Instructions For Completion Of Laboratory-identified

January 2021Instructions for Completion of Laboratory-identified MDRO or CDIEvent form (CDC 57.128)Data FieldFacility IDEvent #Patient IDSocial Security #Secondary IDMedicare #Patient NameGenderDate of BirthEthnicity (specify)Race (specify)Event TypeDate Specimen CollectedSpecific Organism Type1Instructions for Form CompletionThe NHSN-assigned facility ID number will be auto-entered bythe NHSN application.Event ID number will be assigned by NHSN.Required. Enter the alphanumeric patient ID. This is thepatient identifier assigned by the hospital and may consist ofany combination of numbers and/or letters. This should be anID that remains the same for the patient across all visits andadmissions.Optional. Enter the 9-digit numeric patient Social SecurityNumber.Optional. Enter any other patient ID assigned by the facility.Optional Enter the patient’s Medicare number.Optional. Enter the last, first and middle name of the patient.Data may be auto-entered from Patient Form.Required. Circle M (Male), F (Female) or Other to indicate thegender of the patient.Required. Record the date of the patient birth using this format:MM/DD/YYYY.Optional. Enter the patient’s ethnicity:Hispanic or LatinoNot Hispanic or Not LatinoOptional. Enter the patient’s race: Select all that apply.American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhiteEvent DetailsRequired. Event type LabIDRequired. Enter the date the specimen was collected for thisevent using format: MM/DD/YYYYRequired. Check the pathogen identified for this specimenfrom one of the following laboratory-identified organism types:MRSA, MSSA (if tracking MRSA & MSSA), VRE, CephR-Klebsiella,

January 2021MDRO/CDIData FieldTested for carbapenemase?Positive for carbapenemase?OutpatientSpecimen Body SiteSpecimen SourceDate Admitted to Facility2Instructions for Form CompletionCRE (CRE-E. coli, CRE-Klebsiella pneumoniae, CRE-Klebsiellaoxytoca, CRE-Klebsiella aerogenes or CRE-Enterobacter), MDRAcinetobacter, or C. difficile. Use one form per LabID event (1form for each pathogen). See MDRO and CDI protocol forMDRO definitions. Reminder: if conducting surveillance for CRE,the facility must include all three CRE organisms (E. coli,Klebsiella, and Enterobacter) in the monthly reporting plan andconduct surveillance for all three organisms.Conditionally Required. If the specific organism type is CRE,select “Yes” if the bacterial isolate was tested forcarbapenemase. Otherwise, select “No” or “Unknown”. If “Yes”,select which test(s) was performed (may select more than onetests). Users may need to seek additional guidance from thefacility laboratory to answer this question.Conditionally Required. If the bacterial isolate was tested forcarbapenemase, select “Yes” if the isolate tested positive forcarbapenemase. Otherwise, select “No” or “Unknown”.Required. Select “Yes” if the LabID Event is being reportedfrom an outpatient location where there are no admissions (forexample: emergency department, observation unit, woundcare clinic, etc.). If the patient was an outpatient, DateAdmitted to Facility and Date Admitted to Location are notrequired.Required. Enter the main body site from which the specimenwas taken using the description that is most specific. (Forexample, digestive system, central nervous system, etc.).Required. Enter the specific anatomic site from which thespecimen was taken using the source description that is mostaccurate from the available choices (examples: bile specimen,specimen from brain, blood specimen, etc.).Conditionally required. For inpatient events, enter the date thepatient was admitted to an inpatient unit in the facility usingthis format: MM/DD/YYYY. An inpatient is defined as a patientwho is housed in an inpatient location of the healthcare facility.The date admitted to facility should be the calendar day thepatient first locates to an inpatient location for the facility.When determining a patient’s admission dates to both thefacility and specific inpatient location, the NHSN user must takeinto account all such days, including any days spent in aninpatient location as an “observation” patient before beingofficially admitted as an inpatient to the facility, as these dayscontribute to exposure risk. Therefore, days spent in an

