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Att 24_Crosswalk
ICR 202006-0920-015 · OMB 0920-0978 · Object 102145201.
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Cross walk - 2020 form changes ABCs: 1. 2020 ABCs Case Report Form Current Form 7a. Hospital /Lab ID where culture identified T4 – Site from which organism isolated Options: Sterile Sites 1=Blood 2=Bone 3=Brain 4=CSF 5=Heart 6=Joint 7=Kidney 8=Other Sterile Site 9=unknown 10=Liver 11=Lung 12=Lymph node 13=Muscle/Fascia/Tendon (GAS only) 14=Ovary 15=Pancreas 16=Pericardial Fluid 17=Peritoneal Fluid 18=Pleural fluid 19=Spleen 20=Vascular Tissue 21=Vitreous fluid Non-Sterile Sites 22=Amniotic fluid 23=Middle ear 24=Placenta 25=Sinus 26=Sputum 27=Wound T8- If isolate/specimen not available, why not? Options: 1=N/A at Hospital Lab 2=N/A at State Lab, 3=Hospital refuses, 4=Isolate Discrepancy (2x), 5=No DNA (non-viable) Proposed changes T3a. Hospital/Lab ID where test identified T4 – Removed several response options under ‘Non-Sterile sites’; Options: Sterile Sites 1=Blood 2=Bone 3=Brain 4=CSF 5=Heart 6=Joint 7=Kidney 8=Other Sterile Site 9=unknown 10=Liver 11=Lung 12=Lymph node 13=Muscle/Fascia/Tendon (GAS only) 14=Ovary 15=Pancreas 16=Pericardial Fluid 17=Peritoneal Fluid 18=Pleural fluid 19=Spleen 20=Vascular Tissue 21=Vitreous fluid Non-Sterile Sites 22=Amniotic fluid 24=Placenta 27=Wound Question T8 – added response option ‘6=Isolate N/A for collection’ T8- If isolate/specimen not available, why not? Options: 1=N/A at Hospital Lab 2=N/A at State Lab, 3=Hospital refuses, 4=Isolate Discrepancy (2x), 5=No DNA (non-viable), 6=Isolate N/A for collection Added new question: T9- Shipped to CDC? 1=Yes, 0=No Added new question: T9- If Shipped, Accession # 27. Underlying causes or prior illnesses Added new question: 24d. Mark if this is a GBS Blood Spot Study case that lives outside ABCs catchment area 27. Added sub-Checkbox under ‘Immunosuppressive Therapy’ – ‘Ravulizumab (Ultomiris) For N. meningitidis cases only 27d. Other substance abuse, current None Unknown If yes, check all that apply: mode of delivery Illicit opioid IDU non-IDU Unk Prescription Opioid IDU non-IDU Unk Stimulant IDU non-IDU Unk Other ___________ IDU non-IDU Unk Unknown Substance IDU non-IDU Unk 28c. Were records obtained to verify vaccination history? Yes No If yes, what is the source of the information? Vaccine Registry Healthcare Provider Other (specify)_____________________ Added checkbox ‘Opioid, NOS’ and separated checkbox ‘Cocaine or Methamphetamine’ into two separate checkboxes; 27d. Other substances None Unknown Documented Use disorder mode of delivery Marijuana/Cannabinoid (other than smoking) DUD or Abuse IDU Skin Popping non-IDU Unk Opioid, DEA Schedule I DUD or Abuse IDU Skin Popping non-IDU Unk Opioid, DEA Schedule II- IV DUD or Abuse IDU Skin Popping non-IDU Unk Opioid, NOS DUD or Abuse IDU Skin Popping non-IDU Unk Cocaine DUD or Abuse IDU Skin Popping non-IDU Unk Methamphetamine DUD or Abuse IDU Skin Popping non-IDU Unk Other ___________ DUD or Abuse IDU Skin Popping non-IDU Unk Unknown Substance DUD or Abuse IDU Skin Popping non-IDU Unk Removed this question from the form. 2. 2019 2020 Neonatal Infection Expanded Tracking Form 2019 form 2020 Form 12a. Number of prior pregnancies __ __ Unknown (9) Added new question: 3c. Gestational age determined by: Dates (1) Physical Exam (2) Ultrasound (3) Unknown (9) Added new questions: 10a. Did the infant receive antibiotics anytime during the birth hospitalization? Yes (1) No (0) Unknown (9) 10b. IF YES, was it a beta-lactam? Yes (1) No (0) Unknown (9) Variable value changed to harmonize with other unknown indicator variables. Recoding needed for 2018-2019 to match the 2020 change going forward. 12a. Number of prior pregnancies __ __ Unknown (1) Added new question 14a. Maternal underlying or prior illnesses: (check all that apply OR if NONE or CHART UNAVAILABLE, check appropriate box) None Unknown AIDS or CD4 Connective tissue Immunosuppressive count <200 disease therapy 21a. Date & time antibiotics 1st administered: (before delivery) Date: __/__/____ Time: _ _ _ _ Unknown (9) 3. Asthma (Lupus, etc...) CSF Leak (Steroids, etc.) Leukemia Atherosclerotic CVD (ASCVD)/CAD Bone Marrow Transplant (BMT) CVA/Stroke/TIA Dementia Multiple Myeloma Multiple Sclerosis Myocardial Infarction Nephrotic Syndrome Neuromuscular Disorder Obesity Chronic Hepatitis C Chronic Kidney Disease Chronic Liver Disease/ Cirrhosis Chronic Skin Breakdown Diabetes Mellitus, HbA1C____(%), Date: __/__/___ Emphysema/ COPD Heart Failure/CHF HIV infection Parkinson’s Disease Hodgkin’s Disease/ Lymphoma Immunoglobulin Deficiency Complement Peptic Ulcer Deficiency Disease Variable value changed to harmonize with other unknown indicator variables. 21a. Date & time antibiotics 1st administered: (before delivery) Date: __/__/____ Time: _ _ _ _ Unknown (1) 2020 ABCs Severe GAS Infection: Supplemental Form 2019 form 2020 Form 1. Soft-tissue necrosis (necrotizing fasciitis, necrotizing myositis, necrotizing gangrene)? 1 Yes 2 No 9 DK OPTIONAL: e. Is a pathology report available? 1 Yes 2 No 9 DK f. Is a surgical report available? 1 Yes 2 No 9 DK 3. If the case died and was not hospitalized, please indicate date of death: --/--/----(mm/dd/yyyy) Removed OPTIONAL section from the form. Removed this question from the form. Added Laboratory Values Table for Surveillance Officer’s to reference on page 2 4. 2020 ABCs Invasive Pneumococcal Disease in Children (aged ≥2 months to <5 years) 2019 form 2020 Form Added option to record source of vaccination for each reported dose. Added option to record source of vaccination for each reported dose. Also added collection of lot # for this vaccine type. Removed this question FoodNet 5-7. Active Surveillance Variable Current data collection SalGroup Collected StecO157 Collected StecH7 Collected StecNM Collected agclinictesttype; Alere Shiga Toxin Quik Chek agsphltesttype Immunocard STAT! EHEC (Meridian); Duopath Verotoxins (Merck); pcrclinictesttype; Premier EHEC (Meridian); ProSpecT STEC (Remel); VTEC Screen (Denka Seiken); ProSpecT Campylobacter assay (Remel); PREMIER™ CAMPY assay (Meridian); ImmunoCard STAT! CAMPY (Meridian); Xpect Campylobacter assay (Remel); Other; Unknown Biofire FilmArray GI Panel pcrsphltesttype BD Max Enteric Bacterial otherclinictesttype; othersphltesttype Diatherix; Luminex xTAG GI Panel; ProGastroSSCS; Medical diagnostics; Metametrix Verigene (Nanosphere) Enteric Pathogen Test Seegene Biofire Filmarray Meningitis/Encephalitis (ME) Panel Biofire Filmarray Blood Culture Indentification Panel Verigene (Nanosphere) Gram-positive Blood Culture Test Staten Serum Institut PCR assay Lab-developed test Unknown Other; Unknown dxo157testype ImmunoCard STAT! O157 (Meridian) Proposed Changes Suspended (optional in MMG) Suspended (optional in MMG) Suspended (optional in MMG) Suspended (optional in MMG) Abbott Shiga Toxin Quik Check; Merck Duopath STEC Rapid Test; Meridian Premier EHEC; Meridian ImmunoCard STAT! E. coli O157 Plus; Meridian ImmunoCard STAT! EHEC; Remel ProSpecT STEC; Meridian ImmunoCard STAT! CAMPY; Meridian Premier CAMPY; Remel ProSpecT Campylobacter; Remel Xpect Campylobacter; Other; Unknown Biofire Filmarray Gastrointestinal (GI); Biofire Filmarray Meningitis/Encephalitis (ME); Biofire Filmarray Blood Culture Identification (BCID); BD Max Enteric Bacterial; BD Max Extended Enteric Bacterial; Diatherix Gastrointestinal; Hologic Prodesse ProGastro SSCS; Luminex Gram-Positive Blood Culture; Luminex Verigene Enteric Pathogens; Luminex xTag Gastrointestinal Pathogens; Medical Diagnostics; Lab-developed test Unknown Autoflourescence Stained Wet Mount; Wet Mount; Vero Cell Asay; Other; Unknown Meridian ImmunoCard STAT! E. coli O157 Plus; Biofire FilmArray; Diatherix; Luminex; Metametrix; Other pcrclinic; pcrsphl Stx1+; Stx2+; Stx1+ & Stx2+; Positive Undifferentiated; Negative; Not Tested Positive; Negative; Not tested Vibrios V. cholerae Vibrios&V. cholerae AR_antibiotic_use Amoxicillin Amoxicillin/Clavulanate Ampicillin Augmentin Azithromycin Bactrim Biaxin Biofire Filmarray Gastrointestinal (GI); Diatherix Gastrointestinal; Luminex xTag Gastrointestinal Pathogens; Metametrix; Lab-developed test; Other Stx1+; Stx2+; Stx1+ & Stx2+; Positive Undifferentiated; Negative; Not Tested Positive; Negative; Not tested Vibrios V cholerae Vibrios&V cholerae Not Tested Shigella/Stx undiff Shigella/Stx1 Shigella/Stx2 Shigella/Stx1&2 Amoxicillin Amoxicillin / Clavulanate Ampicillin Augmentin Azithromycin Bactrim Biaxin Ceclor Cefaclor Ceftrin Cefixime Cefuorixime Cefzil Cefprozil Cephalexin Cephradine Ciprofloxacin/Cipro Clarithromycin Dapsone Ceclor Cefaclor Ceftin Cefixime Ceftriaxone Cefuorixime Cefzil Cefprozil Cephalexin Cephradine Chloramphenicol Ciprofloxacin / Cipro Doxycycline Duricef Erythromycin Clarithromycin Dapsone Doxycycline Erythromycin/sulfisoxizole Flagyl Floxin Keflex Keftab Levofloxacin Levoquin Metronidazole Norfloxacin/Norflox Ofloxacin/Oflox Pediazole Penicillin/Pen VK Septra Suprax Tetracycline Trimox Trimethoprim/Sulfa Zithromax/Z-Pak Other Unknown AR_antacid_any Aluminium hydroxide Ami-Lac Amphojel Axid Calcium carbonate Cal-Guest Caltrate calcium-based supplements Duricef Erythromycin Erythromycin / sulfisoxizole Flagyl Floxin Keflex Keftab Levofloxacin Levoquin Metronidazole Norfloxacin / Norflox Ofloxacin / Oflox Pediazole Penicillin / Pen VK Septra Suprax Tetracycline Trimox Trimethoprim / Sulfa Zithromax / Z-Pak Other Unknown Aluminium hydroxide Ami-Lac Amphojel Axid Calcium carbonate Cal Gest Caltrate calcium-based supplements Dexilant Dialume Di-Gel Gas-X with Maalox Gaviscon Gelusil Genaton Isopan Maalox / Maox Magaldrate Magnesium Hydroxide Masanti Dexilant Dialume Di-Gel Gas-X with Maalox Gaviscon Gelusil Genaton Isopan Maalox / Maox Magaldrate Magnesium Hydroxide Masanti Mi-Acid Milantex Milk of Magnesia Mi-Acid Milantex Milk of Magnesia Outfetal Mintox Mylanta Nexium Nizatidine Os-Cal Oysco Oyster (shell) calcium Pepcid Pepto Children's Prevacid Prilosec Protonix Ri-Mag Riopan Rolaids Ron-Acid Rulox Tagamet Tempo Titralac Tums Zantac Zegerid Other Unknown Still pregnant; Fetal death; Induced abortion; Delivery Unknown; Diagnostic Laboratory Practices and Volume Reflex CX Yes, always When requested by provider Only for special projects or outbreaks No, specimen sent to reference laboratory for culture No, never Mintox Mylanta Nexium Nizatidine Os-Cal Oysco Oyster (shell) calcium Pepcid Pepto Children's Prevacid Prilosec Protonix Ri-Mag Riopan Rolaids Ron-Acid Rulox Tagamet Tempo Titralac Tums Zantac Zegerid Other Unknown Still pregnant; Fetal death; Delivery Unknown; Yes, always for EIP purposes Yes, always for antimicrobial susceptibility testing Yes, always for public health purposes Sometimes, when requested by a provider Sometimes, for special projects or outbreaks Sometimes, for special populations No, always send to a reference laboratory No, sometime send to a reference laboratory No and don’t send to a reference laboratory FluSurv-NET 8. 