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HAI/AR Response & Prevention Reporting System
Page 1
HARP 1: Status of Required Tasks
Jurisdiction
__________________________________
HARP 1: Status of Required Tasks Instructions: Recipients should report on the status of the
following required tasks for this reporting period (August 1, 2024 - December 31, 2024):
- In Q1, indicate if the HAI/AR Program Staffing Directory includes up-to-date staffing
information for staff involved in HAI/AR Response and Prevention activities as required under
ELC Core Program H.
- In Q2, indicate the status of the annual landscape analysis of outpatient dialysis services
locations as required under SHARP Project I Activity D1.
- CDC will release the HAI/AR Response and Prevention Annual Survey for completion during
Budget Period 1. Additional details will follow. No reporting is required at this time. Please
review the HAI/AR Response & Prevention Reporting System Guide for additional details. This
instrument is due on February 28, 2025 for the reporting period August 1, 2024 - December
31, 2024.
Q1. Does the HAI/AR Program Staffing Directory include updated staffing information for staff involved in HAI/AR
Response and Prevention activities:
Link to HAI/AR Program Staffing Directory: HAI/AR Program Staffing Directory
Q1a. All staff involved in implementing HAI/AR
Response and Prevention strategies and activities,
regardless of funding source, have been added to the
staffing directory.
Yes
No
Don't Know
Q1b. All staff contributing to HAI/AR Response and
Prevention have updated information regarding: (1)
ability to perform onsite/remote assessment, (2)
local, regional, or central designation, (3) funding
source(s), and (4) clinical or non-clinical
designation.
Yes
No
Don't Know
Q2. Status of landscape analysis of outpatient
dialysis services location:
Completed
Underway
Reviewed and revised
Not started
Q3. Status of the HAI/AR Program Response and
Prevention Survey
Submitted
Underway
Not started
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Form Approved
OMB Control Number: 0920-1282
Expiration Date: 6/30/2026
CDC estimates the average public reporting burden for this collection of information as 5 minutes per response,
including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining
the data/information 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/ATSDR Information Collection Review
Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1282).
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HAI/AR Response & Prevention Reporting System
Page 1
HARP 2: nMDRO Responses
Jurisdiction
__________________________________
HARP 2: Novel or Targeted Multi-drug Resistant Organisms (nMDRO) Responses
Instructions:
Please report nMDRO responses conducted by either
- Staff from HAI/AR Program or their designee* (regardless of funding source), or
- Staff partially or fully funded through one of the following mechanisms who contributed to
the response:
- ELC Core Program H
- SHARP 1 or SHARP 2
- Enhancing Detection Expansion/CARES
This instrument is due on February 28, 2025 for the
reporting period August 1, 2024 - December 31, 2024.
Data entry instructions
- Please enter one REDCap form for each nMDRO response that took place during the
reporting period (August 1, 2024 - December 31, 2024, due by February 28, 2025).
- For continuing responses please ensure all the data entered are cumulative irrespective of
the reporting period. The reporting instrument is programmed to display a subset of questions
based on the answer(s) to Question 3a establishing the nMDRO response as an investigation
or consultation. nMDRO investigations must be reported by direct entry into this REDCap
instrument. nMDRO consultations may be reported using the bulk upload tool (available in the
Bulk Upload section of this REDCap project) OR by direct entry into this REDCap instrument.
Please review the HAI/AR Response & Prevention Reporting System Guide for additional
details.
*Designee may include other state health department staff, local health department staff,
contractor, or other partner supported by your program for which your program can assure
the quality of services provided. Recipients should work with designees to ensure that all
responses are submitted without duplication.
HAI/AR Response & Prevention Reporting System Guide
[Attachment: "HAIAR Response & Prevention Reporting System Guide_6Feb2025.pdf"]
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Reported through excel-based tracking tool/Imported
into REDCap
Q1. Local outbreak/response ID
ID for cross-referencing with your local tracking tool
as needed. May use any unique identifier.
Q2. Response start date
Date when the HAI/AR Program first made the decision
to start the response.
Q3a. Did you perform (or provide substantial
technical assistance with) any of the following
activities for this response?
[Check all that were performed]
Note: When considering whether substantial technical
assistance was provided, judgment can be applied
(refer to the "Where to submit HAI/AR response and
prevention activities" section of the HAI/AR Response
& Prevention Reporting Guide for more information)
Q3b. Did the HAI/AR program offer public health
assistance for any of the following, for any facility
involved in the response:
[Check all that were offered]
Q4. During which reporting period did the HAI/AR
Program engage in activities related to this response?
[Check all that apply]
Q5. Did this response involve any of the following
issues:
[Check all that apply]
Q5a. Type of medical device:
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Yes
__________________________________
__________________________________
(If exact date not known, please approximate.)
Onsite infection prevention and control assessment
Remote infection prevention and control assessment
Patient notification or call for cases
Environmental sampling
Colonization screening
None of the above
Onsite infection prevention and control assessment
Remote infection prevention and control assessment
Colonization screening
Unknown
None of the above
August 1, 2019 - July 31, 2020
August 1, 2020 - July 31, 2021
August 1, 2021 - July 31, 2022
August 1, 2022 - July 31, 2023
August 1, 2023 - July 31, 2024
August 1, 2024 - December 31, 2024
Injection safety breach (other than drug diversion)
Drug diversion
Medical device reprocessing breach
Medical product contamination other than device,
extrinsic (facility)
Medical product or device contamination, intrinsic
(pre-facility)
Environmental cleaning and disinfection issue
Water related issue (i.e., building water, faucet,
holding tank, ice, water treatment)
Wastewater plumbing related issue (i.e., suspected
or confirmed transmission from sink drains,
toilets, hoppers, etc.)
Foodborne illness
Other infection prevention and control breach
Other
None
Unknown
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Q5b. Type of product:
Q5c. Type of product:
Q5d. Other infection prevention and control breach,
specify:
Q5e. Other, specify:
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__________________________________
__________________________________
__________________________________
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Q6. What was the trigger for the response?
Select the option that best describes the trigger for
initiating this response. If needed, more than one
option can be selected.
Definitions/Examples
Single clinical case
Multiple clinical cases
Screening (e.g., admission, discharge, etc.)
Regional effort (response involving multiple
facilities in a city/region)
Prevention-based Point Prevalence Survey (PPS)
Other
Unknown
- Single clinical case: A single patient with a nMDRO
detected from clinical culture
- Multiple clinical cases: Multiple patients with a
nMDRO identified from a clinical culture and clustered
in time
- Screening case: Patient colonized (e.g., admission,
discharge, etc.) with a nMDRO
- Regional effort: Response that involves multiple
facilities across a city/region to assess for the
transmission of an emerging resistant organism.
Facilities are not selected based on known direct
epidemiology links to each other but rather based on
characteristics (e.g., high acuity post-acute care).
- Note: When a response to a single clinical case,
multiple clinical cases, or screening case expands to
a regional effort, in which screening is conducted at
facilities without direct epidemiologic links to the
original case, please check regional effort in
addition to the initial response trigger.
- Note: Regional efforts should be aggregated into
one entry.
- Prevention-based Point Prevalence Survey
(PPS): Response based on findings from proactive,
periodic, and prevention-driven PPS (e.g., high-acuity
post-acute care facilities), and admission screening.
From these prevention PPS an acute outbreak is
identified, and a containment response is initiated.
- Note: When transmission is controlled (contained)
and the outbreak facilities are switched to indefinite
periodic PPS's (also called maintenance PPS), ALL
proactive, periodic, and prevention-driven PPS from
this point forward qualify as prevention (HARP 4)
entries.
Q6a (i). Facility ID of Admission Screening
For the purpose of linking responses, please provide
the Facility ID for the prevention-based admission
screening(s) designated in HARP 4.
Q6a (ii). Facility ID of Prevention-based Point
Prevalence Survey
__________________________________
__________________________________
For the purposes of linking responses, please provide
the Facility ID for the prevention-based/proactive PPS
designated in HARP 4.
Q6b. Other trigger, specify:
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Q7. Did more than one targeted MDRO trigger this
response?
Yes
No
Unknown
Note: Targeted MDRO(s) [organism/mechanism] are those
that triggered the response. This does NOT include
other non-targeted organisms subsequently identified
during the response (e.g., through screening).
Refer to "nMDRO Additional Guidance to Complete the
HARP 2 Reporting Form" section of HAI/AR Response &
Prevention Reporting System Guide for additional
details on reporting multiple target MDROs.
Q8. Organism/mechanism that triggered the response
Please list the organism and mechanism (if applicable) that triggered the response. These
organisms will be considered "targeted MDROs" for the remainder of the questions.
Do not include other non-targeted organisms subsequently identified during the response
(e.g., through screening) in this section.
Organisms
Select all the organisms and associated mechanisms
that triggered the response. If no organism prompted
the response, select "No organism identified."
Do not include other non-targeted organisms/mechanisms
subsequently identified during the response (e.g.,
through screening) in this section.
Other organism, specify:
Please specify the genus and species of the organism
that triggered the response.
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Acinetobacter baumannii
Citrobacter spp.
Enterobacter aerogenes (Klebsiella aerogenes)
Enterobacter cloacae complex
Enterobacter spp. (other than E. aerogenes, E.
cloacae complex)
Escherichia coli
Klebsiella oxytoca
Klebsiella pneumoniae
Klebsiella spp. (other than K. oxytoca, K.
pneumoniae, and K. aerogenes)
Morganella morganii
Proteus mirabilis
Providencia spp.
Pseudomonas aeruginosa
Pseudomonas spp. (non- aeruginosa species)
Raoultella spp.
Serratia marcescens
Candida auris
Other(s)
Unknown
No organism identified
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Acinetobacter baumannii mechanism [check all that
apply]
Acinetobacter baumannii other mechanism, specify:
Citrobacter spp. mechanism [check all that apply]
Citrobacter spp. other mechanism, specify:
Enterobacter aerogenes (Klebsiella
aerogenes) mechanism [check all that apply]
Enterobacter aerogenes (Klebsiella aerogenes) other
mechanism, specify:
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KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
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Enterobacter cloacae complex mechanism [check all that
apply]
Enterobacter cloacae complex other mechanism, specify:
Enterobacter spp. (other than E. aerogenes, E.
cloacae complex) mechanism [check all that apply]
Enterobacter spp. (other than E. aerogenes, E. cloacae
complex) other mechanism, specify:
Escherichia coli mechanism [check all that apply]
Escherichia coli other mechanism, specify:
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KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
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Klebsiella oxytoca mechanism [check all that apply]
Klebsiella oxytoca other mechanism, specify:
Klebsiella pneumoniae mechanism [check all that apply]
Klebsiella pneumoniae other mechanism, specify:
Klebsiella spp. (other than K. oxytoca, K. pneumoniae,
K. aerogenes) mechanism [check all that apply]
Klebsiella spp. (other than K. oxytoca, K. pneumoniae,
K. aerogenes) other mechanism, specify:
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KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
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Morganella morganii mechanism [check all that apply]
Morganella morganii other mechanism, specify:
Proteus mirabilis mechanism [check all that apply]
Proteus mirabilis other mechanism, specify:
Providencia spp. mechanism [check all that apply]
Providencia spp. other mechanism, specify:
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KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
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Pseudomonas aeruginosa mechanism [check all that
apply]
Pseudomonas aeruginosa other mechanism, specify:
Psuedomonas spp. (non- aerugionsa species) mechanism
[check all that apply]
Psuedomonas spp. (non- aerugionsa species) other
mechanism, specify:
Raoultella spp. mechanism [check all that apply]
Raoultella spp. other mechanism, specify:
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KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
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Serratia marcescens mechanism [check all that apply]
Serratia marcescens other mechanism, specify:
Other organism mechanism [check all that apply]
Other organism other mechanism, specify:
Unknown organism mechanism [check all that apply]
Other unknown other mechanism, specify:
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KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
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No organism identified mechanism [check all that
apply]
No organism identified other mechanism, specify:
KPC
NDM
IMP
VIM
OXA 48
OXA 23
OXA 24_40
OXA 58
OXA 235
mcr
mCIM+/PCROther
Unknown
__________________________________
Facility/Setting Information
Answer the following questions for all organism/mechanism combinations involved in this
response.