January 2021MDRO/CDIData FieldLocationDate Admitted to Location3Instructions for Form Completioninpatient location, regardless of the billing status of the patient,must be included in the counts of admissions and patient daysfor the facility and specific location. This means that the facilityadmission date must reflect the first day spent in the inpatientlocation regardless of the patients’ status as inpatient or statussuch as observation.Required. Enter the bedded inpatient location, emergencydepartment, or 24-hour observation care unit/location wherethe patient was assigned when the laboratory-identified MDROor C. difficile event specimen was collected. Note: the NHSN“transfer rule” does not apply for LabID events. Special Case: Ifa specimen collected in an affiliated outpatient clinic is positivefor an MDRO or CDI, and the patient it is collected from isadmitted to the facility on the SAME calendar date into aninpatient location that is monitoring LabID Events for theidentified MDRO or CDI, the positive specimen can be reportedas the first specimen for the patient in that admitting inpatientlocation for the month. If the facility is also monitoringoutpatient LabID Events for the same MDRO or CDI in affiliatedoutpatient clinics (FacWideOUT), then the same specimen forthe patient would also be reported a second time for thatoutpatient location.Conditionally required. Enter the most recent date the patientwas admitted to the inpatient care unit/location wherelaboratory-identified monitoring is being performed and wherethe specimen was collected from the patient. Do not considertemporary transfers to non-bedded inpatient locations such asO.R., Interventional Radiology, Cardiac Cath Lab, etc. whendetermining the location admit date. Any days spent in aninpatient location, whether as an officially admitted patient oras an “observation” patient, contribute to exposure risk. Aninpatient is defined as a patient who is housed in an inpatientlocation of the healthcare facility. Therefore, days spent in aninpatient location, regardless of the billing status of the patient,must be included in the counts for the specific location. Thismeans that the admission date must reflect the first day spentin the inpatient location regardless of the patients’ status asinpatient or observation. Note: Due to existing business rulesfor edit checks in NHSN, the date of specimen collection mustbe the same calendar date or later than the location admissiondate.

January 2021Data FieldLast physical overnight location ofpatient immediately prior to arrivinginto facility.MDRO/CDIInstructions for Form CompletionOptional for specimens collected from the emergencydepartment, observation location(s), or less than four daysafter admission into an inpatient unit. Using the availablevariables, select the location in which the patient spent thenight immediately prior to arrival into the facility. Selectionsinclude: (1) Nursing Home/Skilled Nursing Facility; (2) OtherInpatient Healthcare Setting (for example, acute care hospital,inpatient rehabilitation facility/IRF, long term acute carefacility/LTAC, etc.); or (3) Personal Residence/Residential Care(includes personal homes or assisted living environments inwhich 24/7 care is not provided in a group setting). Note: If thepatient’s personal residence is a nursing home or skilled nursingfacility, select Nursing Home/Skilled Nursing Facility.Has patient been discharged from your Required. Circle “Yes” if the patient has been discharged, afterfacility in the past 4 weeks?an inpatient stay, from your facility in the past 28 days fromcurrent positive specimen, otherwise circle “No”. The 28 daycount is a backward count using day of current positivespecimen as day 1.Date of last discharge from your facility Conditionally Required. If the patient was an inpatient anddischarged from your facility in the past 28 days (previousquestion is circled “Yes”), enter the most recent date ofdischarge prior to the current admission. Use format:MM/DD/YYYY. Note: This question is specific to discharge froma facility after being an inpatient in that facility. It is notapplicable to a discharge from an outpatient encounter/visitsuch as an emergency department or other outpatient locationvisit.Has the patient been discharged from Optional. Circle “Yes” if the patient has been discharged, afteranother facility in the past 4 weeks?an inpatient stay, from another facility in the past 28 days.Select “No” if the patient has not been discharged, after aninpatient stay, from another facility in the past 28 days. Select“Unknown” if previous inpatient history is not known.Last discharging facilityOptional. If the patient was discharged from an inpatient stayfrom another facility in the past 28 days, (previous question iscircled “Yes”), select all that apply from the provided list, whichincludes: (1) Nursing Home/Skilled Nursing Facility; or (2) OtherInpatient Healthcare Setting (acute care hospital, inpatientrehabilitation facility/IRF, long term acute care facility/LTAC,etc.).Documented prior evidence of infection Non-editable. This is a system auto-populated field and isor colonization with this specificbased on prior months LabID Events. “Yes” or “No” will beorganism type from a previouslyauto-filled by the system only, depending on whether there isreported LabID Event?prior LabID Event entered for the same organism and same4

January 2021MDRO/CDIData FieldCustom FieldsComments5Instructions for Form Completionpatient in a prior completed month (current reporting monthevents are excluded). Cannot be edited by user. If there is aprevious LabID event for this organism type entered in NHSN ina prior month, the system will auto-populate with a “Yes.”Note: This question is not used in the categorization of C.difficile or MRSA blood specimen only LabID Events.Custom FieldsOptional. Up to 50 fields may be customized for local or groupuse in any combination of the following formats: date(MM/DD/YYYY), numeric, or alphanumeric.Note: Each Custom Field must be set up in the Facility/CustomOptions section of the application before the field can beselected for use.Optional. Enter any information on the Event. This informationmay not be analyzed.

2 Data Field . Instructions for Form Completion. CRE (CRE-E. coli, CRE-Klebsiella pneumoniae, CRE-Klebsiella . oxytoca, CRE-Klebsiella aerogenes. or CRE-Enterobacter), MDR-Acinetobacter, or . C. difficile. Use one form per LabID event (1 form