2019-2020 Influenza Hospitalization Surveillance Network Case Report Form Question on 2018-19 Form E8a. Substance Abuse Type (current use only)? ▪ IVDU ▪ Opioids ▪ Other, specify ▪ Unknown E9. Current Non-Tobacco Smoker ▪ Marijuana ▪ E-cigarettes ▪ Other E10b. Chronic Lung Disease ▪ Active tuberculosis/TB ▪ Chronic bronchitis ▪ Chronic respiratory failure ▪ Cystic fibrosis ▪ Emphysema/Chronic obstructive pulmonary disease (COPD) ▪ Other, specify Question on 2019-20 Form E8a. Substance Abuse Type (current use only)? ▪ IVDU ▪ Opioids ▪ Cocaine ▪ Methamphetamines ▪ Other, specify ▪ Unknown E9. Current Non-Tobacco Smoker ▪ Marijuana ▪ E-nicotine delivery system (ENDS) ▪ Other E10b. Chronic Lung Disease ▪ Active tuberculosis/TB ▪ Asbestosis ▪ Bronchiectasis ▪ Bronchiolitis obliterans ▪ Chronic bronchitis ▪ Chronic respiratory failure ▪ Cystic fibrosis (CF) ▪ Emphysema/Chronic obstructive pulmonary disease (COPD) ▪ Interstitial lung disease (ILD) ▪ Oxygen (O2) dependent ▪ Obstructive sleep apnea (OSA) ▪ Pulmonary fibrosis ▪ Restrictive lung disease ▪ Sarcoidosis ▪ Other, Specify E10c. Chronic Metabolic Disease ▪ Diabetes mellitus (DM) ▪ Thyroid dysfunction ▪ Other, specify E10c. Chronic Metabolic Disease ▪ Adrenal disorders (Addison’s, Adrenal insufficiency, Cushing syndrome, Congenital adrenal hyperplasia) ▪ Diabetes mellitus (DM) ▪ Glycogen or other storage diseases (see list) ▪ Hyper/Hypofunction of pituitary gland ▪ Inborn errors of metabolism (see list) ▪ Metabolic syndrome ▪ Parathyroid syndrome ▪ Parathyroid dysfunction (Hyperparathyroidism, Hypoparathyroidism) ▪ Thyroid dysfunction (Grave’s disease, Hashimoto’s disease, Hyperthyroidism, Hypothyroidism) ▪ Other, specify 10d. Blood Disorders/Hemoglobinopathy ▪ Aplastic anemia ▪ Sickle cell disease ▪ Splenectomy/Asplenia ▪ Other, specify 10d. Blood Disorders/Hemoglobinopathy ▪ Alpha thalassemia ▪ Aplastic anemia ▪ Beta thalassemia ▪ Coagulopathy (Factor V Leiden, Von Willebrand disease (VWD), see list) ▪ Hemoglobin S-beta thalassemia Question on 2018-19 Form Question on 2019-20 Form ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Leukopenia Myelodysplastic syndrome (MDS) Neutropenia Pancytopenia Polycythemia vera Sickle cell disease Splenectomy/Asplenia Thrombocytopenia Other, specify 10e. Cardiovascular Disease ▪ Aortic aneurysm ▪ Aortic stenosis ▪ Atherosclerotic cardiovascular disease ▪ Atrial fibrillation ▪ Cardiomyopathy ▪ Cerebral vascular accident (CVA)/Incident/Stroke ▪ Congenital heart disease ▪ Coronary artery disease ▪ Heart failure/Congestive heart failure ▪ Ischemic cardiomyopathy ▪ Non-ischemic cardiomyopathy ▪ Other, specify 10e. Cardiovascular Disease ▪ Aortic aneurysm (AAA) ▪ Aortic regurgitation (AR) ▪ Aortic stenosis (AS) ▪ Atherosclerotic cardiovascular disease (ASCVD) ▪ Atrial fibrillation (AFib) ▪ Atrioventricular (AV) blocks ▪ Automated implantable devices (AID/AICD)/ Pacemaker ▪ Bundle branch block (BBB/RBBB/LBBB) ▪ Cardiomyopathy ▪ Carotid stenosis ▪ Cerebral vascular accident (CVA)/Incident/Stroke ▪ Congenital heart disease (Specify) o Atrial septal defect o Pulmonary stenosis o Tetralogy of Fallot o Ventricular septal defect o Other, specify ▪ Coronary artery bypass grafting (CABG) ▪ Coronary artery disease (CAD) ▪ Deep vein thrombosis (DVT) ▪ Heart failure/Congestive heart failure (CHF) ▪ Myocardial infarction (MI), history of ▪ Mitral stenosis (MS) ▪ Mitral regurgitation (MR) ▪ Peripheral artery disease (PAD) ▪ Peripheral vascular disease (PVD) ▪ Pulmonary embolism (PE) ▪ Pulmonary hypertension (PHTN) ▪ Pulmonic stenosis ▪ Pulmonic regurgitation ▪ Transient ischemic attack (TIA) ▪ Tricuspid stenosis ▪ Tricuspid regurgitation (TR) ▪ Ventricular tachycardia (VT, VTach) ▪ Ventricular fibrillation (VF, VFib) ▪ Aortic/Mitral/Tricuspid/Pulmonic valve replacement ▪ Other, specify 10f. Neuromuscular Disorder ▪ Duchenne muscular dystrophy ▪ Mitochondrial disorder ▪ Multiple sclerosis (MS) ▪ Muscular dystrophy (see list) ▪ Myasthenia gravis (MG) ▪ Parkinson’s disease 10f. Neuromuscular Disorder ▪ Amyotrophic lateral sclerosis (ALS) ▪ Mitochondrial disorder (see list) ▪ Multiple sclerosis (MS) ▪ Muscular dystrophy (see list) ▪ Myasthenia gravis (MG) ▪ Parkinson’s disease Question on 2018-19 Form ▪ Other, specify Question on 2019-20 Form ▪ ▪ Scoliosis/Kyphoscoliosis Other, specify 10g. Neurologic disorder ▪ Cerebral palsy ▪ Cognitive dysfunction ▪ Dementia/Alzheimer’s disease ▪ Developmental delay ▪ Down syndrome ▪ Epilepsy/Seizure/Seizure disorder ▪ Plegias/Paralysis/Quadriplegia ▪ Other, Specify 10g. Neurologic disorder ▪ Cerebral palsy ▪ Cognitive dysfunction ▪ Dementia/Alzheimer’s disease ▪ Developmental delay ▪ Down syndrome/Trisomy 21 ▪ Edwards Syndrome/Trisomy 18 ▪ Epilepsy/Seizure/Seizure disorder ▪ Neuropathy ▪ Neural tube defects/Spina bifida (See list) ▪ Plegias/Paralysis/Quadriplegia ▪ Traumatic brain injury (TBI) ▪ Other, Specify 10i. Immunocompromised Condition ▪ AIDS or CD4 count<200 ▪ Complement deficiency ▪ HIV infection ▪ Immunoglobulin deficiency ▪ Immunosuppressive therapy ▪ Organ Transplant Stem cell transplant (e.g., bone marrow transplant) ▪ Steroid therapy (taken within 2 weeks of admission) ▪ Other, specify 10i. Immunocompromised Condition ▪ AIDS or CD4 count<200 ▪ Complement deficiency (See list) ▪ Grafts vs host disease/GVHD ▪ HIV infection ▪ Immunoglobulin deficiency/ immunodeficiency (See list) ▪ Immunosuppressive therapy (within the last 12 months of admission)(See list) o If yes, for what condition?: ▪ Leukemia* ▪ Lymphoma/Hodgkins/Non-Hodgkins (NHL)* ▪ Metastatic cancer* ▪ Multiple myeloma* ▪ Solid organ malignancy* o If yes, which organ? ▪ Steroid therapy (within 2 weeks of admission) ▪ Transplant, hematopoietic stem cell (Bone marrow transplant (BMT), peripheral stem cell transplant (PSCT)) ▪ Transplant, solid organ (SOT) ▪ Other, specify *Current/in treatment or diagnosed in last 12 months 10j. Renal Disease ▪ Chronic kidney disease /chronic renal insufficiency ▪ End stage renal disease/Dialysis ▪ Glomerulonephritis/GN ▪ Nephrotic syndrome ▪ Other, specify 10k. Liver Disease ▪ Cirrhosis ▪ Viral hepatitis (B or C) ▪ Other, specify 10j. Renal Disease ▪ Chronic kidney disease (CKD)/chronic renal insufficiency (CRI) ▪ End stage renal disease (ESRD) ▪ Dialysis (HD) ▪ Glomerulonephritis/GN ▪ Nephrotic syndrome ▪ Polycystic kidney disease (PCKD) ▪ Other, specify 10k. Gastrointestinal/Liver Disease (Do Not Record GERD) ▪ Alcoholic hepatitis ▪ Autoimmune hepatitis ▪ Barrett’s esophagitis ▪ Chronic liver disease Question on 2018-19 Form (N/A) Question on 2019-20 Form ▪ Chronic pancreatitis ▪ Cirrhosis/End stage liver disease (ESLD) ▪ Crohn’s disease ▪ Esophageal varices ▪ Esophageal strictures ▪ Hepatitis B, chronic (HBV) ▪ Hepatitis C, chronic (HCV) ▪ Non-alcoholic fatty liver disease/NASH/NAFLD ▪ Ulcerative colitis (UC) ▪ Other, specify 10o. Rheumatologic/Autoimmune/Inflammatory Conditions ▪ Ankylosing spondylitis ▪ Dermatomyositis ▪ Juvenile idiopathic arthritis ▪ Kawasaki disease ▪ Microscopic polyangiitis ▪ Polyarteritis nodosum (PAN) ▪ Polymyalgia rheumatica ▪ Polymyositis ▪ Psoriatic arthritis ▪ Rheumatoid arthritis (RA) ▪ Systemic lupus erythematosus/SLE/Lupus ▪ Systemic sclerosis ▪ Takayasu arteritis ▪ Temporal/Giant cell arteritis ▪ Vasculitis, other (see list) ▪ Other, specify 10o. Other ▪ Systemic lupus erythematosus/SLE/Lupus ▪ Other, specify 10p. Other ▪ Feeding tube dependent (PEG, see list) ▪ Trach dependent/Vent dependent ▪ Wheelchair dependent ▪ Other, specify 10p. Pediatric cases only ▪ Abnormality of airway (see instructions) ▪ Chronic lung disease of prematurity/Bronchopulmonary dysplasia (BPD) ▪ History of febrile seizures ▪ Long term aspirin therapy ▪ Premature (gestation age <37weeks at birth for patients <2 yrs) 10p. Pediatric cases only ▪ Abnormality of airway (see instructions) ▪ History of febrile seizures ▪ Long term aspirin therapy ▪ Premature (gestation age <37weeks at birth for patients <2 yrs) I. Influenza Treatment ▪ Oseltamivir (Tamiflu) ▪ Peramivir (Rapivab) ▪ Zanamivir (Relenza) ▪ Other, specify ▪ Unknown I. Influenza Treatment ▪ Oseltamivir (Tamiflu) ▪ Peramivir (Rapivab) ▪ Zanamivir (Relenza) ▪ Baloxavir marboxil (Xofluza) ▪ Other, specify ▪ Unknown Question on 2018-19 Form J2b. For first abnormal chest x-ray, please check all that apply ▪ Report not available ▪ Air space density ▪ Air space opacity ▪ Bronchopneumonia/pneumonia ▪ Cannot rule out pneumonia ▪ Consolidation ▪ Cavitation ▪ ARDS (acute respiratory distress syndrome) ▪ Lung infiltrate ▪ Interstitial infiltrate ▪ Lobar infiltrate ▪ Other Question on 2019-20 Form J2b. For first abnormal chest x-ray, please check all that apply ▪ Report not available ▪ Air space density ▪ Air space opacity ▪ Bronchopneumonia/pneumonia ▪ Cannot rule out pneumonia ▪ Consolidation ▪ Cavitation ▪ ARDS (acute respiratory distress syndrome) ▪ Lung infiltrate ▪ Interstitial infiltrate ▪ Lobar infiltrate ▪ Other ▪ Pleural effusion/empyema 9. 