Q9. Setting Type(s):
[Check all that apply]
Select setting types involved (where infections were
identified, screenings were conducted, onsite
assessments were performed, etc.). Additionally,
select the setting type that best describes how the
overall facility is licensed (e.g., in a SNF that
cares for ventilated residents, select vSNF.)
If the facility has more than one level of care,
select the level(s) of care relevant to the
investigation and the responses to follow up
activities should be submitted for those level(s)
where investigation was conducted.
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Inpatient Rehabilitation Facility
Long-term Acute Care Hospital (LTACH)
Ventilator-capable Nursing Home/ Skilled Nursing
Facility (vSNF)
Nursing Home/ Skilled Nursing Facility (SNF)
Assisted Living Facility
Other congregate setting (e.g., group homes,
homeless shelter)
Dialysis Facility (outpatient)
Dental Office
Ambulatory Surgical Center
Other outpatient settings
Other healthcare settings
Unknown
Q9a (i). Please select the location within the ACH, if
applicable
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Intensive care unit
Burn unit
Oncology unit
Dialysis unit
Operating room
Emergency department
Transplant unit
Labor and delivery
Medical unit
Surgical unit
Rehab unit
Other
Unknown
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Q9a (ii). Intensive care unit type:
[Optional, Check all that apply]
Q9a (iii). Other location within the ACH facility,
specify:
Q9b. Please select the location within the LTACH, if
applicable
[Check all that apply]
Q9c. Please select the location within the vSNF, if
applicable
[Check all that apply]
Q9d. Please select the location within the SNF, if
applicable
[Check all that apply]
Q9e (i). Please select the types of congregate
settings
[Check all that apply]
Q9e (ii). Other congregate setting type, specify:
Q9f (i). Please select the other outpatient setting
type
[Check all that apply]
Q9f (ii). Other outpatient setting type, specify:
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General
Medical care
Surgical
Neurology
Neonatal intensive care unit (NICU)
Pediatric intensive care unit (PICU)
Other
__________________________________
Intensive care unit
Non-Intensive care unit
Other
Unknown
Ventilator unit (or ventilated residents, if no
separate ventilator unit)
Non-ventilator unit
Other
Unknown
Tracheostomy unit (e.g., provides tracheostomy
care but not license for ventilator services)
Short-stay unit in long-term care facility
Memory care unit
Other
Unknown
Group home
Homeless shelter
Behavioral health/ mental health facility
Correctional Facility
School, health clinic
Migrant shelter
Independent Living Facility
Emergency shelters (other than homeless shelters)
Other
Unknown
__________________________________
Urology
Endoscopy
Wound clinic
Pain clinic
Home health
Oncology
Dermatology
Ophthalmology/ eye clinic
Federally Qualified Health Centers (FQHC)
Other
Unknown
__________________________________
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Q9g. Other healthcare setting type, specify:
Q10a. NHSN OrgID of the primary outbreak facility
(i.e., If this response activity includes more than
one facility, please provide the NHSN OrgID of the
facility where the majority of response activity
occurred).
__________________________________
__________________________________
(If NHSN OrgID is unknown, not available, or cannot
be shared please complete Q10b.)
If NHSN OrgID is unknown, not available, or cannot be
shared please complete Q10b.
Note: For more information on how to obtain a facility
NHSN OrgID visit
https://www.cdc.gov/nhsn/pdfs/orgid-verification-508.p
df
Q10b. Zip code of the primary outbreak facility (i.e.,
If this response activity includes facilities in more
than one zip code, please include the zip code of the
facility where the majority of response activity
occurred)
Q10c. Were any of the facilities involved tribally
operated or a part of the Indian Health Service:
__________________________________
(If zip code cannot be shared or is unknown please
enter 99999)
Yes
No
Unknown
Colonization Screenings and Infection Control Assessments
Answer the following questions for each setting type involved.
Provision of onsite or remote assistance to assess infection control issues may be done
directly by the recipient or by a designee. A designee may include other state health
department staff, local health department staff, contractor, or other partner supported by
your program for which your program can assure the quality of services provided. Recipients
should work with designees to ensure that all responses are submitted without duplication.
The number of infection control assessments conducted should include each unique facility
assessment to include repeat assessments as long as some form of infection control practice
assessment occurs (e.g., not just an update about case counts). In some instances, both
onsite and remote visits may have occurred with a facility, and this should be reflected
accordingly among the different assessment types.
To be counted as an infection control assessment (onsite/remote) requires the use of a
structured form of data collection, such as CDC ICAR tool or a similar state/locally developed
tool.
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Acute Care Hospitals
NOTE: Colonization screening and infection control assessment questions appear based on the choices selected in
Q3a. If infection control assessment(s) or colonization screening(s) were performed and questions are not displayed,
please update your response to question Q3a.
How many acute care hospitals (ACHs) were involved?
This includes the number of ACHs where
infected/colonized patients were identified, screening
was conducted, or onsite/remote infection control
assessments were performed.
If more than one ACH was involved in the response, how
many ACH conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 ACH were involved in the response, but
only 2 conducted screening, enter 2.
How many screening tests were performed for all
targeted MDROs across all ACHs during this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, respectively. Enter C.
auris=50, CRE NDM=60).
Please select the reason(s) for not screening patients
in ACHs
[Check all that apply]
Please specify other reason for not conducting any
screening.
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
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If more than one ACH conducted screenings, how many
facilities had screening tests positive for the
targeted mechanism(s)/organism(s)?
__________________________________
For example, if 2 ACHs conducted screening but only 1
facility detected the targeted
mechanism(s)/organism(s), then enter 1.
How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all ACHs during this response?
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, and 10 were positive
for C. auris while 8 were positive for CRE NDM, enter
C. auris=10, CRE NDM=8).
Did your HAI/AR Program or a designee conduct any of
the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
__________________________________
(If none, enter 0. If exact number screened not
known, please approximate.)
__________________________________
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across all ACHs during this response?
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
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__________________________________
(If no onsite assessments performed, enter 0.)
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How many remote infection control assessments were
conducted across all ACHs during this response?
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
__________________________________
(If no remote assessments performed, enter 0.)
Telephone
Video (i.e, Skype, Zoom)
Critical Access Hospitals
NOTE: Colonization screening and infection control assessment questions appear based on the choices selected in
Q3a. If infection control assessment(s) or colonization screening(s) were performed and questions are not displayed,
please update your response to question Q3a.
How many critical access hospitals (CAHs) were
involved?
This includes the number of CAHs where
infected/colonized patients were identified, screening
was conducted, or onsite/remote infection control
assessments were performed.
If more than one CAH was involved in the response, how
many CAH conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 CAHs were involved in the response, but
only 2 conducted screening, enter 2.
How many screening tests were performed for all
targeted MDROs across all CAHs during this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, respectively. Enter C.
auris=50, CRE NDM=60).
03/03/2025 1:11pm
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
projectredcap.org
Confidential
Page 18
Please select the reason(s) for not screening patients
in CAHs
[Check all that apply]
Please specify other reason for not conducting any
screening.
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
If more than one CAH conducted screenings, how many
facilities had screening tests positive for the
targeted mechanism(s)/organism(s)?
__________________________________
For example, if 2 CAHs conducted screening but only 1
facility detected the targeted
mechanism(s)/organism(s), then enter 1.
How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all CAHs during this response?
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, and 10 were positive
for C. auris while 8 were positive for CRE NDM, enter
C. auris=10, CRE NDM=8).
03/03/2025 1:11pm
__________________________________
(If none, enter 0. If exact number screened not
known, please approximate.)
__________________________________
projectredcap.org
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Page 19
Did your HAI/AR Program or a designee conduct any of
the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across all CAHs during this response?
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
How many remote infection control assessments were
conducted across all CAHs during this response?
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
__________________________________
(If no onsite assessments performed, enter 0.)
__________________________________
(If no remote assessments performed, enter 0.)
Telephone
Video (i.e, Skype, Zoom)
Inpatient Rehabilitation Facilities
03/03/2025 1:11pm
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Page 20
NOTE: Colonization screening and infection control assessment questions appear based on the choices selected in
Q3a. If infection control assessment(s) or colonization screening(s) were performed and questions are not displayed,
please update your response to question Q3a.
How many inpatient rehabilitation facilities (IRFs)
were involved?
This includes the number of inpatient rehabilitation
facilities where infected/colonized patients were
identified, screening was conducted, or onsite/remote
infection control assessments were performed.
If more than one inpatient rehabilitation facility was
involved in the response, how many inpatient
rehabilitation facilities conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 inpatient rehabilitation facilities were
involved in the response, but only 2 conducted
screening, enter 2.
How many screening tests were performed for all
targeted MDROs across all inpatient rehabilitation
facilities during this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, respectively. Enter C.
auris=50, CRE NDM=60).
Please select the reason(s) for not screening patients
in inpatient rehabilitation facilities
[Check all that apply]
Please specify other reason for not conducting any
screening.
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
If more than one inpatient rehabilitation facility
conducted screenings, how many facilities had
screening tests positive for the targeted
mechanism(s)/organism(s)?
__________________________________
For example, if 2 inpatient rehabilitation facilities
conducted screening but only 1 facility detected the
targeted mechanism(s)/organism(s), then enter 1.
03/03/2025 1:11pm
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Page 21
How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all inpatient rehabilitation
facilities during this response?
__________________________________
(If none, enter 0. If exact number not known,
please approximate.)
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, and 10 were positive
for C. auris while 8 were positive for CRE NDM, enter
C. auris=10, CRE NDM=8).
Did your HAI/AR Program or a designee conduct any of
the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
__________________________________
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across all IRFs during this response?
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
03/03/2025 1:11pm
__________________________________
(If no onsite assessments performed, enter 0.)
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How many remote infection control assessments were
conducted across all IRFs during this response?
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
__________________________________
(If no remote assessments performed, enter 0.)
Telephone
Video (i.e, Skype, Zoom)
Long-term Acute Care Hospitals
NOTE: Colonization screening and infection control assessment questions appear based on the choices selected in
Q3a. If infection control assessment(s) or colonization screening(s) were performed and questions are not displayed,
please update your response to question Q3a.
How many long-term acute care hospitals (LTACHs) were
involved?
This includes the number of long-term acute care
hospitals where infected/colonized patients were
identified, screening was conducted, or onsite/remote
infection control assessments were performed.
If more than one LTACH was involved in the response,
how many LTACHs conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 LTACHs were involved in the response,
but only 2 conducted screening, enter 2.
How many screening tests were performed for all
targeted MDROs across all LTACHs during this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, respectively. Enter C.
auris=50, CRE NDM=60).
