Att G.7 HPSC

The National Healthcare Safety
Network (NHSN) Manual
HEALTHCARE PERSONNEL SAFETY
COMPONENT PROTOCOL: Blood and Body
Fluid and Influenza Exposures Modules

Division of Healthcare Quality Promotion
National Center for Emerging, Zoonotic and Infectious Diseases
Atlanta, GA, USA

Last Updated June 26, 2012

Table of Contents
Chapter

Title

1

Introduction to the Healthcare Personnel Safety Component

2

Healthcare Personnel Safety Reporting Plan

3

Blood/Body Fluid Exposure Modules (With and Without
Exposure Management)

4

Influenza Exposure and Treatment Module

5

Tables of Instructions

6

Key Terms

7

CDC Codes (Occupations, Devices and PEP Drugs)

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i

Introduction to the HPS Component of NHSN

Introduction to Healthcare Personnel Safety Component of NHSN
In recent years, occupational hazards faced by healthcare personnel (HCP) in the United States
have received increasing attention. Although recommendations, guidelines, and regulations to
minimize HCP exposure to such hazards have been developed, additional information is needed
to improve HCP safety. In particular, existing surveillance systems are often inadequate to
describe the scope and magnitude of occupational exposures to infectious agents and noninfectious occupational hazards that HCP experience, the outcomes of these exposures and
injuries, and the impact of preventive measures. The lack of ongoing surveillance of
occupational exposures, injuries, and infections in a national network of healthcare facilities
using standardized methodology also compromises the ability of the Centers for Disease
Prevention and Control (CDC) and other public health agencies to identify emerging problems,
to monitor trends, and to evaluate preventive measures.
CDC developed a surveillance system, NaSH or the National Surveillance System for Health
Care Workers that focused on surveillance of exposures and infections among HCP. Operational
from 1995 through 2007, NaSH has been replaced by the Healthcare Personnel Safety
Component (HPS) of the National Healthcare Safety Network (NHSN). The component consists
of four reporting modules: Blood/Body Fluids Exposure with Exposure Management,
Blood/Body Fluids Exposure only, Influenza Exposure Management, and the Influenza
Vaccination Summary. Data collected in this surveillance system will assist healthcare facilities,
HCP organizations, and public health agencies to monitor and report trends in blood/body fluid
exposures, to assess the impact of preventive measures, to characterize antiviral medication use
for exposures to influenza and to monitor influenza vaccination rates among HCP. In addition,
this surveillance component will allow CDC to monitor trends, to identify newly emerging
hazards for HCP, to assess the risk of occupational infection, and to evaluate measures, including
engineering controls, work practices, protective equipment, and post-exposure prophylaxis
designed to prevent occupationally-acquired infections. Hospitals and other healthcare facilities
participating in this system will benefit by receiving technical support and standardized
methodologies for conducting surveillance activities on occupational health. The NHSN
reporting application will enable participating facilities to analyze their own data and compare
these data with aggregate NHSN data published through CDCa.

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Healthcare Personnel Safety Reporting Plan

Article I.

Healthcare Personnel Safety Reporting Plan

The Healthcare Personnel Safety Reporting Plan Form (CDC 57.203) is used by
NHSN facilities to inform CDC which healthcare personnel safety modules are used
during a given month. This allows CDC to select the data that should be included into the
aggregate data pool for analysis. Each participating facility is to enter a monthly Plan to
indicate the module to be used, if any, and the exposures and/or vaccinations that will be
monitored.
A plan must be completed for every month that data are entered into NHSN,
although a facility may choose “No NHSN Healthcare Personnel Safety Modules
Followed this Month” as an option. The Instructions for Completion of Healthcare
Personnel Safety Reporting Plan Form includes brief instructions for collection and entry
of each data element on the form. A minimum of 6 months of data collection for at least
one module is recommended during each calendar year to remain an active participant in
NHSN.

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Blood/Body Fluid Exposure Module

Blood/Body Fluid Exposure Module
Introduction: Transmission of bloodborne pathogens [e.g., Hepatitis B virus (HBV), Hepatitis C
virus (HBC), Human Immunodeficiency Virus (HIV)] from patients to healthcare worker (HCW)
is an important occupational hazard faced by HCP. The risk of bloodborne pathogen
transmission following occupational exposure depends on a variety of factors that include source
patient factors (e.g., titer of virus in the source patient’s blood/body fluid), the type of injury and
quantity of blood/body fluid transferred to the HCW during the exposure, and the HCW’s
immune status. The greatest risk of infection transmission is through percutaneous exposure to
infected blood. Nevertheless, transmission of HBV, HCV, or HIV after mucous membrane or
non-intact skin exposure to blood has also been reported; the risk of transmission of these
pathogens through mucocutaneous exposure is considered lower than the risk associated with a
percutaneous exposure.
An estimated 385,000 percutaneous injuries (i.e., needlesticks, cuts, punctures and other injuries
with sharp objects) occur in U.S. hospitals each year. Prevention of occupational transmission of
bloodborne pathogens requires a diversified approach to reduce blood contact and percutaneous
injuries including improved engineering controls (e.g., safer medical devices), work practices
(e.g., technique changes to reduce handling of sharps), and the use of personal protective
equipment (e.g., impervious materials for barrier precautions). Since 1991, when the U.S.
Occupational Safety and Health Administration (OSHA) first issued its Bloodborne Pathogens
Standard, the focus of regulatory and legislative activity has been on implementing a hierarchy
of control measures. The federal Needlestick Safety and Prevention Act signed into law in
November 2000 authorized OSHA’s revision of its Bloodborne Pathogens Standard to more
explicitly require the use of safety-engineered sharp devices.
(http://www.osha.gov/SLTC/bloodbornepathogens/). Other strategies to prevent infection
include hepatitis B immunization and postexposure prophylaxis for HIV and HBV. Strategies for
prevention of percutaneous injuries are addressed in CDC’s Workbook for Designing,
Implementing, and Evaluating a Sharps Injury Prevention Program at
http://www.cdc.gov/sharpssafety/index.html.
Facilities are not required to collect data for exposures that involve intact skin or exposures to
body fluids that do not carry a risk of bloodborne pathogen transmission (e.g., feces, nasal
secretions, saliva, sputum, sweat, tears, urine and vomitus) unless these are visibly contaminated
with blood. However, facilities that routinely collect data on such exposures may enter this
information into the system.

(i) Methodology
Occupational exposures to blood and body fluids in healthcare settings have the potential to
transmit HBV, HCV, or HIV. Use of the Blood/Body Fluid Exposure Module permits a
healthcare facility to record information about the exposure and its management. This module

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Blood/Body Fluid Exposure Module

can be used in any healthcare setting where there is potential for occupational exposure to blood
and body fluids among HCP. This module requires that data be entered into NHSN when
exposures occur, as indicated in the Healthcare Personnel Safety Reporting Plan (CDC 57.203).
In general, these data may be provided by the occupational health department in the facility or
may be provided by the infection control/epidemiology department, as appropriate. NHSN forms
should be used to collect all required data, using the definitions included for each data field.
Blood/Body Fluid Exposure with or without Exposure Management
A facility may choose to report exposure events alone or exposure events and subsequent
management and follow-up of each event, including administration of postexposure prophylaxis
(PEP) to the HCW and any laboratory test results collected as part of exposure management.
Settings: Any healthcare setting with the potential for occupational exposure to blood and body
fluids.
Requirements: Blood and body fluid exposures are to be reported during the calendar year.
Actively participating NHSN sites will be required to submit blood/body fluid exposure data for
a minimum of 6 months per calendar year.
Definitions:
 Bite: A human bite sustained by an HCW from a patient, other HCW, or visitor.
 Bloodborne pathogens: Pathogenic microorganisms that may be present in human blood
and can cause disease in humans. These pathogens include, but are not limited to hepatitis B
virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV).
 HCW (Healthcare Worker): A person who works in the facility, whether paid or unpaid,
who has the potential for exposure to infectious materials, including body substances,
contaminated medical supplies and equipment, contaminated environmental surfaces, or
contaminated air. Healthcare worker is the singular form of healthcare personnel.
 HCP (Healthcare Personnel): A population of healthcare workers working in healthcare
settings.
 Hollow-bore needle: Needle (e.g., hypodermic needle, phlebotomy needle) with a lumen
through which material (e.g., medication, blood) can flow.
 Mucous membrane exposure: Contact of mucous membrane (e.g., eyes, nose, or mouth)
with the fluids, tissues, or specimens listed below in "Occupational exposure."
 Non-intact skin: Areas of the skin that have been opened by cuts, abrasions, dermatitis,
chapped skin, etc.

