Form 57.132 Reporting Plan HOB and HTCDI

Patient Safety Form Approved

OMB No. 0920-0666

Exp. Date:  06/30/2026

www.cdc.gov/nhsn

HT-CDI and HOB Module Digital Measure Reporting Plan (CDC 57.132)

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*required for saving

Facility ID: ______________*Start Month: _______*Start Year: _________ End Month: ________ End Year: ________

Measure

Healthcare facility onset, antibiotic treated CDI (HT-CDI)

HT-CDI data are collected from and include all applicable inpatient locations, emergency departments, and 24-hour observation units.

Measure HT-CDI

Following ☐

CDI Test Type/Algorithm Specify Other		Month	Year

Hospital onset bacteria (HOB)

HOB data are collected from and include all applicable inpatient locations, emergency departments, and 24-hour observation units.

Measure HOB

Following ☐

FacWideIN = Facility-wide Inpatient Patients Eligible: All patients

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 6 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, Project Clearance Officer, 1600 Clifton Rd., MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0666).

CDC 57.132 (Front) Rev. 5, v9.2

CDC 57.132 (Back) Rev. 5, 9.2