03/03/2025 1:11pm
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
projectredcap.org
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Page 23
Please select the reason(s) for not screening patients
in LTACHs
[Check all that apply]
Please specify other reason for not conducting any
screening.
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
If more than one LTACH conducted screenings, how many
facilities had screening tests positive for the
targeted mechanism(s)/organism(s)?
__________________________________
For example, if 2 LTACHs conducted screening but only
1 facility detected the targeted
mechanism(s)/organism(s), then enter 1.
How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all LTACHs during this response?
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, and 10 were positive
for C. auris while 8 were positive for CRE NDM, enter
C. auris=10, CRE NDM=8).
03/03/2025 1:11pm
__________________________________
(If none, enter 0. If exact number not known,
please approximate.)
__________________________________
projectredcap.org
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Page 24
Did your HAI/AR Program or a designee conduct any of
the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across all LTACHs during this response?
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
How many remote infection control assessments were
conducted across all LTACHs during this response?
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
__________________________________
(If no onsite assessments performed, enter 0.)
__________________________________
(If no remote assessments performed, enter 0.)
Telephone
Video (i.e, Skype, Zoom)
Ventilator-capable Nursing Homes/ Skilled Nursing Facilities
03/03/2025 1:11pm
projectredcap.org
Confidential
Page 25
NOTE: Colonization screening and infection control assessment questions appear based on the choices selected in
Q3a. If infection control assessment(s) or colonization screening(s) were performed and questions are not displayed,
please update your response to question Q3a.
How many ventilator-capable nursing homes/ skilled
nursing facilities (vSNFs) were involved?
This includes the number of vSNF where
infected/colonized patients were identified, screening
was conducted, or onsite/remote infection control
assessments were performed.
If more than one vSNF was involved in the response,
how many vSNFs conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 vSNFs were involved in the response, but
only 2 conducted screening, enter 2.
How many screening tests were performed for all
targeted MDROs across all vSNFs during this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, respectively. Enter C.
auris=50, CRE NDM=60).
Please select the reason(s) for not screening patients
in vSNFs.
[Check all that apply]
Please specify other reason for not conducting any
screening.
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
If more than one vSNF conducted screenings, how many
facilities had screening tests positive for the
targeted mechanism(s)/organism(s)?
__________________________________
For example, if 2 vSNFs conducted screening but only 1
facility detected the targeted
mechanism(s)/organism(s), then enter 1.
03/03/2025 1:11pm
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Page 26
How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all vSNFs during this response?
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, and 10 were positive
for C. auris while 8 were positive for CRE NDM, enter
C. auris=10, CRE NDM=8).
Did your HAI/AR Program or a designee conduct any of
the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
__________________________________
(If none, enter 0. If exact number not known,
please approximate.)
__________________________________
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across all vSNFs during this response?
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
03/03/2025 1:11pm
__________________________________
(If no onsite assessments performed, enter 0.)
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Page 27
How many remote infection control assessments were
conducted across all vSNFs during this response?
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
__________________________________
(If no remote assessments performed, enter 0.)
Telephone
Video (i.e, Skype, Zoom)
Nursing Homes/ Skilled Nursing Facilities
NOTE: Colonization screening and infection control assessment questions appear based on the choices selected in
Q3a. If infection control assessment(s) or colonization screening(s) were performed and questions are not displayed,
please update your response to question Q3a.
How many non-ventilator capable nursing homes/ skilled
nursing facilities (SNFs) were involved?
This includes the number of SNF where
infected/colonized patients were identified, screening
was conducted, or onsite/remote infection control
assessments were performed.
If more than one SNF was involved in the response, how
many SNFs conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 SNFs were involved in the response, but
only 2 conducted screening, enter 2.
How many screening tests were performed for all
targeted MDROs across all SNFs during this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times. If exact number
screened not known, please approximate.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, respectively. Enter C
auris=50, CRE NDM=60).
03/03/2025 1:11pm
__________________________________
(If no patients were screened, please enter 0)
__________________________________
projectredcap.org
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Page 28
Please select the reason(s) for not screening patients
in SNFs
[Check all that apply]
Please specify other reason(s) for not conducting any
screening.
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
If more than one SNF conducted screenings, how many
facilities had screening tests positive for the
targeted mechanism(s)/organism(s)?
__________________________________
For example, if 2 SNFs conducted screening but only 1
facility detected the targeted
mechanism(s)/organism(s), then enter 1.
How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all SNFs during this response?
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, and 10 were positive
for C. auris while 8 were positive for CRE NDM, enter
C. auris=10, CRE NDM=8).
03/03/2025 1:11pm
__________________________________
(If none, enter 0. If exact number not known,
please approximate.)
__________________________________
projectredcap.org
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Page 29
Did your HAI/AR Program or a designee conduct any of
the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across all SNFs during this response?
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
How many remote infection control assessments were
conducted across all SNFs during this response?
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
__________________________________
(If no onsite assessments performed, enter 0.)
__________________________________
(If no remote assessments performed, enter 0.)
Telephone
Video (i.e, Skype, Zoom)
Assisted Living Facilities
03/03/2025 1:11pm
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Page 30
NOTE: Colonization screening and infection control assessment questions appear based on the choices selected in
Q3a. If infection control assessment(s) or colonization screening(s) were performed and questions are not displayed,
please update your response to question Q3a.
How many assisted living facilities (ALFs) were
involved?
This includes the number of intermediate care
facilities (ALFs) where infected/colonized patients
were identified, screening was conducted, or
onsite/remote infection control assessments were
performed.
If more than one ALF was involved in the response, how
many ALFs conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 ALFs were involved in the response, but
only 2 conducted screening, enter 2.
How many screening tests were performed for all
targeted MDROs across all assisted living facilities
during this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, respectively. Enter C
auris=50, CRE NDM=60).
Please select the reason(s) for not screening patients
in assisted living facilities
[Check all that apply]
Please specify other reason(s) for not conducting any
screening.
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
If more than one ALF conducted screenings, how many
facilities had screening tests positive for the
targeted mechanism(s)/organism(s)?
__________________________________
For example, if 2 ALFs conducted screening but only 1
facility detected the targeted
mechanism(s)/organism(s), then enter 1.
03/03/2025 1:11pm
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Page 31
How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across allassisted living facilities during
this response?
__________________________________
(If none, enter 0. If exact number not known,
please approximate.)
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, and 10 were positive
for C. auris while 8 were positive for CRE NDM, enter
C. auris=10, CRE NDM=8).
Did your HAI/AR Program or a designee conduct any of
the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
__________________________________
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across all assisted living
facilities during this response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
03/03/2025 1:11pm
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How many remote infection control assessments were
conducted across all assisted living
facilities during this response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
Telephone
Video (i.e, Skype, Zoom)
Other Congregate Settings
NOTE: Colonization screening and infection control assessment questions appear based on the choices selected in
Q3a. If infection control assessment(s) or colonization screening(s) were performed and questions are not displayed,
please update your response to question Q3a.
How many other congregate settings (e.g., group homes,
homeless shelter) were involved?
This includes the number of congregate facilities
where infected/colonized patients were identified,
screening was conducted, or onsite/remote infection
control assessments were performed.
If more than one congregate setting was involved in
the response, how many facilities conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 congregate settings were involved in the
response, but only 2 conducted screening, enter 2.
How many screening tests were performed for all
targeted MDROs across all congregate settings during
this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, respectively. Enter C
auris=50, CRE NDM=60).
03/03/2025 1:11pm
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
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Please select the reason(s) for not screening patients
in other congregate settings
[Check all that apply]
Please specify other reason(s) for not conducting any
screening.
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
If more than one congregate setting conducted
screenings, how many facilities had screening tests
positive for the targeted mechanism(s)/organism(s)?
__________________________________
For example, if 2 congregate settings conducted
screening but only 1 facility detected the targeted
mechanism(s)/organism(s), then enter 1.
How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all congregate settings during this
response?
__________________________________
(If none, enter 0. If exact number screened not
known, please approximate.)
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, and 10 were positive
for C. auris while 8 were positive for CRE NDM, enter
C. auris=10, CRE NDM=8).
03/03/2025 1:11pm
__________________________________
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Did your HAI/AR Program or a designee conduct any of
the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an online or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across all congregate settings during this
response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
How many remote infection control assessments were
conducted across all congregate settings during this
response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
Telephone
Video (i.e, Skype, Zoom)
Dialysis Facilities (Outpatient)
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NOTE: Colonization screening and infection control assessment questions appear based on the choices selected in
Q3a. If infection control assessment(s) or colonization screening(s) were performed and questions are not displayed,
please update your response to question Q3a.
How many outpatient dialysis facilities were involved?
This includes the number of outpatient facilities
where infected/colonized patients were identified,
screening was conducted, or onsite/remote infection
control assessments were performed.
If more than one outpatient dialysis facility was
involved in the response, how many dialysis facilities
conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 outpatient dialysis facilities were
involved in the response, but only 2 conducted
screening, enter 2.
How many screening tests were performed for all
targeted MDROs accross all outpatient dialysis
facilities during this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, respectively. Enter C
auris=50, CRE NDM=60).
Please select the reason(s) for not screening patients
in outpatient dialysis facilities
[Check all that apply]
Please specify other reason(s) for not conducting any
screening.
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
If more than one outpatient dialysis facility
conducted screenings, how many facilities had
screening tests positive for the targeted
mechanism(s)/organism(s)?
__________________________________
For example, if 2 outpatient dialysis facilities
conducted screening but only 1 facility detected the
targeted mechanism(s)/organism(s), then enter 1.
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How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all outpatient dialysis facilities
during this response?
__________________________________
(If none, enter 0. If exact number not known,
please approximate.)
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, and 10 were positive
for C. auris while 8 were positive for CRE NDM, enter
C. auris=10, CRE NDM=8).
Did your HAI/AR Program or a designee conduct any of
the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
__________________________________
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across all outpatient dialysis
facilities during this response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
03/03/2025 1:11pm
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How many remote infection control assessments were
conducted across all outpatient dialysis
facilities during this response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
Telephone
Video (i.e, Skype, Zoom)
Dental Offices
NOTE: Colonization screening and infection control assessment questions appear based on the choices selected in
Q3a. If infection control assessment(s) or colonization screening(s) were performed and questions are not displayed,
please update your response to question Q3a.
How many dental offices were involved?
This includes the number of other facilities where
infected/colonized patients were identified, screening
was conducted, or onsite/remote infection control
assessments were performed.
If more than one dental office was involved in the
response, how many dental facilities conducted
screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 dental offices were involved in the
response, but only 2 conducted screening, enter 2.
How many screening tests were performed for all
targeted MDROs accross all dental offices during this
response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, respectively. Enter C
auris=50, CRE NDM=60).
03/03/2025 1:11pm
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
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Please select the reason(s) for not screening patients
in dental offices
[Check all that apply]
Please specify other reason(s) for not conducting any
screening.
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
If more than one dental office conducted screenings,
how many facilities had screening tests positive for
the targeted mechanism(s)/organism(s)?
__________________________________
For example, if 2 dental offices conducted screening
but only 1 facility detected the targeted
mechanism(s)/organism(s), then enter 1.
How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all dental offices during this
response?
__________________________________
(If none, enter 0. If exact number not known,
please approximate.)