2019-20 FluSurv-NET/RSV Laboratory Survey Question on 2018-19 form 4a. Select the kit name(s) (manufacturer) for the rapid influenza diagnostic test(s) performed at the laboratory (Check all that apply): ▪ BD Directigen™ EZ Flu A+B (Becton-Dickinson & Co.) ▪ BD Veritor™ System for Rapid Detection of Flu A+B (CLIA-waived), (Becton Dickinson & Co.) ▪ BD Veritor™ System for Rapid Detection of Flu A+B (Moderately Complex), (Becton Dickinson & Co.) ▪ Binax NOW® Influenza A&B Test (Alere Scarborough, Inc.) ▪ BioSign® Flu A+B or OraSure QuickFlu Rapid A+B Test or Polymedco Poly stat Flu A&B Test or LifeSign LLC Status Flu A&B (Princeton BioMedtech Corp.) ▪ ClearView Exact II Influenza A&B Test or Alere Influenza A&B Test (Alere Scarborough, Inc.) ▪ OSOM® Influenza A&B Test (Sekisui Diagnostics) ▪ QuickVue® Influenza A/B Test (Quidel Corp.) ▪ QuickVue® Influenza A+B Test (Quidel Corp.) ▪ RAMP Influenza A/B Assay or 3M™ Rapid Detection Flu A+B Test (Response Biomedical Corp.) SAS™ FluAlert A&B Test (SA Scientific, Inc.) ▪ SAS™ Influenza A Test (SA Scientific, Inc.) ▪ SAS™ Influenza B Test (SA Scientific, Inc.) ▪ Sofia® Analyzer and Influenza A+B FIA (CLIAwaived) (Quidel Corp.) ▪ Sofia® Analyzer and Influenza A+B FIA (Quidel Corp.) ▪ TRU FLU® (Meridian Bioscience, Inc.) ▪ XPECT™ Influenza A/B (Remel Inc./Thermo Fisher Scientific) ▪ Other, specify Question on 2019-20 form 4a. Select the kit name(s) (manufacturer) for the rapid influenza diagnostic test(s) performed at the laboratory (Check all that apply): ▪ BD Veritor™ System for Rapid Detection of Flu A+B (CLIA-waived), (Becton Dickinson & Co.) ▪ BD Veritor™ System for Rapid Detection of Flu A+B (Moderately Complex), (Becton Dickinson & Co.) ▪ Binax NOW® Influenza A&B Card 2 (Abbott) ▪ BioSign® Flu A+B or OraSure QuickFlu Rapid A+B Test or Polymedco Poly stat Flu A&B Test or LifeSign LLC Status Flu A&B (Princeton BioMedtech Corp.) ▪ QuickVue® Influenza A+B Test (Quidel Corp.) ▪ Sofia® Analyzer and Influenza A+B FIA (CLIAwaived) (Quidel Corp.) ▪ Sofia® Analyzer and Influenza A+B FIA (Quidel Corp.) ▪ XPECT™ Influenza A/B (Remel Inc./Thermo Fisher Scientific) ▪ Other, specify: 4b. If more than one kit is selected above, please select the one kit that is (or will be) used most frequently for rapid influenza diagnostic testing at the laboratory during the current influenza season: ▪ BD Directigen™ EZ Flu A+B (Becton-Dickinson & Co.) ▪ BD Veritor™ System for Rapid Detection of Flu A+B (CLIA-waived), (Becton Dickinson & Co.) ▪ BD Veritor™ System for Rapid Detection of Flu A+B (Moderately Complex), (Becton Dickinson & Co.) ▪ Binax NOW® Influenza A&B Test (Alere Scarborough, Inc.) ▪ BioSign® Flu A+B or OraSure QuickFlu Rapid A+B Test or Polymedco Poly stat Flu A&B Test or LifeSign LLC Status Flu A&B (Princeton BioMedtech Corp.) ▪ ClearView Exact II Influenza A&B Test or Alere Influenza A&B Test (Alere Scarborough, Inc.) ▪ OSOM® Influenza A&B Test (Sekisui Diagnostics) ▪ QuickVue® Influenza A/B Test (Quidel Corp.) ▪ QuickVue® Influenza A+B Test (Quidel Corp.) ▪ RAMP Influenza A/B Assay or 3M™ Rapid Detection Flu A+B Test (Response Biomedical Corp.) SAS™ FluAlert A&B Test (SA Scientific, Inc.) ▪ SAS™ Influenza A Test (SA Scientific, Inc.) ▪ SAS™ Influenza B Test (SA Scientific, Inc.) ▪ Sofia® Analyzer and Influenza A+B FIA (CLIAwaived) (Quidel Corp.) ▪ Sofia® Analyzer and Influenza A+B FIA (Quidel Corp.) ▪ TRU FLU® (Meridian Bioscience, Inc.) ▪ XPECT™ Influenza A/B (Remel Inc./Thermo Fisher Scientific) ▪ Other, specify 4c. What does the laboratory do if a rapid influenza diagnostic test result is negative for influenza? ▪ Report the negative result and do nothing else ▪ Reflex to molecular assay (PCR) for confirmation ▪ Report the negative result and submit specimen to state/regional public health lab for PCR confirmation ▪ Report the negative result with a disclaimer asking the physician to submit a second specimen for testing with a more sensitive assay ▪ Send for PCR confirmation by provider request ▪ Other, specify: 4b. If more than one kit is selected above, please select the one kit that is (or will be) used most frequently for rapid influenza diagnostic testing at the laboratory during the current influenza season: ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ BD Veritor™ System for Rapid Detection of Flu A+B (CLIA-waived), (Becton Dickinson & Co.) BD Veritor™ System for Rapid Detection of Flu A+B (Moderately Complex), (Becton Dickinson & Co.) Binax NOW® Influenza A&B Card 2 (Abbott) BioSign® Flu A+B or OraSure QuickFlu Rapid A+B Test or Polymedco Poly stat Flu A&B Test or LifeSign LLC Status Flu A&B (Princeton BioMedtech Corp.) QuickVue® Influenza A+B Test (Quidel Corp.) Sofia® Analyzer and Influenza A+B FIA (CLIAwaived) (Quidel Corp.) Sofia® Analyzer and Influenza A+B FIA (Quidel Corp.) XPECT™ Influenza A/B (Remel Inc./Thermo Fisher Scientific) Other, specify: Question Removed 4d. What does the laboratory do if a rapid influenza diagnostic test result is positive for influenza? ▪ Report the positive result and do nothing else ▪ Reflex to another influenza test for confirmation ▪ Reflex to a confirmatory test only if early in influenza season or off-season ▪ Report the positive result with a disclaimer asking the physician to submit a second specimen for testing with a more sensitive assay ▪ Report the positive result and submit specimen to state/regional public health lab for PCR confirmation ▪ Other, specify 5. Does the laboratory perform rapid molecular assays (e.g. Alere-i, cobas Liat; results available ≤30 minutes) for influenza? 5a. What does the laboratory do if the rapid molecular assay is negative for influenza? Question Removed Question Removed Question Removed ▪ ▪ Report the negative result and do nothing else Reflex to standard molecular assay (PCR) for confirmation ▪ Report the negative result with a disclaimer asking the physician to submit a second specimen for testing with a more sensitive assay ▪ Report the negative result and submit specimen to state/regional public health lab for PCR confirmation ▪ Other, specify 5b. What does the laboratory do if the rapid molecular is positive for influenza? ▪ Report the positive result and do nothing else ▪ Reflex to standard molecular assay (PCR) for confirmation ▪ Report the positive result with a disclaimer asking the physician to submit a second specimen for testing with a standard molecular assay ▪ Report the positive result and submit specimen to state/regional public health lab for PCR confirmation ▪ Reflex for subtyping ▪ Other, specify 6. Does the laboratory perform standard molecular assays (e.g., RT-PCR; with results available > 30 minutes) for influenza? Question Removed 5. Does the laboratory perform molecular assays (including rapid molecular, RT-PCR, RVPs) for influenza? 6a. Select kit name(s) (manufacturer) for all molecular assays performed at the laboratory (Check all that apply): ▪ Alere i NAT Flu A/B (CLIA Waived), (Alere) ▪ Alere i NAT Flu A/B (Moderate), (Alere) ▪ ARIES® Flu A/B & RSV Assay, (Luminex) ▪ CDC Human Influenza Virus Real-Time RT-PCR Diagnostic Panel (Influenza A/B Typing Kit4), (CDC Influenza Division) ▪ CDC Human Influenza Virus Real-Time RT-PCR Detection and Characterization Panel, (CDC Influenza Division) ▪ CDC Influenza A/H5 (Asian Lineage) Virus RealTime RT-PCR Primer and Probe Set, (CDC Influenza Division) ▪ CDC Influenza 2009 A(H1N1)pdm Real-Time RT-PCR Panel, (CDC Influenza Division) ▪ Cepheid Xpert Flu Assay, (Cepheid) ▪ Cepheid Xpert Flu/RSV XC Assay, (Cepheid) ▪ Cepheid Xpert Express Flu Assay, (Cepheid) ▪ Cepheid Xpert Express Flu/RSV Assay, (Cepheid) ▪ Cobas Liat Influenza A/B, (Roche Diagnostics) ▪ Cobas Liat Influenza A/B & RSV, (Roche Diagnostics) ▪ ePlex Respiratory Pathogen Panel (GenMark Diagnostices) ▪ eSensor® Respiratory Viral Panel (RVP), (GenMark Diagnostics) ▪ FilmArray Respiratory Panel, (BioFire Diagnostics, LLC) ▪ Ibis PLEX-ID Flu, (Ibis/Abbott) ▪ IMDx Flu A/B and RSV for Abbott m2000, (IMDx) ▪ Nx-TAG Respiratory Pathogen Panel (Luminex Molecular Diagnostics Inc) ▪ Prodesse PROFLU™, (GenProbe/Hologic) ▪ Prodesse ProFAST™, (GenProbe/Hologic) ▪ Qiagen Artus Influenza A/B Rotor-gene RT-PCR kit, (Qiagen) ▪ Quidel Molecular Influenza A+B, (Quidel) ▪ Simplexa™ Flu A/B & RSV, (Focus Diagnostics, 3M) ▪ Simplexa™ Flu A/B & RSV Direct, (Focus Diagnostics, 3M) ▪ Simplexa™ Influenza A H1N1 (2009), (Focus Diagnostics, 3M) ▪ U.S. Army JBAIDS Influenza A&B Detection Kit , (Biofire Defense) ▪ U.S. Army JBAIDS Influenza A Subtyping Kit, (Biofire Defense) ▪ U.S. Army JBAIDS Influenza A/H5 Kit ,(Biofire Defense) ▪ Verigene® Respiratory Virus Nucleic Acid Test, (Nanosphere, Inc) ▪ Verigene® Respiratory Virus Plus Nucleic Acid Test (RV+), (Nanosphere, Inc) ▪ Verigene® Respiratory Pathogen Nucleic Acid Test (RP Flex), (Nanosphere, Inc) ▪ x-TAG® Respiratory Viral Panel (RVP), (Luminex Molecular Diagnostics Inc) 5a. Select the kit name(s) (manufacturer) for all molecular assays performed at the laboratory (Check all that apply): ▪ ID Now™ Influenza A&B (CLIA Waived), (Abbott) ▪ Accula Flu A/Flu B (Mesa Biotech, Inc.) ▪ ARIES® Flu A/B & RSV Assay, (Luminex) ▪ CDC Human Influenza Virus Real-Time RT-PCR Diagnostic Panel (Influenza A/B Typing Kit4), (CDC Influenza Division) ▪ CDC Human Influenza Virus Real-Time RT-PCR Detection and Characterization Panel, (CDC Influenza Division) ▪ CDC Influenza A/H5 (Asian Lineage) Virus RealTime RT-PCR Primer and Probe Set, (CDC Influenza Division) ▪ CDC Influenza 2009 A(H1N1)pdm Real-Time RT-PCR Panel, (CDC Influenza Division) ▪ Cepheid Xpert Flu Assay, (Cepheid) ▪ Cepheid Xpert Flu/RSV XC Assay, (Cepheid) ▪ Cepheid Xpert Express Flu Assay, (Cepheid) ▪ Cepheid Xpert Express Flu/RSV Assay, (Cepheid) ▪ Cobas Liat Influenza A/B, (Roche Diagnostics) ▪ Cobas