$13,972,858

*Cost for some data collection forms remained the same, due to no changes in annual wages.Values were rounded prior to summation.

Revision of estimated national annual cost burden of data collection by NHSN data collection form. 5