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, and 10 were positive
for C. auris while 8 were positive for CRE NDM, enter
C. auris=10, CRE NDM=8).
03/03/2025 1:11pm
__________________________________
projectredcap.org
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Page 39
Did your HAI/AR Program or a designee conduct any of
the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across all dental offices during this
response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
How many remote infection control assessments were
conducted across all dental offices during this
response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
Telephone
Video (i.e, Skype, Zoom)
Ambulatory Surgical Centers
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NOTE: Colonization screening and infection control assessment questions appear based on the choices selected in
Q3a. If infection control assessment(s) or colonization screening(s) were performed and questions are not displayed,
please update your response to question Q3a.
How many ambulatory surgical centers were involved?
This includes the number of other facilities where
infected/colonized patients were identified, screening
was conducted, or onsite/remote infection control
assessments were performed.
If more than one ambulatory surgical center was
involved in the response, how many dental facilities
conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 ambulatory surgical centers were
involved in the response, but only 2 conducted
screening, enter 2.
How many screening tests were performed for all
targeted MDROs accross all ambulatory surgical centers
during this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, respectively. Enter C
auris=50, CRE NDM=60).
Please select the reason(s) for not screening patients
at ambulatory surgical center(s)
[Check all that apply]
Please specify other reason(s) for not conducting any
screening.
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
If more than one ambulatory surgical center conducted
screenings, how many facilities had screening tests
positive for the targeted mechanism(s)/organism(s)?
__________________________________
For example, if 2 ambulatory surgical centers
conducted screening but only 1 facility detected the
targeted mechanism(s)/organism(s), then enter 1.
03/03/2025 1:11pm
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How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all other outpatient settings during
this response?
__________________________________
(If none, enter 0. If exact number not known,
please approximate.)
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, and 10 were positive
for C. auris while 8 were positive for CRE NDM, enter
C. auris=10, CRE NDM=8).
Did your HAI/AR Program or a designee conduct any of
the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
__________________________________
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across all ambulatory surgical
centers during this response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
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How many remote infection control assessments were
conducted across all ambulatory surgical
centers during this response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
Telephone
Video (i.e, Skype, Zoom)
Other Outpatient Settings
NOTE: Colonization screening and infection control assessment questions appear based on the choices selected in
Q3a. If infection control assessment(s) or colonization screening(s) were performed and questions are not displayed,
please update your response to question Q3a.
How many other outpatient settings were involved?
This includes the number of other facilities where
infected/colonized patients were identified, screening
was conducted, or onsite/remote infection control
assessments were performed.
If more than one other outpatient settings was
involved in the response, how many outpatient
facilities conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 other outpatient settings were involved
in the response, but only 2 conducted screening, enter
2.
How many screening tests were performed for all
targeted MDROs accross all other outpatient settings
during this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, respectively. Enter C
auris=50, CRE NDM=60).
03/03/2025 1:11pm
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
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Please select the reason(s) for not screening patients
in other outpatient settings
[Check all that apply]
Please specify other reason(s) for not conducting any
screening.
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
If more than one other outpatient setting conducted
screenings, how many facilities had screening tests
positive for the targeted mechanism(s)/organism(s)?
__________________________________
For example, if 2 other outpatient settings conducted
screening but only 1 facility detected the targeted
mechanism(s)/organism(s), then enter 1.
How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all other outpatient settings during
this response?
__________________________________
(If none, enter 0. If exact number not known,
please approximate.)
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, and 10 were positive
for C. auris while 8 were positive for CRE NDM, enter
C. auris=10, CRE NDM=8).
03/03/2025 1:11pm
__________________________________
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Page 44
Did your HAI/AR Program or a designee conduct any of
the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across all other outpatient settings during
this response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
How many remote infection control assessments were
conducted across all other outpatient settings during
this response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
Telephone
Video (i.e, Skype, Zoom)
Other Healthcare Settings
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NOTE: Colonization screening and infection control assessment questions appear based on the choices selected in
Q3a. If infection control assessment(s) or colonization screening(s) were performed and questions are not displayed,
please update your response to question Q3a.
How many other healthcare facilities were involved?
This includes the number of other healthcare
facilities where infected/colonized patients were
identified, screening was conducted, or onsite/remote
infection control assessments were performed.
If more than one other healthcare facility was
involved in the response, how many other healthcare
facilities conducted screening?
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
__________________________________
Example: If 3 other healthcare facilities were
involved in the response, but only 2 conducted
screening, enter 2.
How many screening tests were performed for all
targeted MDROs accross all other healthcare facilities
during this response?
Multiple body sites on the same patient on the same
day count as one screening test. If the same patient
was screened multiple times over different PPSs, they
should be included multiple times.
If more than one targeted MDRO triggered the response,
specify the number of screening test performed for
each organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, respectively. Enter C
auris=50, CRE NDM=60).
Please select the reason(s) for not screening patients
in other healthcare facilities
[Check all that apply]
Please specify other reason(s) for not conducting any
screening.
__________________________________
(If no patients were screened, enter 0. If exact
number screened not known, please approximate.)
__________________________________
Facility refused
Patient in contact precautions for entire duration
of stay
Other
Don't know
__________________________________
[Optional]
If more than one other healthcare facility conducted
screenings, how many healthcare facilities had
screening tests positive for the targeted
mechanism(s)/organism(s)?
__________________________________
For example, if 2 ALFs conducted screening but only 1
facility detected the targeted
mechanism(s)/organism(s), then enter 1.
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How many screening tests were positive for targeted
mechanism/organism (e.g., KPC if KPC E. coli was the
trigger) across all other healthcare facilities during
this response?
__________________________________
(If none, enter 0. If exact number not known,
please approximate.)
If multiple body sites are positive on the same
patient on the same day that counts as one positive
screening test. If the same patient has positive
screening test results over different PPSs, these
positive tests should be counted multiple times.
If more than one targeted MDRO triggered the response,
specify the number of positive screening test for each
organism/mechanism (e.g., targeted MDROs included
Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, and 10 were positive
for C. auris while 8 were positive for CRE NDM, enter
C. auris=10, CRE NDM=8).
Did your HAI/AR Program or a designee conduct any of
the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, sink
hygiene, and inter-facility communication process.
__________________________________
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, sink hygiene, and inter-facility
communication process.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
How many onsite infection control assessments were
conducted across all other healthcare
facilities during this response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
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How many remote infection control assessments were
conducted across all other healthcare
facilities during this response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Please select the method in which the remote
assessment was conducted
Telephone
Video (i.e, Skype, Zoom)
Total case count
Q12. How many total patients with the target
mechanisms (for CPOs) or organisms (for C. auris) were
identified during this response?
__________________________________
Include index patients, those identified through
colonization screening, and any other patients
identified on prospective or retrospective
surveillance
Q12a. If more than one targeted MDRO triggered the
response, specify the number of patients identified
for each organism/mechanism (e.g., targeted MDROs
included Candida auris and CRE NDM for which 50 and 60
screening tests were conducted, across all setting
types and including the index case, enter C auris=11,
CRE NDM=9).
Q12b. In which of the following age groups was
colonization or infection identified?
Note: This question does not ask the health
departments to collect any additional information or
perform colonization testing, but to report this
information if it is known
__________________________________
Patients/residents - Infant (0-2 years)
Patients/residents - Pediatric (3-17 years)
Patients/residents - Adults (18-64 years)
Patients/residents - Older adults (65+ years)
No colonization or infection were identified among
patients or residents
Unknown
Q12c. Was colonization or infection identified among any of the following groups during this investigation?
Note: This question does not ask the health departments to collect any additional information or perform
colonization testing, but to report this information if it is known
Definitions
Direct care personnel -Care Providers Direct care personnel-Ancilliary Indirect care personnel Visitors
- Physician
- Nurse Practitioners/Physician Assistants
- Registered Nurse
- Licensed Practical Nurse
- Certified Nursing Assistants
- Respiratory therapist
- Physical/Occupation therapist
- Speech Therapist
- Dietary personnel
- Radiology technicians
- Phlebotomists
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- Registrars
- Volunteers
- Environmental Services Personnel
- Sterile Processing Department
- Pharmacists
- Supply chain
- Patient/resident family members
- Hospice care providers
- Chaplains
- Resident personal services (e.g., hair/nails)
Direct care personnel - Care Providers
Direct care personnel - Ancillary
Indirect care personnel
Visitors
Other
None of the above
Unknown
Q12c (i). Specify the type of care provider:
Physician
Nurse Practitioners/Physician Assistants
Registered Nurse
Licensed Practical Nurse
Certified Nursing Assistants
Other
None of the above
Unknown
Q12c (ii). Specify the type of ancilliary care
personnel:
Respiratory therapist
Physical/Occupation therapist
Speech Therapist
Dietary personnel
Radiology technicians
Phlebotomists
Registrars
Volunteers
Other
None of the above
Unknown
Q12c (iii). Specify the type of indirect care
personnel:
Environmental Services Personnel
Sterile Processing Department
Pharmacists
Supply chain
Others
None of the above
Unknown
Q12c (iv). Specify the type of visitors/contracted
personnel:
Patient/resident family members
Hospice care providers
Chaplains
Resident personal services (e.g., hair/nails)
Others
None of the above
Unknown
Q12c (v). Please specify the "other" group in which
colonization or infection identified:
Q13. Was transmission within the healthcare facility
or facilities suspected in this investigation?
__________________________________
Yes
No
Unknown/unclear
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Q14. How many patients with other (i.e. non-targeted)
MDROs were identified during this investigation?
__________________________________
This includes colonization or infection. Specify
organisms/mechanisms and number (e.g. If the targeted
MDRO was E. coli NDM, and you identified 5 patients
with infections or colonization of another MDRO, such
as 3 with C. auris and 2 with CRPA VIM, please write:
C. auris=3, CRPA VIM=2)
Q14a. In which of the following age groups was
colonization or infection identified?
Note: This question does not ask the health
departments to collect any additional information or
perform colonization testing for HC personnel but to
report this information on healthcare personnel if it
is known
Patients/residents - Infant (0-2 years)
Patients/residents - Pediatric (3-17 years)
Patients/residents - Adults (18-64 years)
Patients/residents - Older adults (65+ years)
No colonization or infection were identified among
patients or residents
Unknown
Q14b. Was colonization or infection identified among any of the following groups during this investigation?
Note: This question does not ask the health departments to collect any additional information or perform
colonization testing for HC personnel but to report this information on healthcare personnel if it is known
Definitions
Direct care personnel -Care Providers Direct care personnel-Ancilliary Indirect care personnel Visitors
- Physician
- Nurse Practitioners/Physician Assistants
- Registered Nurse
- Licensed Practical Nurse
- Certified Nursing Assistants
- Respiratory therapist
- Physical/Occupation therapist
- Speech Therapist
- Dietary personnel
- Radiology technicians
- Phlebotomists
- Registrars
- Volunteers
- Environmental Services Personnel
- Sterile Processing Department
- Pharmacists
- Supply chain
- Patient/resident family members
- Hospice care providers
- Chaplains
- Resident personal services (e.g., hair/nails)
Direct care personnel - care providers
Direct care personnel - ancillary
Indirect care personnel
Visitors
Other
None of the above
Unknown
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Q15. Were any of the isolates identified in this
response as pan-non-susceptible based on testing by
CDC or Regional AR Lab?
Yes
No
Unknown
For CPOs, this is defined as non-susceptible to all
available antibiotics based on testing by CDC or
Regional AR Lab.
