Staff and Personnel Impact Form - Instructions

Instructions for Completion of the COVID-19 Long-term Care Facility (LTCF) Staff and Personnel Impact Form (CDC 57.145)

Data Field	Instructions for Form Completion
NHSN Facility ID #	The NHSN-assigned facility ID will be auto-generated by the system.
CMS Certification Number (CCN)-may be referred to as participation number	Auto-generated by the computer, if applicable, based on the CCN entered during NHSN registration or last updated, if previously edited. Please see NHSN CCN Guidance document for instructions on how to add a new CCN or edit an existing CCN.
Facility Name	Auto-generated by the system based on the facility name previously entered during NHSN registration.
Date for which counts/responses are reported	Required. Select the date on the calendar for which the counts and/or responses in the Staff and Personnel Impact pathway apply. For example, if reporting the number of staff with positive SARS-CoV-2 (COVID-19) viral test results for specimens collected on Monday of the reporting week, Monday should be selected on the calendar as the day for which counts are being reported in the “Staff and Personnel Impact” pathway.
Facility Type	Auto-generated based on the facility type selected during NHSN enrollment. Selections include: LTC-ASSIST – Assisted Living Residence LTC-ICF/IID – Intermediate Care Facilities for Individuals with Intellectual Disabilities. LTC-SKILLNURS – Skilled Nursing Facility + +Includes both skilled nursing facilities and nursing homes LTC-PSYCH – Psychiatric Residential Treatment Facility LTC - SVHALF – Assisted Living Facility for Sate Veteran’s Homes LTC - SVHSNF – Skilled Nursing Facility for State Veteran’s Homes Please see NHSN Guidance document for instructions on How to Correct Your Facility Type if this information is incorrect.
Date Created	Auto-generated based on the first calendar date and time that a user manually enters and saves data or the date the facility first submits a CSV file for a specific pathway. Note: The date and time will automatically generate after the “Save” button is selected and cannot be modified.

Important:

Report only the NEW counts since the last date counts were collected for reporting to NHSN. If the count is zero for any variable, a “0” is to be entered as the response. A blank response is equivalent to missing data. NON-count questions are to be answered one calendar day during the reporting week.

Note: Answers to the questions below are based on NEW counts only. Specifically, reported counts must include only new data since the last date the data were collected for submitting to NHSN COVID19 Module. See examples in the below instructions.