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Blood/Body Fluid Exposure Module

 Non-intact skin exposure: Contact of non-intact skin with the fluids, tissues, or specimens
listed below in "Occupational exposure."
 Non-Responder to Hepatitis B vaccine: A HCW who has received two series of hepatitis
B vaccine is serotested within 2 months after the last dose of vaccine and does not have antiHBs ≥10 mIU/mL.
 Occupational exposure: Contact with blood, visibly bloody fluids, and other body fluids
(i.e., semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal
fluid, pericardial fluid, and amniotic fluid, tissues, and laboratory specimens that contain
concentrated virus) to which Standard Precautions apply and during the performance of an
HCW’s duties. Modes of exposure include percutaneous injuries, mucous membrane
exposures, non-intact skin exposures, and bites.
 Percutaneous injury: An exposure event occurring when a needle or other sharp object
penetrates the skin. This term is interchangeable with “sharps injury.”
 Sharp: Any object that can penetrate the skin including, but not limited to, needles, scalpels,
broken glass, broken capillary tubes, and exposed ends of dental wires.
 Sharps Injury: An exposure event occurring when any sharp penetrates the skin. This term
is interchangeable with “percutaneous injury.”
 Solid Sharp: A sharp (e.g., suture needle, scalpel) that does not have a lumen through which
material can flow.
Reporting Instructions:
Forms Description and Purpose: (See also: Tables of Instructions for Completion of Healthcare
Personnel Safety Component forms)
All NHSN sites following the Blood/Body Fluids Exposure Module:
For either exposure reporting or exposure and exposure management reporting, a site should
complete the following form:
 Healthcare Personnel Safety Component Facility Survey (CDC Form 57.200) – Used
to collect facility administrative data including total patient beds set up and staffed,
annual inpatient days, number of patient admissions per year, , number of annual
outpatient encounters, number of annual employee hours worked. The survey also
collects annual data on the total number of HCP\in selected occupational groups (fulltime equivalents and numbers of HCP, full or part-time).

Exposure-Only Reporting:

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Blood/Body Fluid Exposure Module

Those facilities participating in exposure-only reporting should complete the following forms:
 Healthcare Personnel Safety Monthly Reporting Plan (CDC Form 57.203) – Used to
collect data on which modules and which months (if any) the facilities intend to
participate in NHSN HPS Component. This form should be completed for every
month that the facility will participate in the HPS component.
 Healthcare Worker Demographic Data (CDC Form 57.204) – Used to collect data on
HCW demographics such as gender and occupation for a healthcare worker who has
reported a blood or body fluid exposure. Exposure to Blood/Body Fluids (CDC Form
57.205) – Used to collect information about individual blood and body fluid exposure
events. Sections I – IV should be completed for all reported exposures. For
percutaneous injuries with a needle or sharp object that was not in contact with blood
or other body fluids (as defined in “occupational exposure”) prior to exposure,
thecompletion of Sections V-IX is not required.
Exposure and Exposure Management Reporting:
Facilities participating in exposure reporting and exposure management should complete the
forms listed below in addition to those listed above:
 Exposure to Blood/Body Fluids (CDC Form 57.205) – Used to collect information
about individual blood and body fluid exposure events. Sections I – IV should be
completed for all reported exposures. If a facility chooses to follow the protocol for
exposure management, Sections V – IX are also required.
 Healthcare Worker Prophylaxis/Treatment – BBF Postexposure Prophylaxis (PEP)
(CDC Form 57.206) – Used to collect details of medications administered to a
healthcare worker following blood or body fluid exposure to HIV or HBV. This form
is required if the facility follows the exposure management protocol.
 Follow-Up Laboratory Testing (CDC Form 57.207) – Used to collect additional
laboratory testing results obtained on an HCW following a blood or body fluid
exposure as part of exposure management. These serologic and other laboratory
results are not required for exposure management but provide details for facilities
opting for the long-term follow-up of exposures and evidence of seroconversion.
Data Analysis:
The use of the Blood/Body Fluid Exposure and Exposure Management Modules will allow the
participating NHSN site to estimate the nature, frequency, circumstances, and sequelae of
occupational exposures to bloodborne pathogens (i.e., HBV, HCV, and/or HIV) through
percutaneous injuries, bites, mucous membrane exposures or non-intact skin exposures. . In
addition, facilities can assess for changes in percutaneous injuries with the implementation of
safety devices and other prevention strategies, the timeliness of initiating HIV postexposure
prophylaxis (PEP) when indicated, assess the duration of HIV prophylaxis, and the proportion of

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Blood/Body Fluid Exposure Module

HCP experiencing adverse signs and symptoms after taking HIV PEP for occupational
exposures.
Denominator data from the annual Facility Survey (CDC 57.200) can be used to estimate
rates of exposures to blood/body fluids and to assess the effectiveness of engineering controls,
work practices, and protective equipment in reducing exposure.
References:
The following CDC/PHS publications provide recommendations for management and follow-up
of blood and body fluid exposures to HBV, HCV, and HIV:





Updated U.S. Public Health Service Guidelines for the Management of Occupational
Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis
(MMWR, June 29, 2001 / 50(RR11); 1-42)
Updated U.S. Public Health Service Guidelines for the Management of Occupational
Exposures to HIV and Recommendations for Postexposure Prophylaxis (MMWR,
September 30, 2005 / 54(RR09); 1-17). (PEP medications are updated in NHSN as
required)
A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus
Infection in the United States. (MMWR), December 8, 2006 / 55(RR16); 1-25)

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Influenza Exposure Management Module

Influenza Exposure Management Module
Introduction: The Advisory Committee on Immunization Practices (ACIP) recommends that
all HCP and persons in training for healthcare professions should be vaccinated annually against
influenza.[1,2] Persons who are infected with influenza virus, including those with subclinical
infection, can transmit influenza virus to persons at higher risk for complications from influenza.
Vaccination of HCP has been associated with reduced work absenteeism [3] and with fewer
deaths among nursing home patients [4,5] and elderly hospitalized patients.[5] Although annual
vaccination is recommended for HCP and is a high priority for reducing morbidity associated
with influenza in healthcare settings, national survey data have demonstrated vaccination
coverage levels of <50% among HCP over several vaccination seasons.[1]
Facilities that employ HCP should provide vaccine to personnel using approaches that have
demonstrated effectiveness in increasing vaccination coverage. Healthcare administrators should
consider the level of vaccination coverage among HCP to be one measure of a patient safety
quality program and consider obtaining signed declinations from personnel who decline
influenza vaccination for reasons other than medical contraindications.[6-9] Influenza
vaccination rates (including ward-, unit-, and specialty-specific coverage rates) among HCP
within facilities should be regularly measured and reported to occupational health services.[9]
Healthcare facilities should offer influenza vaccinations to all HCP, including night, weekend,
and temporary staff. Particular emphasis should be placed on providing vaccinations to personnel
who provide direct care for persons at high risk for influenza complications. Efforts should be
made to educate HCP regarding the benefits of vaccination and the potential health consequences
of influenza illness for their patients, themselves, and their family members. Studies have
demonstrated that organized campaigns can attain higher rates of vaccination among HCP with
moderate effort and by using strategies that increase vaccine acceptance.[6,10,11] All HCP
should be provided convenient access to influenza vaccine at the work site, free of charge, as part
of employee health programs.[6,11,12]
Although annual vaccination with the seasonal influenza vaccine is the best way to prevent
infection, antiviral drugs can be effective for prevention and treatment of influenza. When HCP
have not been vaccinated or are exposed to an influenza strain with no vaccine (i.e., nonseasonal), a plan for anti-viral chemoprophylaxis and treatment could be implemented.

(ii) Methodology
Influenza Exposure Management Module
Use of the Influenza Exposure Management Module permits a healthcare facility to record
information on antiviral medication use for chemoprophylaxis or treatment without reporting
influenza vaccination. It can be used in any healthcare setting. This module requires that data be
provided to CDC as per reporting requirements. This module includes reporting of individual-

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Influenza Exposure Management Module

level antiviral medication use for chemoprophylaxis or treatment after exposure to influenza. The
reason for antiviral medication use can be attributed to either seasonal or non-seasonal influenza.
Use of this module will allow facilities and CDC to measure antiviral medication use related to
the prevention and treatment of influenza.
Settings: Any healthcare settings
Requirements: Surveillance for influenza in the healthcare facility is to be conducted during the
vaccination season. It is recommended that actively participating NHSN sites submit data for a
minimum of 6 months per calendar year. A waiver is granted for the first year of participation
since facilities may not have 6 months of data in one calendar year in the first vaccination
season.
Definitions:
 HCW (Healthcare Worker): A person who works in the facility, whether paid or unpaid,
who has the potential for exposure to infectious materials, including body substances,
contaminated medical supplies and equipment, contaminated environmental surfaces, or
contaminated air. Healthcare worker is the singular form of healthcare personnel.
 HCP (Healthcare Personnel): The entire population of healthcare workers working in
healthcare settings.
 Non-seasonal influenza vaccine: A vaccine for additional/novel influenza virus strains
(e.g., 2009 H1N1) not included in the seasonal influenza vaccine which may or may not be
offered on an annual basis.
 Seasonal influenza vaccine: A vaccine for seasonal influenza virus strains that is offered on
an annual basis.
 Severe adverse reaction to antiviral medication use for influenza chemoprophylaxis or
treatment: Adverse reactions severe enough to affect daily activities and/or result in the
discontinuation of the antiviral medication.
 Vaccination season: A 12-month period starting from July 1, 2xxx to the start of the next
traditional influenza season (i.e., June 30 of the following year).
Reporting Instructions
Forms Description and Purpose: (See also: Tables of Instructions for Completion of Healthcare
Personnel Safety Component forms)
All NHSN sites following the Influenza Exposure Management Module:

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Influenza Exposure Management Module

NHSN participants should complete the following forms:
 Healthcare Personnel Safety Component Facility Survey (CDC 57.200) – Used to collect
facility administrative data including total patient beds set up and staffed, annual
inpatient days, number of patient admissions per year, , number of annual outpatient
encounters, number of annual employee hours worked. The survey also collects annual
data on the total number of HCP\in selected occupational groups (full-time equivalents
and numbers of HCP, full or part-time). Numbers of HCWs for at least one nurse
occupation (e.g., registered nurse, nurse midwife) and one physician occupation (i.e.,
intern/resident, fellow, attending physician) are required. All other fields are optional for
the Selected HCW Occupational Groups; you may enter 0 for these optional fields.
 Healthcare Personnel Safety Reporting Plan (CDC 57.203) – Used to collect data on
which modules and which months facilities intend to participate in the NHSN HPS
Component. This form should be completed for every month that the facility will
participate in the HPS influenza surveillance modules (e.g., influenza exposure
management).
 Healthcare Worker Demographic Data (CDC 57.204) – Used to collect data on HCW
demographics such as gender and occupation for each individual HCW. This form also is
used optionally to collect information about immune status for certain vaccinepreventable diseases (e.g., measles, mumps, rubella). This form should be completed for
all HCP offered influenza vaccine. The demographic data may already be contained in a
facility database that can be uploaded into NHSN as an ASCII comma delimited text file.
File specifications and importing instructions are available on the NHSN website
(http://www.cdc.gov/nhsn).
Influenza Exposure Management Reporting:
Facilities participating in Healthcare Personnel Influenza Exposure Management Module for
antiviral medication use should complete the following form:
 Healthcare Worker Prophylaxis/Treatment – Influenza (CDC 57.210) – Used to collect
data on which (if any) antiviral medications were administered to the HCW and any
severe adverse reactions associated with their use.

Data Analyses:
The use of the Influenza Exposure Management Module will allow facilities and CDC to
measure antiviral medication use related to the prevention and treatment of influenza. Antiviral
medication use for chemoprophylaxis or treatment after exposure to influenza can be evaluated
and monitored. Frequencies and trends of antiviral medication use as a result of potential or
confirmed exposures to influenza will be calculated and summarized. Also, frequency estimates
of the personnel types and clinical areas more likely to require chemoprophylaxis or treatment
may be analyzed as well as information on adverse effects associated with the receipt of antiviral
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Influenza Exposure Management Module

medications (as part of chemoprophylaxis or treatment).

References:
[1] Centers for Disease Control and Prevention, Prevention and control of seasonal influenza
with vaccines: Recommendations of the Advisory Committee on Immunization Practices
(ACIP), 2009, MMWR, 58 (2009) 1-52.
[2] Centers for Disease Control and Prevention, Influenza vaccination of health-care personnel,
MMWR, 55 (2006) 1-16.
[3] R. T. Lester, A. McGeer, G. Tomlinson, and A. S. Detsky, Use of, effectiveness of,
attitudes regarding influenza vaccine among house staff, Infection Control and Hospital
Epidemiology, 24 (2003) 839-844.
[4] J. Potter, D. J. Stott, M. A. Roberts, A. G. Elder, B. ODonnell, P. V. Knight, and W. F.
Carman, Influenza vaccination of health care workers in long-term-care hospitals reduces
the mortality of elderly patients, Journal of Infectious Diseases, 175 (1997) 1-6.
[5] R. E. Thomas, T. O. Jefferson, V. Demicheli, and D. Rivetti, Influenza vaccination for
health-care workers who work with elderly people in institutions: a systematic review,
Lancet Infectious Diseases, 6 (2006) 273-279.
[6] F. J. Walker, J. A. Singleton, P. Lu, K. G. Wooten, and R. A. Strikas, Influenza vaccination
of Healthcare workers in the United States, 1989-2002, Infection Control and Hospital
Epidemiology, 27 (2006) 257-265.
[7] P. M. Polgreen, Y. Chen, S. Beekmann, A. Srinivasan, M. A. Neill, T. Gay, J. E.
Cavanaugh, and Infect Dis Soc Amer Emer Infect, Elements of influenza vaccination
programs that predict higher vaccination rates: Results of an emerging infections network
survey, Clinical Infectious Diseases, 46 (2008) 14-19.
[8] Centers for Disease Control and Prevention, Interventions to increase influenza vaccination
of health-care workers- California and Minnesota, MMWR, 54(08) (2005) 196-199.
[9] National Quality Forum. National Voluntary Consensus Standards for Influenza and
Pneumococcal Immunizations.
http://www.qualityforum.org/Publications/2008/12/National_Voluntary_Consensus_Standa
rds_for_Influenza_and_Pneumococcal_Immunizations.aspx , 1-68. 2008. Washington DC,
National Quality Forum. 8-12-2009.
[10] G. A. Poland, P. Tosh, and R. M. Jacobson, Requiring influenza vaccination for health care
workers: seven truths we must accept, Vaccine, 23 (2005) 2251-2255.

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Influenza Exposure Management Module

[11] Joint Commission on Accreditation of Healthcare Organizations, New infection control
requirement for offering influenza vaccination to staff and licensed independent
practitioners, Joint Commission Perspectives, 26 (2006) 10-11.
[12] Infectious Diseases Society of America. Pandemic and seasonal influenza: principles for
U.S. action. http://www.idsociety.org/influenza.htm . 2007. Arlington, VA, Infectious
Diseases Society of America.

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NHSN Healthcare Personnel Safety Component
Tables of Instructions

Tables of Instructions
TABLE

CDC
FORM

1

57.203

Instructions for completion of the Healthcare Personnel
Safety Monthly Reporting Plan form

2

2

57.204

Instructions for completion of the Healthcare Worker
Demographic Data form

3

3

57.205

Instructions for completion of the Exposures to Blood/Body
Fluids form

5

4

57.206

Instructions for completion of the Healthcare Personnel
Postexposure Prophylaxis form

14

5

57.207

Instructions for completion of the Follow-up Laboratory
Testing form

16

6

57.210

Instructions for completion of the Healthcare Worker
Influenza Antiviral Medication Administration form

17

7

57.200

Instructions for completion of the Healthcare Personnel
Safety Component Facility Survey form

19

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NHSN Healthcare Personnel Safety Component
Tables of Instructions

Table 1. Instructions for Completion of the Healthcare Personnel Safety
Monthly Reporting Plan Form (CDC 57.203)
This form collects data on which modules and which months (if any) the facilities intend to participate in
NHSN Healthcare Personnel Safety (HPS) Component. This form should be completed for every month
that the facility will participate in the HPS component.
Data Field

Instructions for Data Collection
Required. The NHSN-assigned facility ID will be autoentered by the application.
Month/Year
Required. Enter the month and year for the surveillance
plan being recorded.
No NHSN Healthcare Personnel Safety
Conditionally required. Check this box if you do not plan
Modules Followed this Month
to follow any of the NHSN Healthcare Personnel Safety
Modules during the month and year selected.
Healthcare Personnel Exposure Modules
Conditionally required. Check this box if you plan to
Blood/Body Fluid Exposure Only
follow blood/body fluid exposures only, without
following exposure management during the month and
year selected.
Conditionally required. Check this box if you plan to
Blood/Body Fluid Exposure with Exposure
follow blood/body fluid exposure with exposure
Management
management during the month and year selected.
Conditionally required. Check this box if you plan to
Influenza Exposure Management
follow influenza exposure management (i.e., antiviral
chemoprophylaxis and/or treatment)
Facility ID #

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NHSN Healthcare Personnel Safety Component
Tables of Instructions

Table 2. Instructions for Completion of the Healthcare Worker Demographic
Data Form (CDC 57.204)
This form must be completed for all HCP who have information recorded in HPS component of NHSN
(e.g., exposure to blood or body fluid or influenza vaccination.) Alternatively, data for all or selected
personnel can be imported from the facility’s personnel database at facility enrollment.

Data Field
Facility ID #
HCW ID #
Social Security #
Secondary ID #
HCW Name:
Last, First, Middle
Street Address
City
State
Zip Code
Home Phone
E-mail Address
Gender
Date of birth
Born in the U.S.?
Ethnicity
Race
Work Phone
Start Date
Work Status
Type of Employment
Work Location

Department

Instructions for Data Collection
Required. The NHSN-assigned facility ID will be auto-entered by the application.
Required. Enter the healthcare worker’s (HCW) alphanumeric identification
number. This identifier is unique to the healthcare facility.
Optional. Enter the HCW’s Social Security Number.
Optional. Enter the HCW’s secondary ID number. This could be the employee’s
medical record # or some other unique identifier.
Optional. Enter demographic information for the HCW.