For C. auris, this is defined as non-susceptible to
all available antifungals based on testing by CDC lab.
Q15a. If yes, please specify which organism and
mechanism combination was pan-non-susceptible.
__________________________________
Public Health Programs Involved in Response
Answer the following questions at the response level (i.e., for any setting affected and any
organism/mechanism combination).
Q16. Which public health programs and partners
contributed to the response?
[Check all that apply]
*Regional Public Health Staff includes regional office
staff and remote staff strategically assigned or
placed to serve a designated geographic region within
the jurisdiction.
Q16a (i). Please list other state/territorial
program(s) involved:
Q16a (ii). Please list the CDC program(s) involved:
Please list the team or division that was involved at
CDC and NOT an individual person (e.g., DHQP AR Team,
DHQP Response Team, Mycotics).
Q16a (iii). Please list regulatory or licensing
group(s) involved:
Q16a (iv). Please list other program(s) involved:
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State/Territorial HAI/AR Program
State/Territorial, other public health program(s),
specify below
Local HAI/AR Program
Local, other public health program(s)
Regional Public Health Staff*
Regional AR Lab
CDC, specify below
Regulatory or licensing group(s), specify below
Other, specify below
Unknown
__________________________________
__________________________________
__________________________________
__________________________________
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Q16b. Which entity had the responsibility of leading
the overall nMDRO response?
State/Territorial HAI/AR Program
State/Territorial, other public health program(s)
Local HAI/AR Program
Local, other public health program(s)
Regional Public Health Staff (e.g., regional
office staff, remote staff strategically assigned
or placed to serve a designated geographic region
within the jurisdiction)
Regional AR Lab
CDC
Regulatory or licensing group(s)
Other
Unknown
Notifications
Q17. Were any of the following notification types
made?
[Check all that apply]
Notifications may have been made by the healthcare
facility, local public health department, and/or
HAI/AR Program.
Patient notification
Provider notification
Public disclosure
None
Unknown
Patient notification: Patients were informed of
investigation or advised of potential exposure or
risk.
Provider notification: Providers were informed of the
investigation or advised of potential exposure or
risk.
Public disclosure: Members of the public were made
aware of the investigation through media reports or
other communication to the public.
Q17a. Approximate number of patients notified
__________________________________
Other Details
Q18. State lab specimen ID of index case
If specimen or isolate was tested at a Public Health
Laboratory, please enter the state laboratory
accession number. If multiple index cases triggered
the response, include at least one state laboratory
accession number. If the specimen was tested at a
regional lab, please include that ID.
Q19. Date of specimen collection of index case
If multiple index cases triggered the response,
include the first one.
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__________________________________
(If isolate was not tested at the Public Health
Laboratory, please input N/A.)
__________________________________
(If exact date not known, please provide
approximate.)
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Q20. Date target mechanism (for CPOs) or organism
(for C. auris) was identified
If multiple index cases triggered the response,
include the first one.
Q21. Were any of the staff contributing to this
response partially or fully funded through the
following funding mechanisms:
[Check all that apply]
Q21a. Please specify the other funding source:
__________________________________
(If exact date not known, please provide
approximate.)
ELC Core Program H
SHARP 1 or SHARP 2
Enhancing Detection Expansion/CARES
State/Local Funding
Other, please specify below
Unknown
__________________________________
Additional Comments
Q22. Additional notes/comments to CDC (any other
information you would like to share about this
particular response)
Q23. Response end date
Date when the HAI/AR Program closed or ended the
response.
__________________________________________
__________________________________
(Please leave this field empty if the response is
ongoing.)
Form Approved
OMB Control Number: 0920-1282
Expiration Date: 6/30/2026
CDC estimates the average public reporting burden for this collection of information as 8 hours per response,
including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining
the data/information 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/ATSDR Information Collection Review
Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1282).
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HAI/AR Response & Prevention Reporting System
Page 1
HARP 3: Other HAI (non-nMDRO) Responses
Jurisdiction
__________________________________
HARP 3: Other HAI/AR (non-nMDRO) Responses Instructions:
Please report HAI/AR (non-nMDRO) responses conducted by either
- Staff from HAI/AR Program or their designee* (regardless of funding source), or
- Staff partially or fully funded through one of the following mechanisms who contributed to
the response.
- ELC Core Program H
- SHARP 1 or SHARP 2
- Enhancing Detection Expansion/CARES
This instrument is due on February 28, 2025 for the
reporting period August 1, 2024 - December 31, 2024.
Data entry instructions
- Please enter one REDCap form for each HAI/AR (non-nMDRO) response that took place
during the reporting period (August 1, 2024 - December 31, 2024, due by February 28, 2025).
- For continuing responses please ensure all the data entered are cumulative irrespective of
the reporting period.
- The reporting instrument is programmed to display a subset of questions based on the
answer(s) to Question 3a establishing the other HAI response as an investigation or
consultation.
- Other HAI investigations must be reported by direct entry into this REDCap instrument.
- Other HAI consultations may be reported using the bulk upload tool (available in the Bulk
Upload section of this REDCap project) OR by direct entry into this REDCap instrument.
Please review the HAI/AR Response & Prevention Reporting System Guide for additional
details.
*Designee may include other state health department staff, local health department staff,
contractor, or other partner supported by your program for which your program can assure
the quality of services provided. Recipients should work with designees to ensure that all
responses are submitted without duplication.
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HAI/AR Response & Prevention Reporting System Guide
[Attachment: "HAIAR Response & Prevention Reporting System Guide_6Feb2025.pdf"]
Reported through excel-based tracking tool/Imported
into REDCap
Q1. Local outbreak/response ID
ID for cross-referencing with your local tracking tool
as needed. May use any unique identifier.
Q2. Response Start Date
Date when the HAI/AR Program first made the decision
to start the response.
Q3a. Did you perform (or provide substantial
technical assistance with) any of the following
activities for this response?
[Check all that were performed]
Note: When considering whether substantial technical
assistance was provided, judgment can be applied
(refer to the "Where to submit HAI/AR response and
prevention activities" section of the HAI/AR Response
& Prevention Reporting Guide for more information)
Q3b. Did the HAI/AR program offer public health
assistance for any of the following, for any facility
involved in the response:
[Check all that were offered]
Yes
__________________________________
__________________________________
(If exact date not known, please approximate.)
Onsite for any reason
Remote infection prevention and control assessment
Patient notification or call for cases
Environmental sampling
Screening
None of the above
Onsite infection prevention and control assessment
Remote infection prevention and control assessment
Colonization screening
Unknown
None of the above
Q4. During which reporting period did the HAI/AR
Program engage in activities related to this response?
[Check all that apply]
August 1, 2019 - July 31, 2020
August 1, 2020 - July 31, 2021
August 1, 2021 - July 31, 2022
August 1, 2022 - July 31, 2023
August 1, 2023 - July 31, 2024
August 1, 2024 - December 31, 2024
Epidemiological investigation
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Q5. Did this response involve any of the following
issues:
[Check all that apply]
Q5a. Type of medical device:
Q5b. Type of product:
Q5c. Type of product:
Q5d. Other infection prevention and control breach,
specify:
Q5e. Other, specify:
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Injection safety breach (other than drug diversion)
Drug diversion
Medical device reprocessing breach
Medical product contamination other than device,
extrinsic (facility)
Medical product or device contamination, intrinsic
(pre-facility)
Environmental cleaning and disinfection issue
Water related issue (i.e., water, faucet, holding
tank, water treatment)
Wastewater plumbing related issue (i.e., suspected
or confirmed transmission from sink drains,
toilets, hoppers, etc.)
Foodborne illness
Other infection prevention and control breach
Other
None
Unknown
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
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Q6. What was the trigger for the response?
Select the option that best describes the trigger for
initiating this response. If needed, more than one
option can be selected.
Single clinical case
Multiple clinical cases
Screening (e.g., admission, discharge, etc.)
Infection control breach
Other
Unknown
Definitions/Examples
- Single clinical case: In some situations,
identifying even a single pathogen, infection, or
condition reflects a departure from baseline and
warrants investigation. Examples include
identification of an unusual HAI, a highly virulent or
infectious pathogen, suspected involvement of
contaminated medical products, an unusual infection
following a procedure or other situations in which
even a single case signals that other people may be at
risk.
- Multiple clinical cases: A response to an unusual
grouping of two or more instances of an
organism/pathogen, infection type, or condition that
occur together in time and space or share some other
unique characteristic.
- Screening case: A response may be initiated as a
result of screening activities (e.g., MRSA
colonization identified through routine NICU
screening).
- Infection control breach: A response to an
infection control breach can occur even in the absence
of any identified infections or colonization.
Infection control breaches may be identified by public
health or may be reported to the health department by
the facility, healthcare personnel, survey agencies,
or other partners.
Q6b. Other trigger, specify:
__________________________________
Total case count
Q7. How many confirmed or probable cases were
identified in this response?
Include all cases (e.g., patient, healthcare
personnel); include infection and colonization, if
relevant.
Q7a. In which of the following age groups was
colonization or infection identified?
Note: This question does not ask the HAI/AR Program
to collect any additional information or perform
colonization testing, but to report this information
if it is known
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__________________________________
(If not known, please approximate and use the
comments field to explain further, as needed.
Please enter 0 if no cases identified.)
Patients/residents - Infant (0-2 years)
Patients/residents - Pediatric (3-17 years)
Patients/residents - Adults (18-64 years)
Patients/residents - Older adults (65+ years)
No colonization or infection were identified among
patients or residents
Unknown
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Q7b. Was colonization or infection identified among any of the following groups during this investigation?
Note: This question does not ask the HAI/AR Programs to collect any additional information or perform colonization
testing, but to report this information if it is known
Definitions
Direct care personnel-Care Providers Direct care personnel-Ancilliary Indirect care personnel Visitors
- Physician
- Nurse Practitioners/Physician Assistants
- Registered Nurse
- Licensed Practical Nurse
- Certified Nursing Assistants
- Respiratory therapist
- Physical/Occupation therapist
- Speech Therapist
- Dietary personnel
- Radiology technicians
- Phlebotomists
- Registrars
- Volunteers
- Environmental Services Personnel
- Sterile Processing Department
- Pharmacists
- Supply chain
- Patient/resident family members
- Hospice care providers
- Chaplains
- Resident personal services (e.g., hair/nails)
Direct care personnel - Care Providers
Direct care personnel - Ancillary
Indirect care personnel
Visitors
Other
None of the above
Unknown
Q7c (i). Specify the type of care provider:
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Physician
Nurse Practitioners/Physician Assistants
Registered Nurse
Licensed Practical Nurse
Certified Nursing Assistants
Other
None of the above
Unknown
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Q7c (ii). Specify the type of ancilliary care
personnel:
Respiratory therapist
Physical/Occupation therapist
Speech Therapist
Dietary personnel
Radiology technicians
Phlebotomists
Registrars
Volunteers
Other
None of the above
Unknown
Q7c (iii). Specify the type of indirect care
personnel:
Environmental Services Personnel
Sterile Processing Department
Pharmacists
Supply chain
Others
None of the above
Unknown
Q7c (iv). Specify the type of visitors/contracted
personnel:
Patient/resident family members
Hospice care providers
Chaplains
Resident personal services (e.g., hair/nails)
Others
None of the above
Unknown
Q7c (v). Please specify the "other" group in which
colonization or infection identified:
Q8. Infection type(s):
[Check all that apply]
Q8a. Other, please specify:
[Optional]
Q9. Number of potentially exposed patients:
Please provide an approximate number, if unknown
please enter "Unknown".