Liat Influenza A/B & RSV, (Roche Diagnostics) ▪ ePlex Respiratory Pathogen Panel (GenMark Diagnostices)* ▪ eSensor® Respiratory Viral Panel (RVP), (GenMark Diagnostics)* ▪ FilmArray® Respiratory Panel, (BioFire Diagnostics, LLC)* ▪ FilmArray® Respiratory Panel, EZ (BioFire Diagnostics, LLC)* ▪ Idylla Respiratory IFV-RSV Panel, (Biocartis)* ▪ IMDx Flu A/B and RSV for Abbott m2000, (IMDx) ▪ Lyra Influenza A+B Assay, (Quidel) Nx-TAG Respiratory Pathogen Panel, (Luminex Molecular Diagnostics Inc)* ▪ Panther Fusion® Flu A/B RSV, (Assay Hologic) ▪ Prodesse PROFLU™, (GenProbe/Hologic) ▪ Prodesse ProFAST™, (GenProbe/Hologic)* ▪ Silaris Infuenza A & Btg, (Sekisui Diagnostic) ▪ Solana Influenza A+B Assay, (Quidel) ▪ Simplexa™ Flu A/B & RSV, (Focus Diagnostics, 3M) ▪ Simplexa™ Flu A/B & RSV Direct, (Focus Diagnostics, 3M) ▪ Simplexa™ Influenza A H1N1 (2009), (Focus Diagnostics, 3M) ▪ Verigene® Respiratory Virus Nucleic Acid Test, (Nanosphere, Inc) ▪ Verigene® Respiratory Virus Plus Nucleic Acid Test (RV+), (Luminex) Verigene® Respiratory Pathogen Nucleic Acid Test (RP Flex)*, (Luminex) ▪ x-TAG® Respiratory Viral Panel Fast (RVP FAST)*, (Luminex Molecular Diagnostics Inc) ▪ In-house developed PCR assay ▪ Other, specify ▪ ▪ ▪ x-TAG® Respiratory Viral Panel Fast (RVP FAST), (Luminex Molecular Diagnostics Inc) In-house developed PCR assay Other, specify 6b. If more than one kit is selected above, please select the one kit that is (or will be used) most frequently for molecular assay at the laboratory during the current influenza season: ▪ Alere i NAT Flu A/B (CLIA Waived), (Alere) ▪ Alere i NAT Flu A/B (Moderate), (Alere) ▪ ARIES® Flu A/B & RSV Assay, (Luminex) ▪ CDC Human Influenza Virus Real-Time RT-PCR Diagnostic Panel (Influenza A/B Typing Kit4), (CDC Influenza Division) ▪ CDC Human Influenza Virus Real-Time RT-PCR Detection and Characterization Panel, (CDC Influenza Division) ▪ CDC Influenza A/H5 (Asian Lineage) Virus RealTime RT-PCR Primer and Probe Set, (CDC Influenza Division) ▪ CDC Influenza 2009 A(H1N1)pdm Real-Time RT-PCR Panel, (CDC Influenza Division) ▪ Cepheid Xpert Flu Assay, (Cepheid) ▪ Cepheid Xpert Flu/RSV XC Assay, (Cepheid) ▪ Cepheid Xpert Express Flu Assay, (Cepheid) ▪ Cepheid Xpert Express Flu/RSV Assay, (Cepheid) ▪ Cobas Liat Influenza A/B, (Roche Diagnostics) ▪ Cobas Liat Influenza A/B & RSV, (Roche Diagnostics) ▪ ePlex Respiratory Pathogen Panel (GenMark Diagnostices) ▪ eSensor® Respiratory Viral Panel (RVP), (GenMark Diagnostics) ▪ FilmArray Respiratory Panel, (BioFire Diagnostics, LLC) ▪ Ibis PLEX-ID Flu, (Ibis/Abbott) ▪ IMDx Flu A/B and RSV for Abbott m2000, (IMDx) ▪ Nx-TAG Respiratory Pathogen Panel (Luminex Molecular Diagnostics Inc) ▪ Prodesse PROFLU™, (GenProbe/Hologic) ▪ Prodesse ProFAST™, (GenProbe/Hologic) ▪ Qiagen Artus Influenza A/B Rotor-gene RT-PCR kit, (Qiagen) ▪ Quidel Molecular Influenza A+B, (Quidel) ▪ Simplexa™ Flu A/B & RSV, (Focus Diagnostics, 3M) ▪ Simplexa™ Flu A/B & RSV Direct, (Focus Diagnostics, 3M) ▪ Simplexa™ Influenza A H1N1 (2009), (Focus Diagnostics, 3M) ▪ U.S. Army JBAIDS Influenza A&B Detection Kit , (Biofire Defense) ▪ U.S. Army JBAIDS Influenza A Subtyping Kit, (Biofire Defense) ▪ U.S. Army JBAIDS Influenza A/H5 Kit ,(Biofire Defense) ▪ Verigene® Respiratory Virus Nucleic Acid Test, (Nanosphere, Inc) ▪ Verigene® Respiratory Virus Plus Nucleic Acid Test (RV+), (Nanosphere, Inc) ▪ Verigene® Respiratory Pathogen Nucleic Acid Test (RP Flex), (Nanosphere, Inc) 5b. If more than one kit is selected above, please select the one kit that is (or will be used) most frequently for molecular assay at the laboratory during the current influenza season: ▪ ID Now™ Influenza A&B (CLIA Waived), (Abbott) ▪ Accula Flu A/Flu B (Mesa Biotech, Inc.) ▪ ARIES® Flu A/B & RSV Assay, (Luminex) ▪ CDC Human Influenza Virus Real-Time RT-PCR Diagnostic Panel (Influenza A/B Typing Kit4), (CDC Influenza Division) ▪ CDC Human Influenza Virus Real-Time RT-PCR Detection and Characterization Panel, (CDC Influenza Division) ▪ CDC Influenza A/H5 (Asian Lineage) Virus RealTime RT-PCR Primer and Probe Set, (CDC Influenza Division) ▪ CDC Influenza 2009 A(H1N1)pdm Real-Time RT-PCR Panel, (CDC Influenza Division) ▪ Cepheid Xpert Flu Assay, (Cepheid) ▪ Cepheid Xpert Flu/RSV XC Assay, (Cepheid) ▪ Cepheid Xpert Express Flu Assay, (Cepheid) ▪ Cepheid Xpert Express Flu/RSV Assay, (Cepheid) ▪ Cobas Liat Influenza A/B, (Roche Diagnostics) ▪ Cobas Liat Influenza A/B & RSV, (Roche Diagnostics) ▪ ePlex Respiratory Pathogen Panel (GenMark Diagnostices)* ▪ eSensor® Respiratory Viral Panel (RVP), (GenMark Diagnostics)* ▪ FilmArray® Respiratory Panel, (BioFire Diagnostics, LLC)* ▪ FilmArray® Respiratory Panel, EZ (BioFire Diagnostics, LLC)* ▪ Idylla Respiratory IFV-RSV Panel, (Biocartis)* ▪ IMDx Flu A/B and RSV for Abbott m2000, (IMDx) ▪ Lyra Influenza A+B Assay, (Quidel) Nx-TAG Respiratory Pathogen Panel, (Luminex Molecular Diagnostics Inc)* ▪ Panther Fusion® Flu A/B RSV, (Assay Hologic) ▪ Prodesse PROFLU™, (GenProbe/Hologic) ▪ Prodesse ProFAST™, (GenProbe/Hologic)* ▪ Silaris Infuenza A & Btg, (Sekisui Diagnostic) ▪ Solana Influenza A+B Assay, (Quidel) ▪ Simplexa™ Flu A/B & RSV, (Focus Diagnostics, 3M) ▪ Simplexa™ Flu A/B & RSV Direct, (Focus Diagnostics, 3M) ▪ Simplexa™ Influenza A H1N1 (2009), (Focus Diagnostics, 3M) ▪ Verigene® Respiratory Virus Nucleic Acid Test, (Nanosphere, Inc) ▪ Verigene® Respiratory Virus Plus Nucleic Acid Test (RV+), (Luminex) Verigene® Respiratory Pathogen Nucleic Acid Test (RP Flex)*, (Luminex) ▪ x-TAG® Respiratory Viral Panel Fast (RVP FAST)*, (Luminex Molecular Diagnostics Inc) ▪ ▪ ▪ ▪ x-TAG® Respiratory Viral Panel (RVP), (Luminex Molecular Diagnostics Inc) x-TAG® Respiratory Viral Panel Fast (RVP FAST), (Luminex Molecular Diagnostics Inc) In-house developed PCR assay Other, specify ▪ ▪ In-house developed PCR assay Other, specify 6d. What testing kit does the testing facility use (or will it use) most often to perform influenza A sub-typing during the current influenza season? (Select one) ▪ Alere i NAT Flu A/B (CLIA Waived), (Alere) Alere i NAT Flu A/B (Moderate), (Alere) ▪ ARIES® Flu A/B & RSV Assay, (Luminex) ▪ CDC Human Influenza Virus Real-Time RT-PCR Diagnostic Panel (Influenza A/B Typing Kit4), (CDC Influenza Division) ▪ CDC Human Influenza Virus Real-Time RT-PCR Detection and Characterization Panel, (CDC Influenza Division) ▪ CDC Influenza A/H5 (Asian Lineage) Virus RealTime RT-PCR Primer and Probe Set, (CDC Influenza Division) ▪ CDC Influenza 2009 A(H1N1)pdm Real-Time RT-PCR Panel, (CDC Influenza Division) ▪ Cepheid Xpert Flu Assay, (Cepheid) ▪ Cepheid Xpert Flu/RSV XC Assay, (Cepheid) ▪ Cepheid Xpert Express Flu Assay, (Cepheid) ▪ Cepheid Xpert Express Flu/RSV Assay, (Cepheid) ▪ Cobas Liat Influenza A/B, (Roche Diagnostics) ▪ Cobas Liat Influenza A/B & RSV, (Roche Diagnostics) ▪ eSensor® Respiratory Viral Panel (RVP), (GenMark Diagnostics) ▪ FilmArray Respiratory Panel, (BioFire Diagnostics, LLC) ▪ Ibis PLEX-ID Flu, (Ibis/Abbott) IMDx Flu A/B and RSV for Abbott m2000, (IMDx) ▪ Prodesse PROFLU™, (GenProbe/Hologic) ▪ Prodesse ProFAST™, (GenProbe/Hologic) ▪ Qiagen Artus Influenza A/B Rotor-gene RT-PCR kit, (Qiagen) ▪ Quidel Molecular Influenza A+B, (Quidel) ▪ Simplexa™ Flu A/B & RSV, (Focus Diagnostics, 3M) ▪ Simplexa™ Flu A/B & RSV Direct, (Focus Diagnostics, 3M) ▪ Simplexa™ Influenza A H1N1 (2009), (Focus Diagnostics, 3M) ▪ U.S. Army JBAIDS Influenza A&B Detection Kit , (Biofire Defense) ▪ U.S. Army JBAIDS Influenza A Subtyping Kit, (Biofire Defense) ▪ U.S. Army JBAIDS Influenza A/H5 Kit ,(Biofire Defense) ▪ Verigene® Respiratory Virus Nucleic Acid Test, (Nanosphere, Inc) ▪ Verigene® Respiratory Virus Plus Nucleic Acid Test (RV+), (Nanosphere, Inc) ▪ Verigene® Respiratory Pathogen Nucleic Acid Test (RP Flex), (Nanosphere, Inc) ▪ x-TAG® Respiratory Viral Panel (RVP), (Luminex Molecular Diagnostics Inc) ▪ x-TAG® Respiratory Viral Panel Fast (RVP FAST), (Luminex Molecular Diagnostics Inc) ▪ In-house developed PCR assay ▪ Other, specify 5d. What testing kit does the testing facility use (or will it use) most often to perform influenza A sub-typing during the current influenza season? ▪ ePlex Respiratory Pathogen Panel (GenMark Diagnostices)* ▪ eSensor® Respiratory Viral Panel (RVP), (GenMark Diagnostics) ▪ FilmArray Respiratory Panel, (BioFire Diagnostics, LLC) ▪ Idylla Respiratory IFV-RSV Panel, (Biocartis) ▪ Nx-TAG Respiratory Pathogen Panel (Luminex Molecular Diagnostics Inc) ▪ Verigene® Respiratory Pathogen Nucleic Acid Test (RP Flex), (Nanosphere, Inc) ▪ x-TAG® Respiratory Viral Panel Fast (RVP FAST), (Luminex Molecular Diagnostics Inc) ▪ In-house developed PCR assay ▪ Other, specify 8a. Which influenza test method does the laboratory perform most frequently for pediatric patients (aged 0-17 years)? (Select one) ▪ Viral culture Indirect fluorescent antibody (IFA)/direct fluorescent antibody stain (DFA) ▪ Rapid influenza antigen diagnostic test (rapid test, RIDT) ▪ Rapid Molecular assay (e.g. RT-PCR, NAAT) – singleplex (influenza only) ▪ Rapid Molecular assay (e.g. RT-PCR, NAAT) – dualplex (influenza/RSV) ▪ Standard Molecular assay (e.g. RT-PCR, NAAT) – singleplex (influenza only) ▪ Standard Molecular assay (e.g. RT-PCR, NAAT) – dualplex (influenza/RSV) ▪ Standard Molecular assay (e.g. RT-PCR, NAAT) – multiplex/respiratory viral panel (RVP) ▪ Not applicable (no pediatric testing) 8b. Which influenza test method does the laboratory perform most frequently for adult patients (aged ≥18 years)? (Select one) ▪ Viral culture Indirect fluorescent antibody (IFA)/direct fluorescent antibody stain (DFA) ▪ Rapid influenza antigen diagnostic test (rapid test, RIDT) ▪ Rapid Molecular assay (e.g. RT-PCR, NAAT) – singleplex (influenza only) ▪ Rapid Molecular assay (e.g. RT-PCR, NAAT) – dualplex (influenza/RSV) ▪ Standard Molecular assay (e.g. RT-PCR, NAAT) – singleplex (influenza only) ▪ Standard Molecular assay (e.g. RT-PCR, NAAT) – dualplex (influenza/RSV) ▪ Standard Molecular assay (e.g. RT-PCR, NAAT) – multiplex/respiratory viral panel (RVP) ▪ Not applicable (no pediatric testing) 9. Based on tests that were performed during the 2017-19 influenza season, approximately what percent of the time are each of these test types used to test for flu overall? (Answers should add to 100%) ▪ % Viral culture ▪ % Indirect fluorescent antibody stain (IFA)/direct fluorescent antibody stain (DFA) ▪ % Rapid influenza antigen diagnostic test (rapid test, RIDT) ▪ % Rapid Molecular assay (e.g. RT-PCR, NAAT) – singleplex (influenza only) ▪ % Rapid Molecular assay (e.g. RT-PCR, NAAT) – dualplex (influenza/RSV) ▪ % Standard Molecular assay (e.g. RT-PCR, NAAT) – singleplex (influenza only) ▪ % Standard Molecular assay (e.g. RT-PCR, NAAT) – dualplex (influenza/RSV) ▪ % Standard Molecular assay (e.g. RT-PCR, NAAT) – multiplex/respiratory viral panel (RVP) 7a. Which influenza test method does the laboratory perform most frequently for pediatric patients (aged 0-17 years)? (Select one) ▪ Viral culture Indirect fluorescent antibody (IFA)/direct fluorescent antibody stain (DFA) ▪ Rapid influenza diagnostic test (rapid test, RIDT) ▪ Rapid Molecular assay – singleplex or dualplex ▪ Standard Molecular assay (e.g. RT-PCR, NAAT) – singleplex or duplex ▪ Standard Molecular assay (e.g. RT-PCR, NAAT) – multiplex/respiratory viral panel (RVP) ▪ Not applicable (no pediatric testing) 7b. Which influenza test method does the laboratory perform most frequently for adult patients (aged ≥18 years)? (Select one) ▪ Viral culture Indirect fluorescent antibody (IFA)/direct fluorescent antibody stain (DFA) ▪ Rapid influenza diagnostic test (rapid test, RIDT) ▪ Rapid Molecular assay – singleplex or dualplex ▪ Standard Molecular assay (e.g. RT-PCR, NAAT) – singleplex or duplex ▪ Standard Molecular assay (e.g. RT-PCR, NAAT) – multiplex/respiratory viral panel (RVP) ▪ Not applicable (no pediatric testing) 8. Based on tests that were performed during the 2018-19 influenza season, approximately what percent of the time are each of these test types used to test for flu overall? ▪ ▪ ▪ ▪ ▪ ▪ % Viral culture % Indirect fluorescent antibody stain (IFA)/direct fluorescent antibody stain (DFA) % Rapid influenza diagnostic test (rapid test, RIDT) % Rapid Molecular assay – singleplex or dualplex % Standard Molecular assay (e.g. RT-PCR, NAAT) – singleplex or dualplex % Standard Molecular assay (e.g. RT-PCR, NAAT) – multiplex/respiratory viral panel (RVP) 13a. Select the kit name(s) (manufacturer for the RSV rapid antigen detection test(s) performed at the laboratory: ▪ ▪ ▪ ▪ BinaxNOW® RSV Card (Alere Scarborough, Inc.) Clearview® RSV (Alere Scarborough, Inc.) QuickVue RSV Test (Quidel Corp.) Sofia RSV FIA (Quidel Corp.) Directigen™ EZ RSV Kit (Becton-Dickinson & Co.) TRU RSV® Kit (Meridian Bioscience, Inc.) ▪ RAMP™ Rapid Detection RSV Test Kit (Response Biomedical Corp.) ▪ SAS™ RSVAlert (SA Scientific, Inc.) ▪ Xpect™ RSV Test (Remel Inc./Thermo Fisher Scientific) ▪ BD Veritor System for Rapid Detection of RSV (Becton-Dickinson & Co.) ▪ Other, specify 13b. If more than one kit is selected above, please select the one kit that is (or will be) used most frequently for RSV rapid antigen detection testing at the laboratory during the current RSV season: ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ BinaxNOW® RSV Card (Alere Scarborough, Inc.) Clearview® RSV (Alere Scarborough, Inc.) QuickVue RSV Test (Quidel Corp.) Sofia RSV FIA (Quidel Corp.) Directigen™ EZ RSV Kit (Becton-Dickinson & Co.) TRU RSV® Kit (Meridian Bioscience, Inc.) RAMP™ Rapid Detection RSV Test Kit (Response Biomedical Corp.) SAS™ RSVAlert (SA Scientific, Inc.) Xpect™ RSV Test (Remel Inc./Thermo Fisher Scientific) BD Veritor System for Rapid Detection of RSV (Becton-Dickinson & Co.) Other, specify 12a. Select the kit name(s) (manufacturer) for the RSV rapid antigen detection test(s) performed at the laboratory: ▪ ▪ ▪ ▪ ▪ ▪ ▪ BinaxNOW® RSV Card (Abott) Clearview® RSV (Alere Scarborough, Inc.) QuickVue RSV Test (Quidel Corp.) Sofia RSV FIA (Quidel Corp.) Directigen™ EZ RSV Kit (Becton-Dickinson & Co.) TRU RSV® Kit (Meridian Bioscience, Inc.) RAMP™ Rapid Detection RSV Test Kit (Response Biomedical Corp.) ▪ SAS™ RSVAlert (SA Scientific, Inc.) ▪ Xpect™ RSV Test (Remel Inc./Thermo Fisher Scientific) ▪ BD Veritor System for Rapid Detection of RSV (Becton-Dickinson & Co.) ▪ Other, specify 12b. If more than one kit is selected above, please select the one kit that is (or will be) used most frequently for RSV rapid antigen detection testing at the laboratory during the current RSV season: ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ BinaxNOW® RSV Card (Abott) Clearview® RSV (Alere Scarborough, Inc.) QuickVue RSV Test (Quidel Corp.) Sofia RSV FIA (Quidel Corp.) Directigen™ EZ RSV Kit (Becton-Dickinson & Co.) TRU RSV® Kit (Meridian Bioscience, Inc.) RAMP™ Rapid Detection RSV Test Kit (Response Biomedical Corp.) SAS™ RSVAlert (SA Scientific, Inc.) Xpect™ RSV Test (Remel Inc./Thermo Fisher Scientific) BD Veritor System for Rapid Detection of RSV (Becton-Dickinson & Co.) Other, specify 14a. Select kit name(s) (manufacturer) for all molecular assays used at the laboratory: ▪ ARIES® Flu A/B & RSV Assay (Luminex) ▪ Alere™ i RSV (Alere) ▪ Cepheid Xpert Flu/RSV XC Assay (Cepheid) ▪ Cobas® Liat® Influenza A/B and RSV Assay (Roche Molecular Systems, Inc.) ▪ eSensor® Respiratory Viral Panel (RVP) (GenMark Diagnostics) ▪ FilmArray Respiratory Panel (BioFire Diagnostics LLC) ▪ IMDx Flu A/B and RSV for Abbott m2000 (IMDx) ▪ Prodesse PROFLU™+ (GenProbe/Hologic) ▪ Simplexa™ Flu A/B & RSV (Focus Diagnostics, 3M) ▪ Simplexa™ Flu A/B & RSV Direct (Focus Diagnostics, 3M) ▪ Verigene® Respiratory Virus Nucleic Acid Test (Nanosphere, Inc) ▪ Verigene® Respiratory Virus Plus Nucleic Acid Test (RV+) (Nanosphere, Inc) ▪ Verigene® Respiratory Pathogen Nucleic Acid Test (RP Flex) (Nanosphere, Inc) ▪ x-TAG® Respiratory Viral Panel (RVP) (Luminex Molecular Diagnostics Inc) ▪ x-TAG® Respiratory Viral Panel Fast (RVP FAST) (Luminex Molecular Diagnostics Inc) ▪ In-house developed PCR assay ▪ CDC Respiratory Syncytial Virus Real-Time RTPCR Assay ▪ Other, specify 13a. Select kit name(s) (manufacturer) for all molecular assays used at the laboratory ▪ ARIES® Flu A/B & RSV Assay (Luminex) ▪ Alere™ i RSV (Alere) Cepheid Xpert Flu/RSV XC Assay (Cepheid) ▪ Cepheid Xpert Xpress Flu/RSV Assay (Cepheid) ▪ Cobas® Liat® Influenza A/B and RSV Assay (Roche Molecular Systems, Inc.) ▪ eSensor® Respiratory Viral Panel (RVP) (GenMark Diagnostics) ▪ FilmArray Respiratory Panel (BioFire Diagnostics LLC) ▪ FilmArray Respiratory Panel EZ (BioFire Diagnostics LLC) IMDx Flu A/B and RSV for Abbott m2000 (IMDx) ▪ Prodesse PROFLU™+ (GenProbe/Hologic) ▪ Simplexa™ Flu A/B & RSV (Focus Diagnostics, 3M) ▪ Simplexa™ Flu A/B & RSV Direct (Focus Diagnostics, 3M) ▪ Verigene® Respiratory Virus Nucleic Acid Test (Luminex) ▪ Verigene® Respiratory Virus Plus Nucleic Acid Test (RV+) (Luminex) ▪ Verigene® Respiratory Pathogen Nucleic Acid Test (RP Flex) (Luminex) ▪ x-TAG® Respiratory Viral Panel Fast (RVP FAST) (Luminex Molecular Diagnostics Inc) ▪ In-house developed PCR assay ▪ CDC Respiratory Syncytial Virus Real-Time RTPCR Assay ▪ Other, specify 14b. If more than one kit is selected above, please select the one kit that is (or will be) used most frequently for molecular assays at the laboratory during the current RSV season: ▪ ARIES® Flu A/B & RSV Assay (Luminex) ▪ Alere™ i RSV (Alere) ▪ Cepheid Xpert Flu/RSV XC Assay (Cepheid) ▪ Cobas® Liat® Influenza A/B and RSV Assay (Roche Molecular Systems, Inc.) ▪ eSensor® Respiratory Viral Panel (RVP) (GenMark Diagnostics) ▪ FilmArray Respiratory Panel (BioFire Diagnostics LLC) ▪ IMDx Flu A/B and RSV for Abbott m2000 (IMDx) ▪ Prodesse PROFLU™+ (GenProbe/Hologic) ▪ Simplexa™ Flu A/B & RSV (Focus Diagnostics, 3M) ▪ Simplexa™ Flu A/B & RSV Direct (Focus Diagnostics, 3M) ▪ Verigene® Respiratory Virus Nucleic Acid Test (Nanosphere, Inc) ▪ Verigene® Respiratory Virus Plus Nucleic Acid Test (RV+) (Nanosphere, Inc) ▪ Verigene® Respiratory Pathogen Nucleic Acid Test (RP Flex) (Nanosphere, Inc) ▪ x-TAG® Respiratory Viral Panel (RVP) (Luminex Molecular Diagnostics Inc) ▪ x-TAG® Respiratory Viral Panel Fast (RVP FAST) (Luminex Molecular Diagnostics Inc) ▪ In-house developed PCR assay ▪ CDC Respiratory Syncytial Virus Real-Time RTPCR Assay ▪ Other, specify 13b. If more than one kit is selected above, please select the one kit that is (or will be) used most frequently for molecular assays at the laboratory during the current RSV season: ▪ ARIES® Flu A/B & RSV Assay (Luminex) ▪ Alere™ i RSV (Alere) Cepheid Xpert Flu/RSV XC Assay (Cepheid) ▪ Cepheid Xpert Xpress Flu/RSV Assay (Cepheid) ▪ Cobas® Liat® Influenza A/B and RSV Assay (Roche Molecular Systems, Inc.) ▪ eSensor® Respiratory Viral Panel (RVP) (GenMark Diagnostics) ▪ FilmArray Respiratory Panel (BioFire Diagnostics LLC) ▪ FilmArray Respiratory Panel EZ (BioFire Diagnostics LLC) IMDx Flu A/B and RSV for Abbott m2000 (IMDx) ▪ Prodesse PROFLU™+ (GenProbe/Hologic) ▪ Simplexa™ Flu A/B & RSV (Focus Diagnostics, 3M) ▪ Simplexa™ Flu A/B & RSV Direct (Focus Diagnostics, 3M) ▪ Verigene® Respiratory Virus Nucleic Acid Test (Luminex) ▪ Verigene® Respiratory Virus Plus Nucleic Acid Test (RV+) (Luminex) ▪ Verigene® Respiratory Pathogen Nucleic Acid Test (RP Flex) (Luminex) ▪ x-TAG® Respiratory Viral Panel Fast (RVP FAST) (Luminex Molecular Diagnostics Inc) ▪ In-house developed PCR assay ▪ CDC Respiratory Syncytial Virus Real-Time RTPCR Assay ▪ Other, specify HAIC 10. 