Required. Indicate the gender of the HCW by checking F (Female) or M (Male).
Required. Enter the date of birth of the HCW using the format: mm/dd/yyyy.
Optional. Select Yes, No, or Unknown.
Optional. Select one ethnicity of the HCW.
Optional. Select the race of the HCW. Check all that apply.
Optional. Enter the work phone number of the HCW.
Required. Enter the date the HCW began employment or affiliation with the facility
(use format: mm/dd/yyyy).
Required. Select Active, Inactive, or No longer affiliated.
Required. Select from Full-time, Part-time, Contract, Volunteer, Other (please
specify).
Required. Select the code that best describes the HCW’s current permanent work
location. This refers to physical work location rather than to department
assignment. For example, a radiology technician who spends most of his/her time
performing portable x-rays throughout the facility works at multiple locations. In
general, most interns/residents are not considered to work at a single location
because they rotate every month or every few months. For HCP who do not work
at least 75% of the time at a single location, the work location code for ‘float’
should be entered. Location codes must be customized to the facility and set up
prior to entering HCW records. The work location must be mapped to a CDC
Location (http://www.cdc.gov/nhsn/PDFs/master-locations-descriptions.pdf).
Optional. Enter the department in which the HCW works (facility defined).

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Tables of Instructions

Data Field
Supervisor
Occupation

Title

Clinical specialty
Performs direct
patient care

Custom Fields

Comments

Instructions for Data Collection
Optional. Enter the name of the HCW’s supervisor (facility defined).
Required. Select the occupation code that most appropriately describes the HCW’s
job. These must be customized to the facility and set up prior to entering HCW
records. The occupation must be mapped to a CDC Occupation Code.
Conditionally required. Required only for HCP designated as Influenza
Vaccinators if the facility intends on using NHSN to fulfill federal recordkeeping
requirements for administration of vaccine covered by the Vaccine Injury
Compensation Program. Enter the HCW’s job title.
Conditionally required. If Occupation is physician, fellow or intern/resident, select
the appropriate clinical specialty.
Conditionally required. Required only when the HCW has influenza vaccination
and/or influenza chemoprophylaxis/treatment records. Select Y (Yes) if the HCW
provides direct patient care (i.e., hands on, face-to-face contact with patients for the
purpose of diagnosis, treatment and monitoring); otherwise select N (No).
Optional. Up to two date fields, two numeric fields, and 10 alphanumeric fields that
may be customized for local use. NOTE: Each Custom Field must be set up in the
Facility/Custom Options section of the application before the field can be selected
for use.
Optional. Enter any information about the HCW. This information cannot be
analyzed.

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Table 3. Instructions for Completion of the Exposures to Blood/Body Fluids
Form (CDC 57.205)
Information for all blood/body fluid exposures should be recorded using this form. The variables to be
entered depend upon whether the facility selects the exposure event only reporting or exposure reporting
and management.
♦

Demographic data auto-entered by application if part of an existing HCW Demographic Data record (CDC 57.204).

Data Field
Facility ID #
Exposure Event #
HCW ID
♦

HCW Name:
Last, First, Middle
♦
Gender

Instructions for Data Collection
The NHSN-assigned facility ID will be autoentered by the application.
The exposure event number will be autogenerated by the application.
Enter the HCW’s alphanumeric identification
number. This identifier is unique to the
healthcare facility.
Enter the HCW’s name.

Indicate the gender of the HCW by checking F
(Female) or M (Male).
♦
Date of Birth
Enter the date of birth of the HCW using the
format: mm/dd/yyyy.
♦
Work Location
Required. Select the code that best describes the
HCW’s current permanent work location. This
refers to physical work location rather than to
department assignment. Location codes are
customized to the facility and set up prior to
entering HCW records. See Table 2 for more
details.
♦
Occupation
Required. Select the occupation code that most
appropriately describes the HCW’s job.
Occupation codes are customized to the facility
and set up prior to entering HCW records. See
Table 2 for more details.
Clinical Specialty
If Occupation is physician, fellow or
intern/resident, enter the appropriate clinical
specialty. The list of clinical specialties can be
found on Form CDC 57.204.
Exposure Type
The default setting is auto-entered by the
application as Blood/Body Fluids.
Section I – General Exposure Information
1. Did the exposure
Choose Y (Yes) or N (No).
occur at this facility

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5-5

Exposure
Event Only
Required

Exposure Event
and Exposure
Management
Required

Required

Required

Required

Required

Optional

Optional

Required

Required

Required

Required

Required

Required

Required

Required

Conditionally
required

Conditionally
required

Required

Required

Required

Required

NHSN Healthcare Personnel Safety Component
Tables of Instructions

Data Field
1a. If No, specify the
name of facility in
which exposure
occurred
2. Date of exposure
3. Time of exposure
4. Number of hours
on duty
5. Is exposed person
a temp/agency
employee?
6. Location where
exposure occurred
7. Type of Exposure
7a. Percutaneous:

Did the exposure
involve a clean,
unused needle or
sharp object?

7b. Mucous
membrane

7c. Skin:

Was skin intact?

Exposure
Event Only
Conditionally
required

Exposure Event
and Exposure
Management
Conditionally
required

Enter date of exposure in mm/dd/yyyy format.
Enter the time the exposure occurred and
whether it was AM or PM.
Enter the number of hours the HCW had been
on duty when the exposure occurred.
Choose Y (Yes) or N (No).

Required
Required

Required
Required

Optional

Optional

Optional

Optional

Choose the appropriate code for the physical
location where the event took place. (This is
customized to the facility).
Check the appropriate exposure type. Check all
that apply.
If Type of Exposure was Percutaneous, then
check this item.

Required

Required

Required

Required

Conditionally
required

Conditionally
required

If percutaneous is checked, then select Yes or
No to indicate whether the exposure involved a
clean, unused needle or sharp object. If the
incident involved a clean, unused needle or
sharp object you may not need to report this as
an exposure (see your protocol for more
information). If not, check No and complete Q8,
Q9 and Section II. If following the protocol for
exposure management also complete Sections
V-XI.
If Type of Exposure was Mucous Membrane,
then check this item and complete Q8, Q9 and
Section III. If following the protocol for
exposure management also complete Sections
V-XI.
If Type of Exposure was Skin, then check this
item.

Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

If Skin is checked, then indicate Y (Yes), N
(No) or (U) Unknown for whether the skin
remained intact during the exposure. If the
answer is No, complete Q8, Q9 and Section III.
If following the protocol for exposure
management also complete Sections V-XI.

Conditionally
required

Conditionally
required

Instructions for Data Collection
If the exposure did not occur at the reporting
facility, enter the name of the facility where the
event occurred.

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Data Field
7d. Bite

8. Type of
fluid/tissue involved
in exposure

9. Body site of
exposure

Exposure
Event Only
Conditionally
required

Exposure Event
and Exposure
Management
Conditionally
required

Required

Required

If Solutions or Body fluids are checked, indicate
whether visibly bloody or not visibly bloody.
For Body Fluids, indicate the primary body
fluid type implicated in the exposure from the
list.

Conditionally
required

Conditionally
required

If Other is selected for either the Type of
Fluid/Tissue involved in the exposure or the
Body Fluid Type, please specify the type.
(Make sure it is not a body fluid that is already
listed in the box on the right side of the form).
Check body site of exposure from the list.
Check all sites that were exposed.

Conditionally
required

Conditionally
required

Required

Required

Conditionally
required

Conditionally
required

Required

Required

Conditionally
required

Conditionally
required

Instructions for Data Collection
If Type of Exposure was Bite, then check this
item and complete Q9 and Section IV. If
following the protocol for exposure
management also complete Sections V-XI.
Select the Type of fluid/tissue from the list.

If the Body site of exposure was (Other), please
specify the site.
Section II – Percutaneous Injury
1. Was the needle or Choose Y (Yes) or N (No).
sharp object visibly
contaminated with
blood prior to
exposure?
2. Depth of the
Indicate the depth of the injury from the needle
injury (check one)
or sharp object using the list provided.
Exposures that are not obviously superficial
(e.g., scratch) or deep (e.g., “muscle contracted”
or “touched bone”), should be classified as
moderate.

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NHSN Healthcare Personnel Safety Component
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Data Field
3. What needle or
sharp object caused
the injury?

Exposure
Event Only
Conditionally
required

Exposure Event
and Exposure
Management
Conditionally
required

Conditionally
required

Conditionally
required

If Other known device is selected, please
specify.
Enter the brand name and model of the device
used. If the brand and model are unknown,
generic device descriptors can be entered.
Choose Y (Yes) or N (No).
If Yes, answer 5a and 5b. If No, skip to Q6.

Conditionally
required
Conditionally
required

Conditionally
required
Conditionally
required

Conditionally
required

Conditionally
required

If above is Y (Yes), choose one item from the
list of safety devices.

Conditionally
required

Conditionally
required

Choose the timing of the injury event with
relation to the use of the safety device. Check
one item from the list provided.

Conditionally
required

Conditionally
required

Instructions for Data Collection
Select one of the following categories: Device,
Non-Device Sharp Object, or Unknown Sharp
Object. If you select Device in the application
you will be provided with a Device button that
will take you to a screen to enter manufacturer,
model, etc. Once a device has been entered you
will be able to select it from the drop down list.
If a Non-Device Sharp is selected, please
describe the item or object.
Within Devices, there are six categories:
Hollow-bore needles, Suture needles, Other
solid sharps, Glass, Plastic, Non-sharp safety
devices, and Other devices.