Q10. Was transmission within a healthcare facility
suspected in this investigation (including
colonization or infection)?
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__________________________________
No infection identified
Gastrointestinal
Respiratory tract
Blood stream
Surgical site
Skin/soft tissue
Eye
Urinary tract
Neurological
Other
Unknown
__________________________________
__________________________________
(Please provide an approximate number, if unknown
please enter "Unknown". Please enter 0 if no
potential exposures.)
Yes
No
Unknown/unclear
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Q11. Primary pathogen identified
Select the most common pathogen identified. Choose the
most specific choice available. For COVID-19, please
select SARS-CoV-2.
If multiple pathogens were identified, please select
"Other" for primary pathogen. When other is select, an
additional field will appear with a text box. Please
enter the pathogen names in the Other, specify box.
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Achromobacter spp.
Acinetobacter spp.
Adenovirus
Aspergillus spp.
Bacillus spp.
Burkholderia spp.
Candida auris
Candida spp. (not including C. auris)
Citrobacter spp.
Creutzfeldt-Jakob disease (CJD)
Clostridioides difficile
Clostridioides perfringens
Clostridioides sordelli
Clostridioides spp. (not including C. difficile)
Cytomegalovirus
Cryptococcus neoformans
Ebola virus
Elizabethkingia spp.
Cronobacter sakazakii (Enterobacter sakazakii)
Enterobacter spp.
Enterococcus spp.
Enterovirus spp.
Escherichia coli
Escherichia spp. (not including E. coli)
Hepatitis A
Hepatitis B
Hepatitis C
Human immunodeficiency virus (HIV)
Influenza virus
Klebsiella spp.
Legionella spp.
Listeria spp.
Measles virus
Middle East respiratory syndrome-coronavirus
(MERS-Cov)
Monkeypox virus
Mucor spp.
Mycobacterium tuberculosis
Nontuberculous mycobacteria (NTM)
Norovirus
Pantoea spp.
Propionibacterium spp.
Proteus spp.
Providencia spp.
Pseudomonas spp.
Ralstonia spp.
Respiratory syncytial virus
Rhodococcus spp.
Salmonella spp.
SARS-CoV-2 (COVID-19)
Serratia spp.
Staphylococcus aureus (methicillin resistant) MRSA
Staphylococcus aureus (methicillin susceptible) MSSA
Staphylococcus aureus (methicillin resistance
unknown)
Staphylococcus spp. (not including S. aureus)
Stenotrophomonas spp.
Streptococcus pyogenes (Group A strep)
Streptococcus agalactiae (Group B strep)
Streptococcus spp. (not including S. pyogenes or
S. agalactiae)
Zika virus
Other
No organism identified
Not applicable
Unknown
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Q11a. Other pathogen(s) identified, specify:
Q11b. Is this pathogen a novel or targeted MDRO
(nMDRO)?
__________________________________
Yes
No
Unknown
If this is an nMDRO investigation, please report in HARP 2: nMDRO Responses instead of HARP 3: Other HAI
(non-nMDRO and COVID-19) Responses
Facility/Setting Information
Q12. Setting Type(s): Select setting types involved
(where infections were identified, screenings were
conducted, onsite assessments were performed, etc.).
Additionally, select the setting type that best
describes how the overall facility is licensed (e.g.,
in a SNF that cares for ventilated residents, select
vSNF.)
If the facility has more than one level of care,
select the level(s) of care relevant to the
investigation and the responses to follow up
activities should be submitted for those level(s)
where investigation was conducted.
[Check all that apply]
Q12a. Please select the location within the ACH, if
applicable
Q12a (i). Other location within the ACH facility,
specify:
Q12a (ii). Intensive care unit type:
[Optional, Check all that apply]
Q12b. Please select the location within the LTACH, if
applicable
[Check all that apply]
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Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Inpatient Rehabilitation Facility
Long-term Acute Care Hospital (LTACH)
Ventilator-capable Nursing Home/ Skilled Nursing
Facility (vSNF)
Nursing Home/ Skilled Nursing Facility (SNF)
Assisted Living Facility
Other congregate setting (e.g., group homes,
homeless shelter)
Dialysis Facility (outpatient)
Dental Office
Ambulatory Surgical Center
Other outpatient setting
Other healthcare settings
Unknown
Intensive care unit
Burn unit
Oncology unit
Dialysis unit
Operating room
Emergency department
Transplant unit
Labor and delivery
Medical unit
Surgical unit
Rehab unit
Other
Unknown
__________________________________
General
Medical care
Surgical
Neuro
Neonatal intensive care unit (NICU)
Pediatric intensive care unit (PICU)
Other
Intensive care unit
Non-Intensive care unit
Other
Unknown
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Q12c. Please select the location within the vSNF, if
applicable
[Check all that apply]
Q12d. Please select the location within the SNF, if
applicable
[Check all that apply]
Q12e (i). Please select the types of congregate
settings
[Check all that apply]
Q12e (ii). Other congregate setting type, specify:
Q12f (i). Please select the other outpatient setting
type and services provided.
[Check all that apply]
Q12f (ii). Other outpatient setting type, specify:
Q12g. Other healthcare setting type, specify:
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Ventilator unit (or ventilated residents, if no
separate ventilator unit)
Non-ventilator unit
Other
Unknown
Tracheostomy unit (e.g., provides tracheostomy
care but not license for ventilator services)
Short-stay unit in long-term care facility
Memory care unit
Other
Unknown
Group home
Homeless shelter
Behavioral health/ mental health facility
Correctional facility
School health clinic
Migrant shelter
Independent living facility
Emergency shelters (other than homeless shelters)
Other
Unknown
__________________________________
Urology
Endoscopy
Wound clinic
Pain clinic
Home health
Oncology
Dermatology
Ophthalmology/ eye clinic
Federally Qualified Health Centers (FQHC)
Other
Unknown
__________________________________
__________________________________
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Q13a. NHSN OrgID of the primary outbreak facility
(i.e., If this response activity includes more than
one facility, please provide the NHSN OrgID of the
facility where the majority of the health department
response activity occurred).
__________________________________
(If NHSN OrgID is unknown, not available, or cannot
be shared please complete Q13b.)
If NHSN OrgID is unknown, not available, or cannot be
shared please complete Q13b.
Note: for more information on how to obtain a facility
NHSN OrgID visit:
https://www.cdc.gov/nhsn/pdfs/orgid-verification-508.p
df.
Q13b. Zip code of the primary outbreak facility (i.e.,
If this response activity includes facilities in more
than one zip code, please include the zip code of the
facility where the majority of response activity
occurred)
Q14. Were any of the facilities involved tribally
operated or a part of the Indian Health Service:
__________________________________
(If zip code cannot be shared or is unknown please
enter 99999.)
Yes
No
Unknown
Infection Control Assessments
Answer the following questions for each setting type involved.
Provision of onsite or remote assistance to assess infection control issues may be done
directly by the recipient or by a designee. A designee may include other state health
department staff, local health department staff, contractor, or other partner supported by
your program for which your program can assure the quality of services provided. Recipients
should work with designees to ensure that all responses are submitted without duplication.
The number of infection control assessments conducted should include each unique facility
assessment to include repeat assessments as long as some form of IC practice assessment
occurs (e.g., not just an update about case counts). In some instances, both onsite and remote
visits may have occurred with a facility, and this should be reflected accordingly among the
different assessment types.
To be counted as an infection control assessment (onsite/remote) requires the use of a
structured form of data collection, such as CDC ICAR tool or a similar state/locally developed
tool.
Acute Care Hospitals
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NOTE: Infection control assessment questions appear based on the choices selected in Q3a. If infection control
assessment(s) were performed and questions are not displayed, please update your response to question Q3a.
Q15a. How many acute care hospitals (ACHs) were
involved?
Q15a(i). Did your HAI/AR Program or a designee conduct
any of the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, and
sink hygiene.
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, and sink hygiene.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
Q15a(ii). How many onsite infection control
assessments were conducted across all ACHs during this
response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Q15a(iii). How many remote infection control
assessments were conducted across all ACHs during this
response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Critical Access Hospitals
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NOTE: Infection control assessment questions appear based on the choices selected in Q3a. If infection control
assessment(s) were performed and questions are not displayed, please update your response to question Q3a.
Q15b. How many critical access hospitals (CAHs) were
involved?
Q15b(i). Did your HAI/AR Program or a designee conduct
any of the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, and
sink hygiene.
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, and sink hygiene.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
Q15b(ii). How many onsite infection control
assessments were conducted across all CAHs during this
response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Q15b(iii). How many remote infection control
assessments were conducted across all CAHs during this
response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
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Inpatient Rehabilitation Facilities
NOTE: Infection control assessment questions appear based on the choices selected in Q3a. If infection control
assessment(s) were performed and questions are not displayed, please update your response to question Q3a.
Q15c. How many inpatient rehabilitation facilities
(IRFs) were involved?
Q15c(i). Did your HAI/AR Program or a designee conduct
any of the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, and
sink hygiene.
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, and sink hygiene.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
Q15c(ii). How many onsite infection control
assessments were conducted across all IRFs
during this response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
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Q15c(iii). How many remote infection control
assessments were conducted across all IRFs
during this response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Long-term Acute Care Hospitals
NOTE: Infection control assessment questions appear based on the choices selected in Q3a. If infection control
assessment(s) were performed and questions are not displayed, please update your response to question Q3a.
Q15d. How many long-term acute care hospitals (LTACHs)
were involved?
Q15d(i). Did your HAI/AR Program or a designee conduct
any of the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, and
sink hygiene.
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, and sink hygiene.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
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Q15d(ii). How many onsite infection control
assessments were conducted across all LTACHs during
this response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Q15d(iii). How many remote infection control
assessments were conducted across all LTACHs during
this response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Ventilator-capable Nursing Homes/ Skilled Nursing Facilities
NOTE: Infection control assessment questions appear based on the choices selected in Q3a. If infection control
assessment(s) were performed and questions are not displayed, please update your response to question Q3a.
Q15e. How many ventilator-capable nursing home/skilled
nursing facility (vSNFs) were involved?
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__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
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Q15e(i). Did your HAI/AR Program or a designee
conduct any of the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, and
sink hygiene.
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, and sink hygiene.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
Q15e(ii). How many onsite visits included infection
control assessments?
In general, the initial IC assessment should include
not only a review of policies, but also observations
of key IC practices such as hand hygiene, PPE use,
environmental cleaning and disinfection, and sink
hygiene.
Q15e(iii). How many remote infection control
assessments were conducted across all vSNFs during
this response?
__________________________________
(If no onsite assessments performed, enter 0.)
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Nursing Homes/ Skilled Nursing Facilities
NOTE: Infection control assessment questions appear based on the choices selected in Q3a. If infection control
assessment(s) were performed and questions are not displayed, please update your response to question Q3a.
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Q15f. How many non-ventilator capable nursing
home/skilled nursing facilities (SNFs) were involved?
Q15f(i). Did your HAI/AR Program or a designee conduct
any of the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, and
sink hygiene.