2020 MuGSI Case Report Form for Carbapenem-resistant Enterobacteriaceae (CRE) and Acinetobacter baumannii (CRAB) Question on 2019 form Title: 2019 Carbapenem Resistant Enterobacteriaceae (CRE)/ Carbapenem Resistant A. baumannii (CRAB) Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare Associated Infection Community Interface (HAIC) Case Report 10. ORGANISM: Carbapenem-resistant: □ Enterobacteriaceae (CRE) □ Escherichia coli □ Enterobacter cloacae □ Klebsiella aerogenes □ Klebsiella pneumoniae □ Klebsiella oxytoca □ A. baumannii (CRAB) 17. TYPES OF INFECTION ASSOCIATED WITH CULTURE(S): (Check all that apply) None Unknown Question on 2020 form Title: 2020 Carbapenem Resistant Enterobacteriaceae (CRE)/ Carbapenem Resistant A. baumannii (CRAB) Multisite Gram-Negative Surveillance Initiative (MuGSI) Healthcare Associated Infection Community Interface (HAIC) Case Report (change in title) 10. ORGANISM: □ CRE □ CRAB If CRE, select one of the following: □ Escherichia coli □ Enterobacter cloacae □ Klebsiella aerogenes □ Klebsiella pneumoniae □ Klebsiella oxytoca (change in formatting) 17a. TYPES OF INFECTION ASSOCIATED WITH CULTURE(S): (Check all that apply) None Unknown Colonized (adding the option to choose “colonized” 17b. RECURRENT UTI Yes No Unknown (new question) 17c. WAS THE PATIENT TREATED FOR THE MUGSI ORGANISM? Yes No Unknown (new question) 18. UNDERLYING CONDITIONS: (Check all that apply) RENAL DISEASE Chronic kidney disease Lowest serum creatinine: _______mg/DL 19 SUBSTANCE USE OTHER SUBSTANCES: (Check all that apply) Cocaine or methamphetamine 18. UNDERLYING CONDITIONS: (Check all that apply) RENAL DISEASE Chronic kidney disease Lowest serum creatinine: _______mg/DL Unknown or not done (Added an option for “Unknown or not done”) 19. SUBSTANCE USE OTHER SUBSTANCES: (Check all that apply) Opioid, NOS (new check box) Cocaine Methamphetamine (split out cocaine and methamphetamine) During the current hospitalization did the patient receive medication assisted treatment (MAT) for opioid use disorder? Yes No N/A (patient not hospitalized or did not have DUD 24c. IF TESTED, WHAT WAS THE TESTING RESULT? Molecular Test Results: □ NDM □ KPC □ OXA □ OXA-48 □ VIM □ IMP (New question) 24c. IF TESTED, WHAT WAS THE TESTING RESULT? Molecular Test Results: □ NDM □ KPC □ OXA □ OXA-48 □ VIM □ IMP □ Other (specify): (added other specify check box) 31d. DATE OF ABSTRACTION: ___ ___ - ___ ___ - ___ ___ ___ ___ 31d. COMMENTS: __________________________________ (new question) 31e. COMMENTS: __________________________________ (changed question number) 11. 2020 Multi-site Gram-Negative Surveillance Initiative (MuGSI)- Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae (ESBL) Question on 2019 form Title: 2019 Carbapenem Resistant Enterobacteriaceae (CRE)/ Carbapenem Resistant A. baumannii (CRAB) Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare Associated Infection Community Interface (HAIC) Case Report 17. TYPES OF INFECTION ASSOCIATED WITH CULTURE(S): (Check all that apply) None Unknown 18. RECURRENT UTI Question on 2020 form Title: 2020 Extended-Spectrum Beta-Lactamase (ESBL)Producing Enterobacteriaceae Multi-site Gram-Negative Surveillance Initiative (MuGSI) Healthcare Associated Infection Community Interface (HAIC) Case Report (change in title) 17a. TYPES OF INFECTION ASSOCIATED WITH CULTURE(S): (Check all that apply) None Unknown Colonized (adding the option to choose “colonized”) 17b. RECURRENT UTI (changed question number) 19. UNDERLYING CONDITIONS: (Check all that apply) RENAL DISEASE Chronic kidney disease Lowest serum creatinine: _______mg/DL 19 SUBSTANCE USE OTHER SUBSTANCES: (Check all that apply) Cocaine or methamphetamine 18. UNDERLYING CONDITIONS: (Check all that apply) RENAL DISEASE Chronic kidney disease Lowest serum creatinine: _______mg/DL Unknown or not done (Changed question number, added an option for “Unknown or not done”) 19. SUBSTANCE USE OTHER SUBSTANCES: (Check all that apply) Opioid, NOS (new check box) Cocaine Methamphetamine (split out cocaine and methamphetamine) During the current hospitalization did the patient receive medication assisted treatment (MAT) for opioid use disorder? Yes No N/A (patient not hospitalized or did not have DUD 21. RISK FACTORS: (Check all that apply) (New question) 20. RISK FACTORS: (Check all that apply) 22a. WEIGHT (Changed question number) 21a. WEIGHT 22b. HEIGHT (Changed question number) 21b. HEIGHT 22c. BMI (Changed question number) 21c. BMI 23. RECORD THE COLONY COUNT: (Changed question number) 22. RECORD THE COLONY COUNT: (Changed question number) 24. SIGNS AND SYMPTOMS ASSOCIATED WITH URINE CULTURE: 23. SIGNS AND SYMPTOMS ASSOCIATED WITH URINE CULTURE: (Changed question number) 27d. DATE OF ABSTRACTION: ___ ___ - ___ ___ - ___ ___ ___ ___ 27d. COMMENTS: __________________________________ 12. (New question) 27e. COMMENTS: __________________________________ (Changed question number) 2020 Invasive MRSA Infection Case Report Form Questions on 2019 Form 29. RENAL DISEASE Chronic kidney disease Lowest serum creatinine: _______mg/DL 30. Opioid, DEA schedule I (e.g., heroin) Opioid, DEA schedule II (e.g., methadone, oxycodone) 30. Cocaine or methamphetamine Documented use disorder Documented use disorder Documented use disorder 30. 31. Prior healthcare exposure(s) IDU Skin popping NonIDU Unknown IDU Skin popping NonIDU Unknown IDU Skin popping NonIDU Unknown Questions on 2020 Form 29. RENAL DISEASE Chronic kidney disease Lowest serum creatinine: _______mg/DL Unknown or not done (Added an option for “Unknown or not done”) 30. Was the patient homeless in the year before DISC? Yes No Unknown (New question) 31. Opioid, DEA Documented IDU Skin schedule I (e.g., use disorder popping Nonheroin) IDU Unknown Opioid, DEA Documented IDU Skin schedule II (e.g., use disorder popping Nonmethadone, IDU Unknown oxycodone) Opioid, NOS Documented IDU Skin use disorder popping NonIDU Unknown (Updated question number, added question opioid, not otherwise specified) 31. Cocaine Documented IDU Skin use disorder popping NonIDU Unknown Documented IDU Skin Methamphetamine use disorder popping NonIDU Unknown (separated cocaine and methamphetamine) 31. During the current hospitalization did the patient receive medication assisted treatment (MAT) for opioid use disorder? Yes No N/A (patient not hospitalized or did not have DUD (New question) 32. Prior healthcare exposure(s) (Updated question number) 32. Patient outcome 33. Was case identified through audit? 34. CRF Status 35. Does this case have recurrent MRSA disease? 36. Date reported to EIP site 33. Patient outcome (Updated question number) 34. Was case identified through audit? (Updated question number) 35. CRF status (Updated question number) 36 Does this case have recurrent MRSA disease? (Updated question number) 37. Date reported to EIP site (Updated question number) 38. Date of abstraction: ___-___-_______ (New question) 39. S.O. Initials ____________ (Updated question number) 40. Comments: (Updated question number) 37. S.O. Initials: __________ 38. Comments: 13. 2020 Invasive MSSA Infections Case Report Form Questions on 2019 Form 29. RENAL DISEASE Chronic kidney disease Lowest serum creatinine: _______mg/DL 30. 30. Opioid, DEA schedule I (e.g., heroin) Opioid, DEA schedule II (e.g., methadone, oxycodone) Documented use disorder Documented use disorder IDU Skin popping NonIDU Unknown IDU Skin popping NonIDU Unknown Questions on 2020 Form 29. RENAL DISEASE Chronic kidney disease Lowest serum creatinine: _______mg/DL Unknown or not done (Added an option for “Unknown or not done”) 30. Was the patient homeless in the year before DISC? Yes No Unknown (New question) 31. Opioid, DEA Documented IDU Skin schedule I (e.g., use disorder popping Nonheroin) IDU Unknown Opioid, DEA Documented IDU Skin schedule II (e.g., use disorder popping Nonmethadone, IDU Unknown oxycodone) Opioid, NOS Documented IDU Skin use disorder popping NonIDU Unknown (Updated question number, added question opioid, not otherwise specified) 30. Cocaine or methamphetamine Documented use disorder IDU Skin popping NonIDU Unknown 31. Cocaine Methamphetamine 30. Documented use disorder Documented use disorder IDU Skin popping NonIDU Unknown IDU Skin popping NonIDU Unknown (separated cocaine and methamphetamine) 31. During the current hospitalization did the patient receive medication assisted treatment (MAT) for opioid use disorder? Yes No N/A (patient not hospitalized or did not have DUD 31. Prior healthcare exposure(s) 32. Patient outcome 33. Was case identified through audit? 34. CRF Status 35. Does this case have recurrent MSSA disease? 36. Date reported to EIP site 37. S.O. Initials: __________ 38. Comments: (New question) 32. Prior healthcare exposure(s) (Updated question number) 33. Patient outcome (Updated question number) 34. Was case identified through audit? (Updated question number) 35. CRF status (Updated question number) 36 Does this case have recurrent MSSA disease? (Updated question number) 37. Date reported to EIP site (Updated question number) 38. Date of abstraction: ___-___-_______ (New question) 39. S.O. Initials ____________ (Updated question number) 40. Comments: (Updated question number) 14. 2020 CDI Case Report and Treatment Form Question on 2019 Form Question on 2020 Form 9. Positive diagnostic assay for C.diff (Check all that apply) □ EIA □ Culture □ GDH □ Cytotoxin □ NAAT □ Other (specify) ____________ Unknown 9. Diagnostic assay for C.diff 9a. EIA □ Positive □ Negative □ Not tested 9b. GDH □ Positive □ Negative □ Not tested 9c. Cytotoxin □ Positive □ Negative □ Not tested 9d. NAAT (C. diff only) □ Positive □ Negative □ Not tested 9e. NAAT (GI panel) □ Positive □ Negative □ Not tested 9.e.1 If positive, was result suppressed? □ Yes □ No □ Unknown 9f. Other (specify): ___________ □ Positive □ Negative □ Not tested [21. Underlying conditions] Renal disease □ Chronic kidney disease Lowest serum creatinine: _______________________mg/DL [23c. Other substances] [not on 2019 CRF] [23c. Other substances] □ Cocaine or methamphetamine □ DUD or abuse □IDU □Skin popping □Non-IDU □Unknown [not on 2019 CRF] [not on 2019 CRF] 39. Comments 15. 