4. Manufacturer and
model
5. Did the needle or
other sharp object
involved in the
injury have a safety
feature?
5a. If Yes, indicate
the type of safety
feature
5b. If the device had
a safety feature,
when did the injury
occur?

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NHSN Healthcare Personnel Safety Component
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Data Field
6. When did the
injury occur?
(check one)
Before use of the
item

Instructions for Data Collection
Choose the timing of the injury event from the
list provided.

During use of the
item

Injuries that occurred during the use of the
needle or sharp object. It also includes surgical
or other invasive procedures with many steps.

After use of item,
before disposal

Injuries that occurred while in transit to
disposal, cleaning instrument or recapping.

During or after
disposal

Injuries that occurred during or after the process
of disposal or because of improper disposal of a
needle or other sharp object.

Unknown

Time of injury relative to the use of the device
or object is unknown.
Choose from the lists provided. If Other specify
the purpose in the space provided.

7. For what purpose
or activity was the
sharp device being
used?

8. What was the
activity at the time
of injury?

Exposure
Event Only
Conditionally
required

Exposure Event
and Exposure
Management
Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

Conditionally
required

Injuries that occurred prior to intended use and
usually involve clean needles or sharp objects. It
may also include injuries that occurred with a
clean device that passed through bloody gloves.

Select Unknown if injury was a result of contact
with discarded or uncontrolled sharps, or in
circumstances where the intent of device or
object use is unknown or cannot be ascertained.
Choose the activity being performed at the time
of injury involving the sharp object or needle. If
the activity being performed at the time of the
injury was different than the purpose indicated
in Q7, select the activity at the time the actual
injury event took place.
Select one answer.

9. Who was holding
the device at the
time the injury
occurred?
10. What happened
Choose one item from the list.
when the injury
If Other, please record details in the space
occurred?
provided.
Section III – Mucous Membrane and/or Skin Exposure
1. Estimate the
Select the estimated amount of blood or body
amount of
fluid involved in the mucous membrane or skin
blood/body fluid
exposure. Indicate Unknown if unable to
exposure
estimate the amount.

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Data Field
2. Activity/event
when exposure
occurred
3. Barriers used by
the worker at the
time of exposure
Section IV – Bite
1. Wound
description
2. Activity/event
when exposure
occurred

Exposure
Event Only
Conditionally
required

Exposure Event
and Exposure
Management
Conditionally
required

If Other is selected record details of the activity
or event in the space provided.
Check all that apply.

Conditionally
required
Conditionally
required

Conditionally
required
Conditionally
required

If Other is selected, list other barriers in the
space provided.

Conditionally
required

Conditionally
required

Select the description of the bite wound from
the list provided.
Choose the activity or event when the bite
occurred.

Conditionally
required
Conditionally
required

Conditionally
required
Conditionally
required

Instructions for Data Collection
Select the activity or event at the time mucous
membrane or skin exposure occurred.

If Other, specify the event in the space
Conditionally Conditionally
provided.
required
required
Sections V – IX are required when following the protocols for Exposure Management
Section V – Source Information
1. Was the source
Choose Y (Yes) if the source of the exposure
Optional
Required
patient known?
(patient) is known. Otherwise, select N (No).
2. Was HIV status
Indicate Y (Yes) if the source patient’s
Optional
Required
known at time of
serostatus was known at the time of exposure.
exposure?
3. Check the test
Use codes: P= positive, N= negative,
Optional
Required
results for the source I=Indeterminate, U=Unknown, R=Refused and
patient:
NT=Not tested.
Hepatitis B
HbsAg
HBeAg
Total anti-HBc
anti-HBs
Hepatitis C
anti-HCV EIA
anti-HCV suppl
PCR-HCV RNA
HIV
HIV EIA, ELISA
Rapid HIV
Confirmatory HIV

Indicate the results of any tests performed prior
to the exposure (as found in the medical record)
or performed immediately after the exposure. If
the source is not known, check U. If the source
refuses to be tested, check R. Not all tests listed
on the form need to be offered after all
exposures.

Section VI – For HIV Infected Source
1. Stage of Disease
Indicate the stage of HIV disease of the source
patient. Use CDC surveillance definitions. For
end stage AIDS and acute HIV illness, use
definitions as defined in the protocol.

Last Updated June 26, 2012

5-10

Optional

Conditionally
required

NHSN Healthcare Personnel Safety Component
Tables of Instructions

Data Field
2. Is the source
patient taking antiretroviral drugs?
2a. If Yes, indicate
drug(s)

3. Most recent CD4
count

Instructions for Data Collection
Indicate if the source patient is was taking antiretroviral drugs at the time of the exposure, Y
(Yes), N (No), or U (Unknown).
If the source patient was taking anti-retroviral
drugs at the time of the exposure, list them here.
Drug codes are listed in Chapter 7 and will be in
a drop down list in the application.
If available, indicate the most recent CD4 count
in mm3 for the source patient.

Enter the month and year of the test for the
source patient.
4. Viral Load
If available, indicate the most recent HIV viral
load (# of copies per ml) or Undetectable for the
source patient.
Date
Enter the month and year of the test.
Section VII: Initial Care Given to Healthcare Worker
1. HIV postexposure
prophylaxis

Exposure
Event Only
Optional

Exposure Event
and Exposure
Management
Conditionally
required

Optional

Conditionally
required

Optional

Conditionally
required

Optional

Conditionally
required

Optional

Required

Optional

Required

Optional

Required

Optional

Conditionally
Required

Optional

Required

Optional

Conditionally
Required

Date

Offered?

Choose Y (Yes), N (No), or U (Unknown) if
antiretroviral drugs were offered to the HCW
following this exposure.

Taken?

Choose Y (Yes), N (No), or U (Unknown) if
antiretroviral drugs were taken by the HCW. If
Yes is selected, complete Post-Exposure
Prophylaxis/Treatment form (CDC form
57.206).
Choose Y (Yes), N (No), or U Unknown) for
whether Hepatitis B immunoglobulin was given.

2. HBIG given?

Date administered

3. Hepatitis B
vaccine given?
Date first dose
administered

Enter date HBIG prophylaxis pertaining to this
exposure was administered. Use mm/dd/yyyy
format.
Choose Y (Yes), N (No), or U. (Unknown) for
whether Hepatitis B vaccine was given after
exposure.
Enter date of first dose of Hepatitis B vaccine
(mm/dd/yyyy format). This and subsequent
doses to complete the HBV series should be
recorded in the HCW’s file.

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NHSN Healthcare Personnel Safety Component
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Data Field
4. Is the HCW
pregnant?
4a. If yes, which
trimester?

Instructions for Data Collection
Indicate the pregnancy status of HCW. Choose
Y (Yes), N (No), or U (Unknown).
Check 1 (1st trimester), 2 (2nd trimester), or 3
(3rd trimester) at the time of exposure. If stage of
pregnancy is unknown, check U.
Section VIII – Baseline Lab Testing
Was baseline testing Choose Y (Yes) or N (No) or U (Unknown).
performed on the
Baseline lab tests should be performed within
HCW?
hours of the exposure .
HIV EIA
Enter the dates for each test performed and the
HIV confirmatory
result (Use codes: P= Positive, N= Negative,
HepC anti-HCV EIA
I=Indeterminate, U=Unknown, R=Refused).

Exposure
Event Only
Optional
Optional

Exposure Event
and Exposure
Management
Conditionally
required
Conditionally
required

Optional

Required

Optional

Conditionally
required

Optional

Optional

Optional

Required

Optional

Conditionally
Required

Optional

Optional

HepC anti-HCV-supp
HepC PCR HCV RNA
HepB HBsAg
HepB IgM anti-Hbc
HepB Total anti-Hbc
HepB Anti-HBs
ALT
Amylase
Blood glucose
Hematocrit
Hemoglobin
Platelets
Blood cells in urine
WBC
Creatinine
Other

Additional baseline laboratory tests may be
completed to document potential physiologic
changes associated with a blood/body fluid
exposure. Enter the date (in mm/dd/yyyy
format) and result, using the specified units.

Section IX – Follow-up
1. Is it recommended Choose Y (Yes) or N (No).
that the HCW return
for follow-up of this
exposure?
1a. If Yes, will
Choose Y (Yes) or N (No).
follow-up be
performed at this
facility?
Section X – Narrative
In the worker’s
Enter the narrative of the HCW’s description of
words, how did the
how the injury occurred.
injury occur?
Section XI – Prevention

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NHSN Healthcare Personnel Safety Component
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Data Field
In the worker’s
words, what could
have prevented the
injury?
Custom Fields

Comments

Instructions for Data Collection
Enter the narrative of the HCW’s assessment of
how the injury might have been prevented.

Up to two date fields, two numeric fields, and
10 alphanumeric fields that may be customized
for local use. NOTE: Each Custom Field must
be set up in the Facility/Custom Options section
of the application before the field can be
selected for use.
Enter any additional information about the
HCW. CDC will not analyze this information.