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, and sink hygiene.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
Q15f(ii). How many onsite infection control
assessments were conducted across all SNFs during
this response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Q15f(iii). How many remote infection control
assessments were conducted across all SNFs during
this response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Assisted Living Facilities
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NOTE: Infection control assessment questions appear based on the choices selected in Q3a. If infection control
assessment(s) were performed and questions are not displayed, please update your response to question Q3a.
Q15g. How many assisted living facilities (ALFs) were
involved?
Q15g(i). Did your HAI/AR Program or a designee conduct
any of the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, and
sink hygiene.
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, and sink hygiene.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
Q15g(ii). How many onsite infection control
assessments were conducted across all assisted living
facilities during this response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Q15g(iii). How many remote infection control
assessments were conducted across all assisted living
facilities during this response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
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Other Congregate Settings
NOTE: Infection control assessment questions appear based on the choices selected in Q3a. If infection control
assessment(s) were performed and questions are not displayed, please update your response to question Q3a.
Q15h. How many other congregate settings (e.g., group
homes, homeless shelter) were involved?
Q15h(i). Did your HAI/AR Program or a designee conduct
any of the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, and
sink hygiene.
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, and sink hygiene.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an online or
remote assessment.
__________________________________
[Optional]
Q15h(ii). How many onsite infection control
assessments were conducted across all congregate
settings during this response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
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Q15h(iii). How many remote infection control
assessments were conducted across all congregate
settings during this response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Dialysis Facilities (Outpatient)
NOTE: Infection control assessment questions appear based on the choices selected in Q3a. If infection control
assessment(s) were performed and questions are not displayed, please update your response to question Q3a.
Q15i. How many outpatient dialysis facilities were
involved?
Q15i(i). Did your HAI/AR Program or a designee conduct
any of the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, and
sink hygiene.
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, and sink hygiene.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an online or
remote assessment.
__________________________________
[Optional]
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Q15i(ii). How many onsite infection control
assessments were conducted across all outpatient
dialysis facilities during this response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Q15i(iii). How many remote infection control
assessments were conducted across all outpatient
dialysis facilities during this response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Dental Offices
NOTE: Infection control assessment questions appear based on the choices selected in Q3a. If infection control
assessment(s) were performed and questions are not displayed, please update your response to question Q3a.
Q15j. How many dental offices were involved?
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__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
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Q15j(i). Did your HAI/AR Program or a designee
conduct any of the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, and
sink hygiene.
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, and sink hygiene.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
Q15j(ii). How many onsite infection control
assessments were conducted across all dental
offices during this response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Q15j(iii). How many remote infection control
assessments were conducted across all dental
offices during this response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Ambulatory Surgical Centers
NOTE: Infection control assessment questions appear based on the choices selected in Q3a. If infection control
assessment(s) were performed and questions are not displayed, please update your response to question Q3a.
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Q15k. How many ambulatory surgical centers were
involved?
Q15k(i). Did your HAI/AR Program or a designee conduct
any of the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, and
sink hygiene.
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, and sink hygiene.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
Q15k(ii). How many onsite infection control
assessments were conducted across all ambulatory
surgical centers during this response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Q15k(iii). How many remote infection control
assessments were conducted across all ambulatory
surgical centers during this response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Other Outpatient Settings
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NOTE: Infection control assessment questions appear based on the choices selected in Q3a. If infection control
assessment(s) were performed and questions are not displayed, please update your response to question Q3a.
Q15l. How many other outpatient facilities were
involved?
Q15l(i). Did your HAI/AR Program or a designee conduct
any of the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, and
sink hygiene.
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, and sink hygiene.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
Q15l(ii). How many onsite infection control
assessments were conducted across all other outpatient
settings during this response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Q15l(iii). How many remote infection control
assessments were conducted across all other outpatient
settings during this response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
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Other Healthcare Settings
NOTE: Infection control assessment questions appear based on the choices selected in Q3a. If infection control
assessment(s) were performed and questions are not displayed, please update your response to question Q3a.
Q15m. How many other facilities were involved?
Q15m(i). Did your HAI/AR Program or a designee conduct
any of the following?
In general, the initial onsite infection control (IC)
assessment should include a review of IC policies AND
observations of key IC practices such as hand hygiene,
PPE use, environmental cleaning and disinfection, and
sink hygiene.
__________________________________
(Please provide approximate number of facilities if
exact number is not known.)
Onsite infection control assessment
Remote infection control assessment
No infection control assessment conducted
In general, the initial remote IC assessment should
include a review of key IC policies AND practices such
as hand hygiene, PPE use, environmental cleaning and
disinfection, and sink hygiene.
To be counted as IC (remote/onsite) assessment require
use of structured form of data collection, such as CDC
ICAR tool or similar state/locally developed tool.
Please specify reason for not conducting an onsite or
remote assessment.
__________________________________
[Optional]
Q15m(ii). How many onsite infection control
assessments were conducted across all other healthcare
facilities during this response?
__________________________________
(If no onsite assessments performed, enter 0.)
This number should include each unique facility
assessments to include repeat onsite visits as long as
some form of IC practice assessment occurs during that
visit (e.g., not just an update about case counts). In
some instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
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Q15m(iii). How many remote infection control
assessments were conducted across all other healthcare
facilities during this response?
__________________________________
(If no remote assessments performed, enter 0.)
This number should include each unique facility
assessment to include repeat remote assessments as
long as some form of IC practice assessment occurs
(e.g., not just an update about case counts). In some
instances, both remote and onsite visits may have
occurred with a facility, and this should be reflected
accordingly among the different assessment types.
Public Health Programs Involved in Response
Answer the following questions at the response level (i.e., for any setting affected and any
pathogen).
Q16. Which public health programs and partners
contributed to the response?
[Check all that apply]
*Regional Public Health Staff includes regional office
staff and remote staff strategically assigned or
placed to serve a designated geographic region within
the jurisdiction.
Q16a(i). Please list other state/territorial
program(s) involved:
State/Territorial HAI/AR Program
State/Territorial, other public health program(s),
specify below
Local HAI/AR Program
Local, other public health program(s)
Regional Public Health Staff*
Regional AR Lab
CDC, specify below
Regulatory or licensing group, specify below
Other, specify below
Unknown
__________________________________
Q16a(ii). Please list the CDC program(s) involved:
Please list the team or division that was involved at
CDC and NOT an individual (e.g., DHQP AR Team, DHQP
Response Team, Mycotics).
Q16a(iii). Please list regulatory or licensing
group(s) involved:
Q16a(iv). Please list other program(s) involved:
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__________________________________
__________________________________
__________________________________
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Q16a. Which entity had the responsibility of leading
the overall HAI/AR response?
State/Territorial HAI/AR Program
State/Territorial, other public health program(s)
Local HAI/AR Program
Local, other public health program(s)
Regional Public Health Staff (e.g., regional
office staff, remote staff strategically assigned
or placed to serve a designated geographic region
within the jurisdiction)
Regional AR Lab
CDC
Regulatory or licensing group(s)
Other
Unknown
Notifications
Q17. Were any of the following notification types
made?
[Check all that apply]
Notifications may have been made by the healthcare
facility, local public health department, and/or
HAI/AR Program.
Patient notification
Provider notification
Public disclosure
None
Unknown
Patient notification: Patients were informed of
investigation or advised of potential exposure or
risk.
Provider notification: Providers were informed of the
investigation or advised of potential exposure or
risk.
Public disclosure: Members of the public were made
aware of the investigation through media reports or
other communication to the public.
Q17a. Approximate number of patients notified
__________________________________
Other Details
Q18. State lab specimen ID of index case
If specimen or isolate was tested at a Public Health
Laboratory, please enter the state laboratory
accession number. If multiple index cases triggered
the response, include at least one state laboratory
accession number. If the specimen was tested at a
regional lab, please include that ID.
Q18a. Date primary pathogen of response was identified
If multiple index cases triggered the response,
include the first one.
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__________________________________
(If isolate was not tested at the Public Health
Laboratory, please input N/A)
__________________________________
(If exact date not known, please provide
approximate.)
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Q19. Were any of the staff contributing to this
response partially or fully funded through the
following funding mechanisms:
[Check all that apply]
Q19a. Please specify the other funding source:
ELC Core Program H
SHARP 1 or SHARP 2
Enhancing Detection Expansion/CARES
State/Local Funding
Other, please specify below
Unknown
__________________________________
Additional Comments
Q20. Additional notes/comments to CDC (any other
information you would like to share about this
particular response)
Q21. Response end date
Date when the HAI/AR Program closed or ended the
response.
__________________________________________
__________________________________
(Please leave this field empty if the response is
ongoing.)
Form Approved
OMB Control Number: 0920-1282
Expiration Date: 6/30/2026
CDC estimates the average public reporting burden for this collection of information as 8 hours per response,
including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining
the data/information 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/ATSDR Information Collection Review
Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1282).
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HARP 4: Prevention-based Activities
Jurisdiction
HAI/AR Response & Prevention Reporting System
Page 1
__________________________________
HARP 4: Prevention-based Infection Control Assessments, Admission Screenings, and Point
Prevalence Surveys (PPS) Instructions:
Please report prevention-based activities conducted by either
- Staff from HAI/AR Program or their designee* (regardless of funding source), or
- Staff partially or fully funded through one of the following mechanisms who contributed to
the response.
- ELC Core Program H
- SHARP 1 or SHARP 2
- Enhancing Detection Expansion/CARES
This instrument is due on February 28, 2025 for the
reporting period August 1, 2024 - December 31, 2024.
Data entry instructions
- The Facility ID field will be used to link assessments, screenings, and PPS within the same
facility. Please use the same Facility ID if a facility recieved multiple prevention-based
activities.
- Prevention-based Infection Control Assessments or Prevention-based Admission Screenings
- Please enter one REDCap form instance for each facility conducting prevention-based
infection control assessment or prevention-based admission screenings that took place during
the reporting period (August 1, 2024 - December 31, 2024, due by February 28, 2025). Please
report the total number of assessments/admission screenings for the facility.
- Prevention-based infection control assessments are distinct from response-driven
assessments. Prevention-based infection control assessments are intended to provide
feedback on infection control policies and practices before a problem is identified and require
direct observation (either in person or via video) using a structured form for data collection.
These typically are focused on facility types with characteristics associated with increased risk
of HAI/AR threats (e.g., MDRO transmission, COVID-19 prevention, or other HAI threats).
Admission screening is the use of colonization screening to identify an MDRO at the time of
admission to a new healthcare facility or unit within the same facility to ensure timely
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implementation of recommended interventions (e.g., use of contact precautions, placement in
a cohort unit). In addition, admission screening can be useful to measure infection prevention and control
effectiveness at a facility (i.e., parsing MDRO importation from intra-facility transmission when coupled with repeat
PPSs) and identify other facilities in the region with a high MDRO prevalence. Prevention-based admission screenings
are conducted proactively and are not triggered by a case or an outbreak.
- Prevention-based Point Prevalence Surveys (PPS)
- Please enter one REDCap form instance for each PPS (this is different from above). You may complete multiple
instances of this form if a facility recieved repeated PPS during the reporting period.
- Prevention-based/proactive PPS are colonization screenings conducted at a healthcare facility at a predetermined
frequency (e.g., every four to six months) and are not triggered by identification of a case. Prevention-based PPSs
are a way to improve surveillance and identify those who require infection control actions to prevent further
transmission. These PPSs can occur prior to a facility's identification of both novel and targeted MDRO cases, may
involve only a subset of patients/residents (such as a single high acuity unit), and are distinct from PPSs performed in
response to a single case or suspected transmission.