2020 HAIC Candidemia Case Report (split out each option into positive/negative/not tested, assigned a question number to each assay, split out NAAT into C. diff only tests and GI panel tests, added question about suppression of GI panel results, re-ordered response options, removed culture as an option) [21. Underlying conditions] Renal disease □ Chronic kidney disease Lowest serum creatinine: _______________________mg/DL □ Unknown or not done (added option for unknown or not done) [23c. Other substances] □ Opioid, NOS □ DUD or abuse □IDU □Skin popping □Non-IDU □Unknown [23c. Other substances] □ Cocaine □ DUD or abuse □IDU □Skin popping □Non-IDU □Unknown □ Methamphetamine □ DUD or abuse □IDU □Skin popping □Non-IDU □Unknown (Split into two questions) [23c. Other substances] During the current hospitalization, did the patient receive medication assisted treatment (MAT) for opioid use disorder? □ Yes □ No □ N/A (patient not hospitalized or did not have DUD) (new question) 39. Date of abstraction __ __ / __ __ / __ __ __ __ (new question) 40. Comments (updated question number) Questions from 2019 26. Additional non-Candida organisms isolated from blood cultures in the 7 days before the DISC: 1 Yes 0 No 9 Unknown 27. Any subsequent positive Candida blood cultures in the 30 days after the DISC? 1 Yes 0 No 9 Unknown 28. Documented negative Candida blood culture in the 30 days after the DISC? 1 Yes 0 No 9 Unknown 29. Did the patient have any of the following types of infection/colonization related to their Candida infection? (check all that apply): None Unknown Abscess Splenic Liver Pulmonary Candiduria CNS involvement (meningitis, brain abscess) Eyes (endophthalmitis or chorioretinitis) Endocarditis Peritonitis Respiratory specimen with Candida Septic emboli Lungs Brain Osteomyelitis Skin lesions Other (specify): _____________________ Questions from 2020 26. Additional non-Candida organisms isolated from blood cultures on the day of or in the 6 days before the DISC: 1 Yes 0 No 9 Unknown (Updated timeframe wording to be clearer) 28. Any subsequent positive Candida blood cultures in the 29 days after, not including the DISC? 1 Yes 0 No 9 Unknown (Updated timeframe wording to be clearer) 29. Documented negative Candida blood culture on the day of or in the 29 days after the DISC? 1 Yes 0 No 9 Unknown (Updated timeframe wording to be clearer) 30. Did the patient have any of the following types of infection/colonization related to their Candida infection? (check all that apply): None Unknown Abscess Splenic Liver Pulmonary Other (specify): _____________ Candiduria CNS involvement (meningitis, brain abscess) Eyes (endophthalmitis or chorioretinitis) Endocarditis Peritonitis Respiratory specimen with Candida Septic emboli Lungs Brain Osteomyelitis Skin lesions Other (specify): _____________________ 36. Overnight stay in LTCF in the 90 days before the DISC: 1 Yes 0 No 9 (Added another option “Other, specify” under the heading of Abscess) 37. Previous Hospitalization in the 90 days before, not including the DISC: 1 Yes 0 No 9 Unknown (Updated timeframe wording to be clearer) 38. Overnight stay in LTACH in the 90 days before, not including the DISC: 1 Yes 0 No 9 Unknown (Updated timeframe wording to be clearer) 39. Overnight stay in LTCF in the 90 days before, not including the DISC: 1 Yes 0 No 9 37. Underlying Conditions (Updated timeframe wording to be clearer) 40. Underlying Conditions 34. Previous Hospitalization in the 90 days before the DISC: 1 Yes 0 No 9 Unknown 35. Overnight stay in LTACH in the 90 days before the DISC: 1 Yes 0 No 9 Unknown Renal Disease Chronic Kidney Disease Lowest serum creatinine: ______________mg/DL Renal Disease Chronic Kidney Disease Lowest serum creatinine: ______________mg/DL Unknown or not done (Added a checkbox for unknown lowest serum creatinine) 40. Other Substances (Check all that apply): None Unknown Marijuana (other IDU Skin than smoking) Documented popping Nonuse disorder IDU Unknown Opioid, DEA IDU Skin schedule I (e.g., Documented popping Nonheroin) use disorder IDU Unknown Opioid, DEA IDU Skin schedule II-IV (e.g., Documented popping Nonmethadone, use disorder IDU Unknown oxycodone) Cocaine or IDU Skin methamphetamine Documented popping Nonuse disorder IDU Unknown Other (Specify): IDU Skin Documented popping Nonuse disorder IDU Unknown Unknown IDU Skin substance Documented popping Nonuse disorder IDU Unknown NEW QUESTION 44. Surgeries in the 90 days before the DISC: Abdominal surgery Non-abdominal surgery (specify): __________________ No surgery 45. Pancreatitis in the 90 days before the DISC: 1 Yes 0 No 43. Other Substances (Check all that apply :) None Unknown Marijuana (other IDU Skin than smoking) Documented popping Nonuse disorder IDU Unknown Opioid, DEA IDU Skin schedule I (e.g., Documented popping Nonheroin) use disorder IDU Unknown Opioid, DEA IDU Skin schedule II-IV (e.g., Documented popping Nonmethadone, use disorder IDU Unknown oxycodone) Opioid, NOS IDU Skin Documented popping Nonuse disorder IDU Unknown Cocaine IDU Skin Documented popping Nonuse disorder IDU Unknown Methamphetamine IDU Skin Documented popping Nonuse disorder IDU Unknown Other (Specify): IDU Skin Documented popping Nonuse disorder IDU Unknown Unknown IDU Skin substance Documented popping Nonuse disorder IDU Unknown (Added a new option, Opioid, NOS for instances where the medical chart does not specify the exact Opioid; Cocaine and Methamphetamines were separated out to be different questions) 44. During the current hospitalization, did the patient receive medication-assisted treatment (MAT) for opioid use disorder? 1 Yes 0 No 8 N/A (patient not hospitalized or did not have DUD) 9 Unknown 47. Surgeries on the day of or in the 89 days before the DISC: Abdominal surgery Non-abdominal surgery (specify): __________________ No surgery (Updated timeframe wording to be clearer) 48. Pancreatitis on the day of or in the 89 days before the DISC: 1 Yes 0 No 9 Unknown (Updated timeframe wording to be clearer and added an unknown option) 46a. If yes, did the patient have any urinary tract procedures in the 90 days before the DISC? 1 Yes 0 No 9 Unknown 47. Was the patient neutropenic in the 2 calendar days before the DISC? 1 Yes 0 No 9 Unknown (no WBC days -2 or 0, or no differential) 48. Was the patient in an ICU in the 14 days before the DISC? 1 Yes 0 No 9 Unknown 50. Did the patient have a CVC in the 2 calendar days before the DISC? 1 Yes 2 No 3 Had CVC but can’t find dates 9 Unknown 50b. Were all CVCs removed or changed in the 7 days after the DISC? 1 Yes 2 No 3 CVC removed, but can’t find dates 5 Died or discharged before indwelling catheter replaced 9 Unknown 51. Did the patient have a midline catheter in the 2 calendar days before the DISC? 1 Yes 0 No 9 Unknown 52. Did the patient have any of the following indwelling devices present in the 3 calendar days before the DISC? Urinary Catheter/Device Indwelling urethral Suprapubic Respiratory ET/NT Tracheostomy Gastrointestinal Gastrostomy 53. Did the patient receive systemic antibacterial medication in the 14 days before the DISC? 1 Yes 0 No 9 Unknown 49a. If yes, did the patient have any urinary tract procedures on the day of or in the 89 days before the DISC? 1 Yes 0 No 9 Unknown (Updated timeframe wording to be clearer) 50. Was the patient neutropenic in the 2 calendar days before, not including the DISC? 1 Yes 0 No 9 Unknown (no WBC days 2 or 0, or no differential) (Updated timeframe wording to be clearer) 33. Was the patient in an ICU in the 14 days before, not including the DISC? 1 Yes 0 No 9 Unknown (Updated timeframe wording to be clearer) 51. Did the patient have a CVC in the 2 calendar days before, not including the DISC? 1 Yes 2 No 3 Had CVC but can’t find dates 9 Unknown (Updated timeframe wording to be clearer) 51b. Were all CVCs removed or changed on the day of or in the 6 days after the DISC? 1 Yes 2 No 3 CVC removed, but can’t find dates 5 Died or discharged before indwelling catheter replaced 9 Unknown (Updated timeframe wording to be clearer) 52. Did the patient have a midline catheter in the 2 calendar days before, not including the DISC? 1 Yes 0 No 9 Unknown (Updated timeframe wording to be clearer) 53. Did the patient have any of the following indwelling devices present in the 2 calendar days before, not including the DISC? None Unknown Urinary Catheter/Device Indwelling urethral Suprapubic Respiratory ET/NT Tracheostomy Gastrointestinal Abdominal drain (specify): _________________ Gastrostomy (Changed timeframe wording to be clearer, added a none and unknown option for easier cleaning and coding, added an option under gastrointestinal looking at abdominal drains) 54. Did the patient receive systemic antibacterial medication in the 14 days before, not including the DISC? 1 Yes 0 No 9 Unknown (Updated timeframe wording to be clearer) 54. Did the patient receive total parenteral nutrition (TPN) in the 14 days before the DISC? 1 Yes 0 No 9 Unknown 55. Did the patient receive total parenteral nutrition (TPN) in the 14 days before, not including the DISC? 1 Yes 0 No 9 Unknown 55. Did the patient receive systemic antifungal medication in the 14 days before the DISC? 1 Yes (if Yes, fill out question 58) 0 No 9 Unknown (Updated timeframe wording to be clearer) 56. Did the patient receive systemic antifungal medication on the day of or in the 13 days before the DISC? 1 Yes (if Yes, fill out question 58) 0 No 9 Unknown 56. Was the patient administered systemic antifungal medication after the DISC? 1 Yes (if Yes, fill out question 58) 0 No 9 Unknown (Updated timeframe wording to be clearer) 57. Was the patient administered systemic antifungal medication after, not including the DISC? 1 Yes (if Yes, fill out question 58) 0 No 9 Unknown (Updated timeframe wording to be clearer) 16. HAIC- Annual Survey of Laboratory Testing Practices for C. difficile Infections Questions on 2019 Survey Was this lab audited in 2018? Questions on 2020 Survey Was this lab audited in 2019? 