Last Updated June 26, 2012

5-13

Exposure
Event Only
Optional

Exposure Event
and Exposure
Management
Optional

Optional

Optional

Optional

Optional

NHSN Healthcare Personnel Safety Component
Tables of Instructions

Table 4. Instructions for Completion of the Healthcare Personnel
Postexposure Prophylaxis Form (CDC 57.206)
Use this form if HIV postexposure prophylaxis (PEP) was administered to a healthcare worker following
a blood or body fluid exposure.
♦

Demographic data auto-entered by application if part of an existing HCW Demographic Data record (CDC 57.204).

Data Field
Facility ID #
MedAdmin ID#
HCW ID #
♦

HCW Name:
Last, First, Middle
♦
Gender
♦
Date of Birth
Infectious Agent
Exposure Event #

Initial PEP
Time between
exposure and 1st dose
Drug
Drug
Drug
Drug
Date Started

Date Stopped

Reason for Stopping

Last Updated June 26, 2012

Instructions for Data Collection
Required. The NHSN-assigned facility ID will be auto-entered by the application.
Required. Medical administration number. Data will be auto-entered by the
application.
Required. Enter the HCW’s alphanumeric identification number. This identifier is
unique to the healthcare facility.
Optional. Enter the HCW’s name.
Required. Indicate the gender of the HCW by checking F (Female) or M (Male).
Required. Enter the date of birth of the HCW using the format: mm/dd/yyyy.
Required. Enter HIV on form. Select HIV in the application.
Required. The Exposure event number will be auto-entered by the system. Use the
Link/Unlink button to find any exposures for the entered HCW, select, and link
the exposure for which PEP is being administered. PEP records cannot be saved
unless they are linked to an exposure. PEP records entered from the Blood and
Body Fluid Exposure Form will automatically be linked to that exposure.
Indication: Prophylaxis
Required. Enter the number of hours between the exposure and when the 1st dose
of PEP was administered.
Required. Enter any drugs prescribed for prophylaxis. See Chapter 7 in the
protocol for a list of individual drug codes.
Conditionally required. Enter any additional drugs prescribed for initial
prophylaxis.
Conditionally required. Enter any additional drugs prescribed for prophylaxis.
Conditionally required. Enter any additional drugs prescribed for prophylaxis.
Required. Enter the date the initial PEP regimen commenced (mm/dd/yyyy
format). The start date will apply to all drugs selected as the initial PEP regimen.
The date started must be on or after the exposure date.
Required. Enter the date the initial PEP regimen was stopped (mm/dd/yyyy
format).
Note: If any drug(s) of a drug regimen are discontinued, the entire regimen is
considered ‘stopped.’ If select drugs in the regimen continue to be used as
prophylaxis (and if other drugs are added) enter them as drugs under a PEP
change with a new start date.
Required. Indicate the primary reason for stopping the initial PEP regimen by
selecting the appropriate choice.

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NHSN Healthcare Personnel Safety Component
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Data Field
PEP Change 1
Drug
Drug
Drug
Drug
Date Started
Date Stopped

Reason for Stopping
PEP Change 2
Drug

Drug
Drug
Drug
Date Started
Date Stopped

Reason for Stopping
Adverse Reactions
Signs or symptoms of
adverse reactions to
post-exposure
prophylaxis
Custom Fields

Comments

Last Updated June 26, 2012

Instructions for Data Collection
Indication: Prophylaxis
Required. Enter drugs prescribed for a second prophylaxis regimen. Note that the
second PEP regimen may contain drugs that were included in the first regimen.
Conditionally required. Enter any additional drugs prescribed for prophylaxis.
Conditionally required. Enter any additional drugs prescribed for prophylaxis.
Conditionally required. Enter any additional drugs prescribed for prophylaxis.
Conditionally required. Enter the date the second PEP regimen was started using
mm/dd/yyyy format.
Conditionally required. Enter the date the second PEP regimen was stopped using
mm/dd/yyyy format.
Note: If any drug(s) of a drug regimen are discontinued, the regimen is
considered ‘stopped.’ Whatever drugs in the regimen are continued (and if other
drugs are added) will constitute a new regimen and should be recorded as part of a
new PEP regimen(s) with dates that resume from the last stop date. .
Conditionally required. Indicate the primary reason for stopping this PEP regimen
by selecting the appropriate choice.
Indication: Prophylaxis
Conditionally required. Enter drugs prescribed for a third prophylaxis regimen.
Note that the third PEP regimen may contain drugs that were included in previous
regimens.
Conditionally required. Enter any additional drugs prescribed for prophylaxis.
Conditionally required. Enter any additional drugs prescribed for prophylaxis.
Conditionally required. Enter any additional drugs prescribed for prophylaxis.
Conditionally required. Enter the date the new PEP regimen was started using
mm/dd/yyyy format.
Conditionally required. Enter the date the new PEP regimen was stopped using
mm/dd/yyyy format.
Note: If any drug(s) of a drug regimen are discontinued, the regimen is
considered ‘stopped.’ Whatever drugs in the regimen are continued (and if other
drugs are added) will constitute a new regimen and should be entered as such.
Conditionally required. Indicate the primary reason for stopping this PEP regimen
by selecting the appropriate choice.
Optional. Indicate any adverse signs/symptoms the HCW experienced while
receiving postexposure prophylaxis. You may select up to six.
If Other is selected, briefly specify details of adverse reaction.
Optional. Up to two date fields, two numeric fields, and 10 alphanumeric fields
that may be customized for local use. NOTE: Each Custom Field must be set up
in the Facility/Custom Options section of the application before the field can be
selected for use.
Optional. Enter any additional information about the HCW. CDC will not analyze
this information.

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NHSN Healthcare Personnel Safety Component
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Table 5: Instructions for Completion of Follow-Up Laboratory Testing Form
(CDC 57.207)
This form should be completed for HCP who have additional laboratory testing done as a result of blood
or body fluid exposures. These tests would occur after baseline laboratory testing had been completed.
♦

Demographic data auto-entered by application if part of an existing HCW Demographic Data record (CDC 57.204).

Data Field
Facility ID #
Lab #
HCW ID #
♦

HCW Name:
Last, First, Middle
♦
Gender
♦
Date of birth
Exposure Event #

Lab Results
Lab Test

Instructions for Data Collection
Required. The NHSN-assigned facility ID will be auto-entered by the application.
Required. The lab testing ID number will be auto-generated by the application.
Required. Enter the HCW’s alphanumeric identification number. This identifier is
unique to the healthcare facility.
Optional. Enter the HCW’s name.
Required. Indicate the gender of the HCW by checking F (Female) or M (Male).
Required. Enter the date of birth of the HCW using the format: mm/dd/yyyy.
Required. The user is required to link the laboratory follow-up record to a blood and
body fluid exposure record using the Link feature within the application. Once the
exposure is selected and submitted, the form will display the message “Lab is
Linked.” Laboratory records must be linked to an exposure.
Required (At least one laboratory test and date are required). Multiple test results
may be recorded on this form. Select lab test from dropdown menu:
HIV EIA
HIV confirmatory
HepC anti-HCV EIA
HepC anti-HCV-supp
HepC PCR HCV RNA
HepB HBsAg
HepB IgM anti-Hbc
HepB Total anti-Hbc
HepB Anti-HBs

Date
Result
Custom Fields

Comments

ALT
Amylase
Blood glucose
Hematocrit
Hemoglobin
Platelets
Blood cells in urine
WBC
Creatinine
Other

Required. Indicate date of test using mm/dd/yyyy format.
Conditionally required. Select one of the result codes:
Use codes: P= positive, N= negative, I=Indeterminate, U=Unknown, R=Refused)
Optional. Up to two date fields, two numeric fields, and 10 alphanumeric fields that
may be customized for local use. NOTE: Each Custom Field must be set up in the
Facility/Custom Options section of the application before the field can be selected
for use.
Optional. Enter any additional information about the HCW. CDC will not analyze
this information.

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Table 6. Instructions for Completion of the Healthcare Worker Influenza
Antiviral Medication Administration Form (CDC 57.210)
This form should be completed when an HCW receives antiviral medications as influenza treatment or as
chemoprophylaxis against influenza infection. It is used to collect information on which antiviral
medications were administered, when, and what (if any) adverse reactions were experienced by the HCW.
♦

Demographic data auto-entered by application if part of an existing HCW Demographic Data record (CDC 57.204).