Data Field	Instructions for Form Completion
Staff and Personnel Impact
POSITIVE TESTS Number of staff and facility personnel with a new positive COVID-19 viral test result.	Positive Tests: Defined by NHSN as number of staff members newly positive for COVID-19 based on a viral test result. The test result may be from a NAAT/PCR or an antigen test. The definition includes staff with an NHSN defined re-infection. Note: Exclude staff and facility personnel who have a positive SARS-CoV-2 antigen test, but a negative SARS-CoV-2 NAAT (PCR). The PCR will need to be performed within 2 calendar days (date of specimen collection is calendar day 1) of the initial antigen test for this rule to apply. Important: Positive Tests is a surveillance method for capturing positive diagnostic results only, clinical decisions should not be made based on this definition. Instead, diagnostic test results should be used in the context of available clinical, resident/patient, epidemiological, and diagnostic information. Report incidence counts only (specifically, staff and personnel newly identified in Positive Tests count) to avoid falsely inflated data. For example, if a facility reports counts to NHSN more than once per week, the facility should report new counts since the last date data were reported to NHSN. Positive Tests are based on the date of specimen collection. The Positive Tests definition, as defined by NHSN, may not represent the definition individual states use to define Confirmed SARS-CoV-2 (COVID-19) cases. Include staff with serial viral test results only when the additional tests were collected within two calendar days of initial SARS-CoV-2 viral test. Day of specimen collection is equal to day 1. Tests in which specimens are collected more than 2 calendar days apart should be considered separate tests. If staff/personnel were present in the facility during the infectious period, as defined by the interim guidance for risk assessment and work restrictions for HCP exposure to COVID-19 (https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html ), please report this positive test result to the Staff and Personnel Impact Pathway. This includes testing performed outside the facility (can include but not limited to home tests, over the counter tests, and test performed by a clinic or doctor’s office) If the facility performs the test for the staff member and the result is positive, the facility will need to include that result in the positive test count. Staff and facility personnel include anyone working or volunteering in the facility, which includes, but not limited to contractors, temporary staff, resident care givers, shared staff, etc. Diagnostic Terms and Definitions: NAAT: Nucleic acid amplification testing, a form of molecular testing. Includes but are not limited to Polymerase Chain Reaction (PCR) and Real Time Polymerase Chain Reaction (RT-PCR). A viral test is used to detect infection with SARS-CoV-2, the virus that causes COVID-19. Molecular (specifically, NAAT) and antigen tests are types of viral tests. CDC-NHSN recognizes positive results from both molecular and antigen diagnostic tests for diagnosing active COVID-19 infection. Exclude antibody test results. They are used to detect previous infection with SARS-CoV-2, the virus that causes COVID-19. This type of test is also called a serological test. Antibody test results are not considered appropriate for diagnosis of active COVID-19 infection. Example: The following SARS-CoV-2 tests and results were documented for staff and facility personnel in DHQP Skilled Nursing Facility (SNF) this week (counts represent newly positive or re-infected staff and facility personnel only): Monday: A total of 3 staff and facility personnel had positive SARS-CoV2 (COVID-19) viral test results: Of the 3-positive, all 3 staff and facility personnel had positive point-of-care (POC) antigen results. 2 of the staff and facility personnel had a follow-up negative NAAT (PCR) test result performed within 2 calendars days of the POC antigen test. 1 of the staff and facility personnel had a follow-up positive NAAT result performed on the same day. Tuesday: A total of 3 staff and facility personnel had positive SARS-CoV-2 (COVID-19) viral test results. Of the 3 positive, all 3 were antigen positive. No other testing performed on two of the staff and facility personnel. Only one of the three staff and facility personnel had a follow-up negative PCR, performed 4 days later. Since the follow up PCR was performed outside of the 2 calendar day window, this test would be counted independently form the initial test. In this case, the initial positive test will be included in the positive test count for this reporting week Wednesday: A total of 1 staff had a positive SARS-CoV-2 (COVID-19) viral test result. The contract nurse tested positive via NAAT/PCR. No other COVID19 testing performed. Thursday: A total of 1 staff had a positive SARS-CoV-2 (COVID-19) viral test result. Of the 1 positive POC antigen test result, the staff had no other tests performed. He did have a laboratory positive COVID-19 test result over 3 months ago and fully recovered. He developed fever and loss of smell today, prompting antigen POC testing. Friday: A total of 3 staff and facility personnel had positive SARS-CoV-2 (COVID-19) NAAT/PCR viral test results. Of the 3 staff and facility personnel, all had positive COVID-19 antigen test results two weeks ago and were already submitted to NHSN as Positive Tests. Saturday: 0 newly positive test results among staff and facility personnel Sunday: 1 positive SARS-CoV-2 NAAT/PCR viral test result for a staff nurse with no other testing performed Based on the above information, the following Positive Tests counts were submitted to NHSN: Monday: 1; Tuesday:3; Wednesday:1; Thursday: 1; Friday: 0; Saturday: 0; Sunday: 1. TOTAL POSITIVE TESTS FOR THE WEEK: 7
COVID-19 DEATHS Number of staff and facility personnel with COVID-19 who died.	COVID-19 Deaths: Defined by NHSN as staff and/or facility personnel who died from SARS-CoV-2 (COVID-19) related complications. Enter the number of staff and/or facility personnel with COVID-19 who died. Notes: Staff and facility personnel include anyone working or volunteering in the facility, which includes, but not limited to contractors, temporary staff, resident care givers, shared staff, etc. Report only the new COVID-19 deaths among staff and/or facility personnel since the last time these counts were collected for NHSN submission.
Staff and Personnel Impact for Non-COVID-19 (SARS-CoV-2) Respiratory Illness
INFLUENZA Number of staff and facility personnel with a new influenza (flu).	Influenza: Defined by NHSN as a new positive influenza test result, also referred to as a positive flu test result. Notes: A new positive influenza/flu test result is required to be included in the influenza count. Duplicate counting of staff and facility personnel with Influenza will result in falsely inflated counts.

Long Term Care Facility: Staffing Shortages
Data Field	Instructions for Form Completion
Staffing and Personnel Shortages Does your organization have a shortage of staff and/or personnel?	Select YES if your facility does have a shortage of staff and/or personnel Select NO if your facility does NOT a shortage of staff and/or personnel
Staff and Personnel Groups If YES is selected above, please select the items below for which there is a shortage
Nursing Staff Shortage Indicate if your facility has a shortage of nursing staff “YES” if facility has a shortage “NO” if facility does not a shortage	Nursing Staff: registered nurse, licensed practical nurse, vocational nurse Select YES if your facility does have a shortage of nursing staff, otherwise select NO
Clinical Staff Shortage Indicate if your facility has a shortage of clinical staff “YES” if facility has a shortage “NO” if facility does not a shortage	Clinical Staff: physician, physician assistant, advanced practice nurse Select YES if your facility does have a shortage of clinical staff, otherwise select NO
Aide Shortage Indicate if your facility has a shortage of Aids “YES” if facility has a shortage “NO” if facility does not a shortage	Aide: certified nursing assistant, nurse aide, medication aide, and medication technician Select YES if your facility does have a shortage of Aides, otherwise select NO
Other Staff and Facility Personnel Shortage Indicate if your facility has a shortage of Other Staff and Facility Personnel “YES” if facility has a shortage “NO” if facility does not a shortage	Other staff or facility personnel: regardless of clinical responsibility or resident contact not included in the categories above (for example, environmental services) Select YES if your facility does have a shortage of other staff or facility personnel, otherwise select NO