- Bulk Uploads
- Data for HARP 4 may be reporting using the bulk upload tools (available in the Bulk Upload section of this REDCap
project) OR by direct entry into this REDCap instrument.
- Please refer to the "Excel-Based Tracking and Bulk Upload Process" section of the HAI/AR Response & Prevention
Reporting System Guide for additional details regarding the use of bulk upload tools.
*Designee may include other
state health department staff, local health department staff, contractor, or other partner supported by your program
for which your program can assure the quality of services provided. Recipients should work with designees to ensure
that prevention activities are submitted without duplication.
HAI/AR Response & Prevention Reporting System Guide
[Attachment: "HAIAR Response & Prevention Reporting System Guide_6Feb2025.pdf"]
Reported through excel-based tracking tool/Imported
into REDCap
Yes
Reported through excel-based tracking tool/Imported
into REDCap
Yes
Reported through excel-based tracking tool/Imported
into REDCap
Yes
Facility Level Information
Q1. Facility ID
The Facility ID field will be used to link
prevention-based activities (i.e., assessments,
screenings, and PPS) within the same facility. Please
use the same Facility ID if a facility recieved
multiple prevention-based activities.
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__________________________________
(Please assign a unique identifier for the facility
in which this activity took place. This ID will be
utilized for tracking purposes)
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Q2. Please indicate facility setting type
Q2a. Please specify the other outpatient setting:
Q2b. Please specify the other healthcare setting type:
Q3a. NHSN OrgID of facility
If NHSN OrgID is unknown, not available, or cannot be
shared please complete Q3b.
Acute Care Hospital (ACH)
Critical Access Hospital (CAH)
Inpatient Rehabilitation Facility
Long-term Acute Care Hospital (LTACH)
Ventilator-capable Nursing Home/ Skilled Nursing
Facility (vSNF)
Nursing Home/ Skilled Nursing Facility (SNF)
Assisted Living Facility
Other congregate setting (e.g., group homes,
homeless shelter)
Dialysis Facility (outpatient)
Dental Office
Ambulatory Surgical Center
Other outpatient setting
Other healthcare settings
Unknown
__________________________________
__________________________________
__________________________________
(If NHSN OrgID is unknown, not available, or cannot
be shared please complete Q3b.)
Note: For more information on how to obtain a facility
NHSN OrgID visit
https://www.cdc.gov/nhsn/pdfs/orgid-verification-508.p
df
Q3b. Zip code of the facility
__________________________________
(If zip code cannot be shared or is unknown please
enter 99999)
Q4. Was this facility tribally operated or a part of
the Indian Health Service:
Yes
No
Unknown
Q5. Please indicate the type of prevention-based
activity conducted:
Prevention-based Infection Control Assessments
Prevention-based Admission Screenings
Prevention-based Point Prevalence Survey
Q6. Please indicate the reporting period for when
these prevention-based infection control
assessments/admission screenings occurred.
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August 1, 2024 - December 31, 2024
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Prevention-based Infection Control Assessments
Report all prevention-based infection control assessments for the facility during the reporting
period.
Only one instance of HARP 4 should be completed PER facility to describe to TOTAL number of
prevention-based infection control assessments conducted in the facility during the reporting
period.
Q7a (i). Type of assessment(s) performed
[Check all that apply]
Onsite
Remote
Q7a (ii). Total number of onsite infection control
assessments:
__________________________________
Q7a (iii). Total number of remote infection control
assessments:
__________________________________
Q7b. Reason for infection control assessment(s)
[Check all that apply]
MDRO prevention
COVID-19 prevention
General HAI prevention (general non-MDRO or
request from facility, etc.)
None of the above
Prevention-based Admission Screenings
Report all prevention-based admission screenings for the facility during the reporting period.
Only one instance of HARP 4 should be completed PER facility to describe to TOTAL number of
prevention-based admission screenings conducted in the facility during the reporting period.
Q8. Indicate target(s) screened:
C. auris
KPC, VIM, IMP, OXA-48-like, NDM
CRAB with OXA-23, -24/40, -58, -235
Other
C. auris
Total Screened Total Positive
______ ______
Total Screened Mechanism Total Positive Associated Organism
KPC, VIM, IMP, OXA-48-like, NDM ______ KPC only ______ ______
VIM only ______ ______
IMP only ______ ______
OXA-48-like only ______ ______
NDM only ______ ______
Multiple Mechanisms (i.e., dual, triple) - Combo 1 ______ ______
Multiple Mechanisms (i.e., dual, triple) - Combo 2 ______ ______
Multiple Mechanisms (i.e., dual, triple) - Combo 3 ______ ______
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If there were multiple mechanisms (i.e., dual, triple)
- combo 1, please list:
__________________________________
Example: KPC/NDM
If there were multiple mechanisms (i.e., dual, triple)
- combo 2, please list:
__________________________________
Example: KPC/NDM
If there were multiple mechanisms (i.e., dual, triple)
- combo 3, please list:
__________________________________
Example: KPC/NDM
Total Screened Mechanism Total Positive
CRAB with OXA-23, -24/40, -58, -235 ______ OXA-23 only ______
OXA-24/40 only ______
OXA-58 only ______
OXA-235 only ______
Multiple Mechanisms (i.e., dual, triple) - Combo 1 ______
Multiple Mechanisms (i.e., dual, triple) - Combo 2 ______
Multiple Mechanisms (i.e., dual, triple) - Combo 3 ______
If there were multiple mechanisms (i.e., dual, triple)
- combo 1, please list:
__________________________________
Example: OXA-23/OXA-235
If there were multiple mechanisms (i.e., dual, triple)
- combo 2, please list:
__________________________________
Example: OXA-23/OXA-235
If there were multiple mechanisms (i.e., dual, triple)
- combo 3, please list:
__________________________________
Example: OXA-23/OXA-235
Other
Please specify target orangism and/or mechanism
______
Total Screened Total Positive
______ ______
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Prevention-based Point Prevalence Survey
Only PREVENTION-based PPS should be reported here. Response based activities should be
reported in HARP 2/3.
Multiple instances of HARP 4 may be completed for facilities receiving more than one PPS
during the reporting period. Additional PPS rounds should be captured in an additional
instance of HARP 4, where the Facility ID remains the same.
Q9. Date of PPS:
Q10. Indicate which target(s) screened and number of
screenings performed:
__________________________________
(If exact date not known, please approximate.)
C. auris
KPC, VIM, IMP, OXA-48-like, NDM
CRAB with OXA-23, -24/40, -58, -235
Other
C. auris
Total Screened Total Positive
______ ______
Total Screened Mechanism Total Positive Associated Organism
KPC, VIM, IMP, OXA-48-like, NDM ______ KPC only ______ ______
VIM only ______ ______
IMP only ______ ______
OXA-48-like only ______ ______
NDM only ______ ______
Multiple Mechanisms (i.e., dual, triple) - Combo 1 ______ ______
Multiple Mechanisms (i.e., dual, triple) - Combo 2 ______ ______
Multiple Mechanisms (i.e., dual, triple) - Combo 3 ______ ______
If there were multiple mechanisms (i.e., dual, triple)
- combo 1, please list:
__________________________________
Example: KPC/NDM
If there were multiple mechanisms (i.e., dual, triple)
- combo 2, please list:
__________________________________
Example: KPC/NDM
If there were multiple mechanisms (i.e., dual, triple)
- combo 3, please list:
__________________________________
Example: KPC/NDM
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Total Screened Mechanism Total Positive
CRAB with OXA-23, -24/40, -58, -235 ______ OXA-23 only ______
OXA-24/40 only ______
OXA-58 only ______
OXA-235 only ______
Multiple Mechanisms (i.e., dual, triple) - Combo 1 ______
Multiple Mechanisms (i.e., dual, triple) - Combo 2 ______
Multiple Mechanisms (i.e., dual, triple) - Combo 3 ______
If there were multiple mechanisms (i.e., dual, triple)
- combo 1, please list:
__________________________________
Example: OXA-23/OXA-235
If there were multiple mechanisms (i.e., dual, triple)
- combo 2, please list:
__________________________________
Example: OXA-23/OXA-235
If there were multiple mechanisms (i.e., dual, triple)
- combo 3, please list:
__________________________________
Example: OXA-23/OXA-235
Other
Please specify target organism and/or mechanism
______
Total Screened Total Positive
______ ______
Q11a. Was there a public health investigation
conducted as a result of this prevention-based
PPS?
Yes
No
Q11b. nMDRO Response ID:
The nMDRO Response ID should match the Local
outbreak/Response ID associated with Q1 of HARP 2.
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__________________________________
(If multiple responses were conducted, separate
nMDRO Response IDs with a semicolon)
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Funding
Q12. Were any of the staff contributing to this
prevention-based activity partially or fully funded
through the following funding mechanisms:
[Check all that apply]
Q12a. Please specify the other funding source:
ELC Core Program H
SHARP 1 or SHARP 2
Enhancing Detection Expansion/CARES
State/Local Funding
Other, please specify below
Unknown
__________________________________
Additional Comments
Q13. Additional notes/comments to CDC (any other
information you would like to share about this
facility/PPS):
__________________________________________
Form Approved
OMB Control Number: 0920-1282
Expiration Date: 6/30/2026
CDC estimates the average public reporting burden for this collection of information as 8 hours per response,
including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining
the data/information 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/ATSDR Information Collection Review
Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1282).
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HAI/AR Response & Prevention Reporting System
Page 1
HARP Bulk Uploads
Jurisdiction
__________________________________
HARP Bulk Uploads
HAI/AR Programs may submit HAI/AR Response & Prevention Reporting System data for:
- HARP 2: nMDRO Consultations
- HARP 3: HAI (non-nMDRO) Consultations
- HARP 4: Prevention-based Activities via the Excel-based tool linked below. Prior to using
this tool, please thoroughly review the "Excel-Based Tracking and Bulk Upload Process"
section of the HAI/AR Response & Prevention Reporting System Guide for additional details
regarding the use of the bulk upload tool.
HAI/AR Response & Prevention Reporting System Guide
[Attachment: "HAIAR Response & Prevention Reporting System Guide_6Feb2025.pdf"]
HAI/AR Response & Prevention Bulk Upload Tool
Please download this Excel file (.xlsx) if you wish to participate in bulk data upload. The Excel file has 7 tabs
(instructions, codebook, nMDRO consultations, HAI consultations, prevention-based infection control assessments,
prevention-based admission screenings, and prevention-based point prevalence surveys).
[Attachment: "BP1_BulkUpload_Template.xlsx"]
The 2025 Bulk Upload Tool will be made available in March 2025.
Please acknowledge that you have reviewed the
"Excel-based Tracking and Bulk Data Upload Process"
section of the HAI/AR Response & Prevention Reporting
System Guide prior to submitting the bulk upload
tool.
Yes
All values that do not match those originally coded
in the Excel-based tool will be imported as missing
data.
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Please upload a completed version of the Bulk Upload
Excel Tool:
(File must be saved as .xlsx)
The file uploaded should have the naming convention
"harp_bulk_2024_JURIS.xlsx" where JURIS is the
standard 2 letter abbreviation for your
state/territory. Cities/counties may spell out their
name (e.g., harp_bulk_2024_chicago or
harp_bulk_2024_lacounty).
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| File Type | application/pdf |
| File Modified | 2025-03-03 |
| File Created | 2025-03-03 |