Data Field
Facility ID #
Med Admin ID #
HCW ID #
♦

HCW Name:
Last, First, Middle
♦
Gender
♦
Date of Birth
♦
Work Location

♦

Occupation

♦

Clinical Specialty

♦

Performs direct
patient care
Infectious agent
For season

#
Indication
Influenza subtype

Antiviral
medication
Start date
Stop date

Instructions for Data Collection
Required. The NHSN-assigned facility ID will be auto-entered by the application.
Required. The medication administration ID number will be auto-generated by the
application.
Required. Enter the HCW’s alphanumeric identification number. This identifier is
unique to the healthcare facility.
Optional. Enter the HCW’s name.
Required. Indicate the gender of the HCW by checking F (Female) or M (Male).
Required. Enter the date of birth of the HCW using the format: mm/dd/yyyy.
Required. Select the code that best describes the HCW’s current permanent work
location. This refers to physical work location rather than to department assignment.
Location codes are customized to the facility and set up prior to entering HCW
records. See Table 2 for more details.
Required. Select the occupation code that most appropriately describes the HCW’s
job. Occupation codes are customized to the facility and set up prior to entering
HCW records. See Table 2 for more details.
Conditionally required. If Occupation is physician, fellow or intern/resident, enter the
appropriate clinical specialty. The list of clinical specialties can be found on Form
CDC 57.204.
Required. Select Yes if the HCW provides direct patient care (i.e., hands on, face-toface contact with patients for the purpose of diagnosis, treatment and monitoring);
otherwise select No.
Required. Auto-filled on hard copy form. Select Influenza in application.
Required. Select the vaccination season. Specify the year(s) during which this
chemoprophylaxis or treatment date falls. For NHSN purposes, the vaccination
“season” is 7/1 of the first year to 6/30 of the next calendar year.
Required. Indicate up to 10 antiviral medications given using sequential numbers
starting with 1.
Required. Select Prophylaxis or Treatment as appropriate.
Required. Select the influenza subtype for which the HCW is receiving antiviral
medications (for post-exposure chemoprophylaxis or for treatment). Select Unknown,
if you do not know the specific subtype necessitating antiviral medication use.
Required. Enter the code of the antiviral medication that was administered to the
HCW using the codes listed at the bottom of the form.
Required. Enter the start date of the antiviral using mm/dd/yyyy format.
Conditionally required. Enter the stop date of the antiviral using mm/dd/yyyy format.

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NHSN Healthcare Personnel Safety Component
Tables of Instructions

Data Field
Adverse reactions?

Adverse reactions
to antiviral
medication
#1…#10

Custom Fields

Comments

Instructions for Data Collection
Required. Check Yes if the HCW had a severe adverse reaction attributable to the
influenza antiviral medication; otherwise check No. If it is unknown whether or not
the HCW experienced any adverse reactions, check Don’t Know.
Conditionally required. If the HCW had a severe adverse reaction, check all reactions
that apply for each medication administered. Please correlate the antiviral medication
# with the antiviral medication on page 1. If an adverse reaction is not listed, check
Other and specify the adverse reaction in the space provided. All Other adverse
reactions should be included if the reactions were severe enough to affect daily
activities and/or resulted in the discontinuation of the antiviral medication.
Optional. Up to two date fields, two numeric fields, and 10 alphanumeric fields that
may be customized for local use. NOTE: Each Custom Field must be set up in the
Facility/Custom Options section of the application before the field can be selected for
use.
Optional. Enter any additional information about the HCW. CDC will not analyze
this information.

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NHSN Healthcare Personnel Safety Component
Tables of Instructions

Table 7. Instructions for Completion of Healthcare Personnel Safety
Component Facility Survey Form (CDC 57.200)
This form must be completed once a year by any facility using the Healthcare Personnel Safety
Component.
Data Field
Tracking #
Facility ID #
Survey year
Total beds set up and staffed
Patient admissions
Inpatient days
Outpatient encounters
Number of hours worked by
all employees

Number of HCWs

Number of FTEs

Last Updated June 26, 2012

Instructions for Data Collection/Entry
Required. The NHSN-assigned Tracking # will be auto-entered by the
application.
Required. The NHSN-assigned facility ID will be auto-entered by the
application.
Required. Enter the year of the survey using the format: yyyy.
Required. Enter the number of all active beds across specialties and
intensive care units.
Required. Enter the number of patients, excluding newborns, admitted for
inpatient service.
Required. Enter the number of adult and pediatric days of care, excluding
newborn days of care, rendered during a specified reporting period.
Required. Enter the number of visits by patients who are not admitted as
inpatients to the hospital while receiving medical, dental, or other services.
Optional. Number of hours worked is available from OSHA300 reporting
logs. The value can also be calculated by identifying the number of full
time employees working in your facility within a year, multiply by the
number of work hours for one full time employee in a year (typically
ranges from 2000-2100 hours per year). Add in overtime hours and total
hours worked by part-time, temporary, and contracted staff.
Required. HCWs are all persons who work in the hospital. Calculate the
number of attending physicians by including only those who are active or
associate staff (e.g. similar methodology to the American Hospital
Association annual survey, if applicable). Do not include courtesy,
consulting, honorary, provisional, or other attending physicians in this
number. If you cannot determine the exact number for a particular category,
please estimate it. If the facility does not have any HCP in a specific
occupation, the user may enter 0. This is the denominator when used to
calculate rates of particular exposure events per HCW.
Required. A subset of total number of HCP. FTEs are all HCP whose
regularly scheduled workweek is 35 hours or more. To calculate the
number of FTE’s add the number of FTEs to ½ the number of part-time
HCP (e.g., 2 part-time HCP = 1 FTE). If you cannot determine the exact
number for a particular category, please estimate it. If the facility does not
have any FTEs in a specific occupation, the user may enter 0. This is the
denominator used to calculate rates of particular exposure events per FTE.

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NHSN Healthcare Personnel Safety Component
Tables of Instructions

REFERENCES
The following CDC/PHS publications provide recommendations for management and follow-up of blood and body
fluid exposures to HBV, HCV, and HIV:
 Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV,
HCV, and HIV and Recommendations for Postexposure Prophylaxis. (MMWR, June 29, 2001 / 50(RR11); 142)
 Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and
Recommendations for Postexposure Prophylaxis (PEP regimens have been changed). (MMWR, September
30, 2005 / 54(RR09); 1-17)

The following CDC/PHS publication provides recommendations for the immunization of HCP:
 A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the
United States. (MMWR, December 8, 2006 / 55(RR16); 1-25)
 Influenza Vaccination of Health-care Personnel. (MMWR, February 24, 2006 / 55(RR02); 1-16)
 Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee
on Immunization Practices (ACIP). (MMWR, July 29, 2009 / 58(Early Release); 1-52)

Last Updated June 26, 2012

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NHSN Healthcare Personnel Safety Component
Key Terms

Key Terms
Key term

Definition

Antiviral
medications for
influenza

Drugs used to treat or to prevent influenza infections, not necessarily to treat the
symptoms of influenza (e.g., analgesics)

Adverse reaction to
influenza vaccine

A reaction experienced by the HCW that is attributable to the influenza vaccine. The
Vaccine Information Statement defines a reaction as “Any unusual condition, such as
high fever or behavior changes.” Typically, adverse reactions to vaccines are only
known when the HCW notifies you (i.e., passive surveillance) rather than you following
up after the vaccination (i.e., active surveillance).

Bite

A human bite sustained by an HCW from a patient, other HCW, or visitor.

Bloodborne
pathogens

Pathogenic microorganisms that may be present in human blood and can cause disease
in humans. These pathogens include, but are not limited to hepatitis B virus (HBV),
hepatitis C virus (HCV) and human immunodeficiency virus (HIV).

CDC Location

A CDC-defined designation given to a patient care area housing patients who have
similar disease conditions or who are receiving care for similar medical or surgical
specialties. Each facility location that is monitored is “mapped” to one CDC Location.
The specific CDC Location code is determined by the type of patients cared for in that
area according to the 80% Rule. That is, if 80% of patients are of a certain type (e.g.,
pediatric patients with orthopedic problems) then that area is designated as that type of
location (in this case, an Inpatient Pediatric Orthopedic Ward). Work locations must be
mapped to a CDC location. For CDC locations, see
http://www.cdc.gov/nhsn/PDFs/pscManual/15LocationsDescriptions_current.pdf

CDC (occupation)
Code

A CDC-defined designation for each occupation type in a facility. A facility occupation
is “mapped” to one CDC Code. See Chapter 7 of protocol for list of occupations.

Contractor

Individual facilities may have differing classifications of work status. According to the
Bureau of Labor Statistics, workers with no explicit or implicit contract for a long-term
employment arrangement, such as temporary or term positions, are considered
contingent or contract workers. Facilities should use their own definition of a
contractor.

Device

Any of the following devices (hollow-bore needle, suture needle, glass, plastic, other
solid sharps, and non-sharp safety devices) used at the healthcare facility.

Direct patient care

Hands on, face-to-face contact with patients for the purpose of diagnosis, treatment and
monitoring.

Float

A work location for HCP who do not work at least 75% of the time in a single location.
For example, a radiology technician who spends most of his/her time performing
portable x-rays throughout the facility.

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NHSN Healthcare Personnel Safety Component
Key Terms

Key term

Definition

Full Time
Equivalent (FTE)

HCP whose regularly scheduled workweek is 35 hours or more. To calculate the
number of FTE’s add the number of FTEs to ½ the number of part-time HCP (e.g., 2
part-time HCWs = 1 FTE).

Healthcare
personnel (HCP)

A population of healthcare workers working in healthcare settings. HCP might include
(but are not limited to) physicians, nurses, nursing assistants, therapists, technicians,
emergency medical service personnel, dental personnel, pharmacists, laboratory
personnel, autopsy personnel, students and trainees, contractual staff not employed by
the healthcare facility, and persons (e.g., clerical, dietary, housekeeping, maintenance,
and volunteers) not directly involved in patient care but potentially exposed to
infectious agents that can be transmitted to and from HCP. It includes students, trainees,
and volunteers.

Healthcare worker
(HCW)

A person who works in the facility, whether paid or unpaid, who has the potential for
exposure to infectious materials, including body substances, contaminated medical
supplies and equipment, contaminated environmental surfaces, or contaminated air.
Healthcare worker is the singular form of healthcare personnel.

Hollow-bore needle

Needle (e.g., hypodermic needle, phlebotomy needle) with a lumen through which
material (e.g., medication, blood) can flow.

Location

The patient care area to which an HCW is assigned while working in the healthcare
facility. See also CDC Location for how locations are defined. CDC location codes may
be accessed: at http://www.cdc.gov/nhsn/PDFs/master-locations-descriptions.pdf

Mucous membrane
exposure

Contact of mucous membrane (e.g.., eyes, nose, or mouth) with the fluids, tissues, or
specimens listed on the blood and body fluids exposure form.

Non-intact skin

Areas of the skin that have been opened by cuts, abrasions, dermatitis, chapped skin,
etc.

Non-intact skinexposure

Contact of non-intact skin with the fluids, tissues, or specimens listed under
Occupational Exposure

Non-Responder to
Hepatitis B vaccine

An HCW, who has received two series of hepatitis B vaccine, is serotested within 2
months after the last dose of vaccine and does not have anti-HBs ≥10 mIU/mL.

Non-seasonal
influenza vaccine

A vaccine for additional/novel influenza virus strains (e.g., 2009 H1N1) not included in
the seasonal influenza vaccine which may or may not be available on an annual basis.

Occupational
exposure

Contact with blood, visibly bloody fluids, and other body fluids (i.e., semen, vaginal
secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial
fluid, and amniotic fluid, tissues, and laboratory specimens that contain concentrated
virus) to which Standard Precautions apply and during the performance of a healthcare
worker’s duties. Modes of exposure include percutaneous injuries, mucous membrane
exposures, non-intact skin exposures, and bites.

Part Time
Equivalent (PTE)

HCP whose regularly scheduled workweek is less than 35 hours. Two PTEs equal 1
FTE.

Last Updated June 26, 2012

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NHSN Healthcare Personnel Safety Component
Key Terms

Key term

Definition

Percutaneous injury

An exposure event occurring when a needle or other sharp object penetrates the skin.
For percutaneous injuries with a needle or sharp object that was not in contact with
blood or other body fluids prior to exposure, collection of data is optional. Facilities are
not required to collect data that involve intact skin or exposures to body fluids to which
contact precautions do not apply unless they are visibly bloody. However, facilities that
routinely collect data on such exposures may enter this information into the system.

Safety device

Includes any safety device (e.g., needless IV systems, blunted surgical needles, selfsheathing needles) used at the healthcare facility.

Seasonal influenza
vaccine

A vaccine for seasonal influenza virus strains that is offered on an annual basis.

Severe adverse
reaction to antiviral
medication use for
influenza
chemoprophylaxis
or treatment

Adverse reactions severe enough to affect daily activities and/or result in the
discontinuation of the antiviral medication.

Sharp

Any object that can penetrate the skin including, but not limited to, needles, scalpels,
broken glass, broken capillary tubes, and exposed ends of dental wires.

Sharps Injury

An exposure event occurring when any sharp penetrates the skin

Solid Sharp

A sharp (e.g., suture needle, scalpel) that does not have a lumen through which material
can flow.

Vaccination season

A 12-month period starting from September 1, 2xxx to the start of the next traditional
influenza season (i.e., August 31 of the following year).

Work location

A HCW’s current permanent work location. This refers to physical work location rather
than to department assignment.

Last Updated June 26, 2012

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NHSN Healthcare Personnel Safety Component
CDC Codes

CDC occupation Codes used to code (“map”) facility locations
CDC (occupation) Code
ATT-Attendant/orderly
CLA-Clerical/administrative
CNA-Nurse Anesthetist
CNM-Nurse Midwife
CSS-Central Supply
CSW-Counselor/Social Worker
DIT-Dietician
DNA-Dental Assistant/Tech
DNH-Dental Hygienist
DNO-Other Dental Worker
DNT-Dentist
DST-Dental Student
EMT-EMT/Paramedic
FEL-Fellow
FOS-Food Service
HEM-Hemodialysis Technician
HSK-Housekeeper
ICP-Infection Control Professional
IVT-IVT Team Staff
LAU-Laundry Staff
LPN-Licensed Practical Nurse
MLT -Medical Laboratory
Technician
MNT-Maintenance/Engineering
MOR-Morgue Technician
MST-Medical Student
MTE-Medical Technologist
NUA-Nursing Assistant
NUP-Nurse Practitioner
OAS-Other Ancillary Staff
OFR-Other First Responder

Last Updated June 26, 2012

BLS SOC
(2000)*
31-1012

33-7012
21-1020
29-1030
31-9091
29-2021
29-1020
29-2041
35-0000
37-2010

29-2061
29-2012

CDC (occupation) Code
OH-Occupational Health
Professional
OMS-Other Medical Staff
ORS-OR/Surgery Technician
OTH-Other
OTT-Other Technician/Therapist
PAS-Physician Assistant
PCT-Patient Care Technician
PHA-Pharmacist
PHL-Phlebotomist/IV Team
PHW-Public Health Worker
PHY-Physician
PLT-Physical Therapist
PSY-Psychiatric Technician
RCH-Researcher
RDT-Radiologic Technologist
RES-Intern/Resident
RNU-Registered Nurse
RTT-Respiratory Therapist/Tech
STU-Other Student
TRA-Transport/Messenger/Porter
VOL-Volunteer

BLS SOC
(2000)*
29-9010

29-2055
29-2099
29-1071
29-1051

29-1060
29-1123
29-2053
19-1040
29-2034
29-1111
29-1126

* Bureau of Labor Statistics (BLS) Standard
Occupational Codes (SOC), available online at
the United States Department of Labor, Bureau
of Labor Statistics at http://www.bls.gov/soc/
29-2090

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NHSN Healthcare Personnel Safety Component
CDC Codes

CDC Device description used to code (“map”) medical devices used in the
facility
CDC Device Description
IVPER - IV catheter - peripheral
IVCATH - IV catheter – central line
HYPO - Hypodermic needle, attached syringe
UNATT - Unattached hypodermic needle
PREFILL - Prefilled cartridge syringe
STYLET - I.V. Stylet
VHOLD - Vacuum tube holder/needle
SPINAL - Spinal or epidural needle
BMARROW - Bone marrow needle
BIOPSY - Biopsy needle
OTH-HOL - Other hollow-bore needle
UNK-HOL - Hollow-bore needle, type unknown
HUBER - Huber needle
WINGED - Winged-steel (Butterfly™-type) needle
HEMODIAL - Hemodialysis needle
HYPO-TUB - Hypodermic, attached to IV tubing
DENTASP -Dental aspirating syringe with needle
ABCD - Arterial Blood Collection Device
SUTR - Suture needle
BCUT - Bone cutter
BOVIE - Electrocautery device
BUR - Bur
ELEV - Elevator
EXPL - Explorer
FILE - File
FORCEPS - Extraction Forceps
LANCET - Lancet
MICRO - Microtome blade
PIN - Pin
RAZOR - Razor
RETRACT - Retractor
ROD - Rod (orthopaedic)

Last Updated August 26, 2009

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CDC Device Description
SCALE - Scaler/curette
SCALPEL - Scalpel blade
SCIS - Scissors
TENAC - Tenaculum
TROCAR - Trocar
WIRE - Wire
COLLTUBE - Blood collection tubes
CAPILL - Capillary tube
MED - Medication ampule/vial/IV bottle
PIPE - Pipette (glass)
SLIDE - Slide
TUBE - Specimen/test/vacuum tube
BCADAP - Blood culture adapter
IVDEL - IV Delivery System
CATHSECD - Catheter Securement Device
PCOLLTUBE - Blood collection tubes - plastic
PCAPILL - Capillary tube - plastic
PTUBE - Specimen/test/vacuum tube - plastic
UNK - Unknown type of sharp object
OTHER - Other sharp

NHSN Healthcare Personnel Safety Component
CDC Codes

Antiretroviral and Associated Drug Codes for Use on Healthcare Worker
BBF Postexposure Prophylaxis form (CDC 57.206)
CDC Drug Code
3TC - lamivudine
ABC - abacavir
ATV - atazanavir
CD4 - CD4 therapies
D4T - stavudine
ddI - didanosine
DLV - delavirdine
DRV - darunavir
EFV - efavirenz
ENF - enfuvirtide (T-20)
ETR - etravirine
fAPV - fosamprenavir
FTC - emtricitabine
HU - hydroxyurea
IDV - indinavir
IL2 - interleukin2
INT - interferon
LPV - lopinavir
NFV - nelfinavir
NVP - nevirapine
OTH - other
RLT - raltegravir
RIL - Rilpivirine
RTV - ritonavir
SQV - saquinavir
TDF - tenofovir
TIP - tipranavir (PNU-140690)
ZDV - zidovudine (AZT)

Last Updated June 26, 2012

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