2. What type and order of testing is routinely used by your laboratory in standard testing for C. difficile? (Enter letter from choices below; choose only one option for each line of testing) (Updated year referenced) 2. What type and order of testing is routinely used by your laboratory in standard testing for C. difficile? (Enter letter from choices below; choose only one option for each line of testing) 1st line of testing: ________ 2nd line of testing: ________ 3rd line of testing: ________ A. EIA Toxin A and B B. EIA for Toxin A only C. EIA for Toxin B only D. EIA Antigen (GDH) E. EIA Toxin A/B and Antigen (Simultaneous testing) F. EIA Other Specify other EIA type: __________________________ G. Nucleic Acid Amplification (e.g. PCR, Illumigene, Luminex) H. Culture I. Cytotoxin J. Other Specify other test type: __________________________ K. No one routine test; clients can order from among several tests 1st line of testing: ________ 2nd line of testing: ________ 3rd line of testing: ________ A. EIA Toxin A and B B. EIA for Toxin A only C. EIA for Toxin B only D. EIA Antigen (GDH) E. EIA Toxin A/B and Antigen (Simultaneous testing) F. EIA Other Specify other EIA type: __________________________ G. Nucleic Acid Amplification (e.g. PCR, Illumigene, Luminex, Biofire) H. Culture I. Cytotoxin J. Other Specify other test type: __________________________ K. No one routine test; clients can order from among several tests Specify types: __________________________ L. None nd 2a. Which specimens are used during your 2 line of testing? (Choose one) ⃝ Positive by the 1st line of testing ⃝ Negative by the 1st line of testing ⃝ Specimens with discordant results (e.g. EIA+/GDHor GDH+/EIA-) ⃝ All specimens ⃝ Do not use 2nd line of testing (go to question 3a) 2b. Which specimens are used during your 3rd line of testing? (Choose one) ⃝ Positive by the 2nd line of testing ⃝ Negative by the 2nd line of testing ⃝ Specimens with discordant results (e.g. EIA+/GDHor GDH+/EIA-) ⃝ All specimens ⃝ Do not use 3rd line of testing (go to question 3a) [Question did not exist] Specify types: __________________________ L. None (Added “Biofire” as an example to response option G) 2a. Which specimens are used during your 2nd line of testing? (Choose one) ⃝ Positive by the 1st line of testing ⃝ Negative by the 1st line of testing ⃝ Specimens with discordant results (e.g. EIA+/GDHor GDH+/EIA-) ⃝ All specimens ⃝ Do not use 2nd line of testing (removed “go to question 3a” from final response option) 2b. Which specimens are used during your 3rd line of testing? (Choose one) ⃝ Positive by the 2nd line of testing ⃝ Negative by the 2nd line of testing ⃝ Specimens with discordant results (e.g. EIA+/GDHor GDH+/EIA-) ⃝ All specimens ⃝ Do not use 3rd line of testing (removed “go to question 3a” from final response option) 2c. Does your laboratory perform any onsite testing for C. difficile outside of your normal testing algorithm? ⃝ No, all onsite testing is done according to the testing algorithm specified above ⃝ Yes, on physician request Specify tests: __________________________ ⃝ Other Specify: __________________________ 3b. Which Nucleic Acid Amplification test is currently used by your laboratory? (Check all that apply) □ BD-GeneOhm C. difficile □ Cepheid Xpert C. difficile □ Meridian Illumigene □ Prodesse (Gen-Probe) Progastro CD □ Luminex xTAG GPP □ Biofire Filmarray GI Panel □ Other Specify other test: ____________________ □ N/A (Do not use nucleic acid amplification) (New question) 3b. Which Nucleic Acid Amplification test is currently used by your laboratory? (Check all that apply) □ BD-GeneOhm C. difficile □ BD MAX C. difficile □ Cepheid Xpert C. difficile □ Meridian Illumigene □ Prodesse (Gen-Probe) Progastro CD □ Luminex xTAG GPP □ Biofire Filmarray GI Panel □ Quidel AmpliVue C. difficile Assay □ Great Basin Portrait Toxigenic C. difficile Assay □ Nanosphere Verigene SP □ Other Specify other test: ____________________ □ N/A (Do not use nucleic acid amplification) (Added response options) 3c. If your laboratory uses a multiplex PCR (e.g., Biofire Filmarray GI Panel, Luminex xTAG GPP) to test for several GI pathogens, does your laboratory suppress the result so that clinicians cannot see it? □ Yes □ No □ N/A (Do not use multiplex PCR) [Question did not exist] 4a. If your laboratory uses a multiplexed molecular diagnostic (e.g., Biofire Filmarray GI Panel, Luminex xTAG GPP) to test for several GI pathogens, does your laboratory suppress the C. diff result so that clinicians cannot see it? □ Yes, always □ Yes, at clinician request □ Yes, but will release the result upon clinician request □ Yes, sometimes Specify: ______________ □ No, clinicians always see C. diff result □ N/A (Do not use multiplexed molecular diagnostic) (Changed wording of question and “No” and “N/A” response options, expanded the “yes” response option for clarity, and changed question number) 4b. If your laboratory uses a multiplexed diagnostic and the result is suppressed, where does the suppression occur? □ At the multiplexed molecular diagnostic instrument level (the result is not entered into the laboratory information management system (LIMS)) □ At the laboratory information management system (LIMS) level □ Other Specify: ______________ □ N/A (Do not use multiplexed molecular diagnostic or the result is never suppressed) 5a. (If yes) What was your previous type and order of testing? (Enter letter from choices below; choose only one option for each line of testing) (New question) 5. What are the testing codes associated with the tests your lab currently uses? (Changed question number) 6. Has your lab testing algorithm for C. difficile changed since January 1, 2019? ⃝ Yes What date did this change occur? ______ / ______ / ______ ⃝ No (Changed question number and date referenced) 6a. (If yes) What was your previous type and order of testing? (Enter letter from choices below; choose only one option for each line of testing) 1st line of testing: ________ 2nd line of testing: ________ 3 line of testing: ________ A. EIA Toxin A and B B. EIA for Toxin A only C. EIA for Toxin B only D. EIA Antigen (GDH) E. EIA Toxin A/B and Antigen (Simultaneous testing) F. EIA Other 1st line of testing: ________ 2nd line of testing: ________ 3 line of testing: ________ A. EIA Toxin A and B B. EIA for Toxin A only C. EIA for Toxin B only D. EIA Antigen (GDH) E. EIA Toxin A/B and Antigen (Simultaneous testing) F. EIA Other 4. What are the testing codes associated with the tests your lab currently uses? 5. Has your lab testing algorithm for C. difficile changed since January 1, 2018? ⃝ Yes What date did this change occur? ______ / ______ / ______ ⃝ No rd rd Specify other EIA type: __________________________ G. Nucleic Acid Amplification (e.g. PCR, Illumigene, Luminex) H. Culture I. Cytotoxin J. Other Specify other test type: __________________________ K. No one routine test; clients can order from among several tests Specify types: __________________________ L. None 5b. Which specimens were used during your 2nd line of testing? 5c. Which specimens were used during your 3rd line of testing? 6. Does your lab have a policy to reject stool specimens for C. difficile testing? 6a. Has your rejection policy for stool specimens changed since January 1, 2018? ⃝ Yes What date did this change occur? ______ / ______ / ______ Specify changes: __________________________ ⃝ No [Question did not exist] Specify other EIA type: __________________________ G. Nucleic Acid Amplification (e.g. PCR, Illumigene, Luminex, Biofire) H. Culture I. Cytotoxin J. Other Specify other test type: __________________________ K. No one routine test; clients can order from among several tests Specify types: __________________________ L. None (Changed question number and added “Biofire” as an example to response option G) 6b. Which specimens were used during your 2nd line of testing? (Changed question number) 6c. Which specimens were used during your 3rd line of testing? (Changed question number) 7. Does your lab have a policy to reject stool specimens for C. difficile testing? (Changed question number) 7a. Has your rejection policy for stool specimens changed since January 1, 2019? ⃝ Yes What date did this change occur? ______ / ______ / ______ Specify changes: __________________________ ⃝ No (Updated year referenced and question number) 8. How many stool samples did you test for C. diff each month in 2019? Month January February March April May June July August September October November December Stool samples tested C. diff+ samples 7. Since your laboratory changed its testing algorithm for CDI diagnosis in the past year and this may have had an impact in the number of positive specimens, it is very important for us to have information on the number of stool samples tested for C. difficile and the number of stool samples positive for C. difficile in the 3 months prior to and the 3 months following the change in testing methodology. (New question) [Removed question] 17. HAIC- CDI Annual Surveillance Officers Survey Questions on 2019 Survey 2. In 2018, did any laboratories drop out of participation? 3. In 2018, did you identify any additional laboratories inside or outside of your catchment area which identify C.diff assays from persons who are residents of your catchment area? 11. What software do you use for geocoding? 12. For each facility that treated a case in 2018, please provide the following: a. Facility ID or Provider ID as it appears on the CRF b. Type of facility (i.e. hospital inpatient, outpatient, LTCF, LTACH, other). When possible, use the CMS classification to determine type of facility c. Either the state and county of the facility or an indication of if the facility is in catchment or out of catchment Questions on 2020 Survey 2. In 2019, did any laboratories drop out of participation? (Updated year referenced) 3. In 2019, did you identify any additional laboratories inside or outside of your catchment area which identify C.diff assays from persons who are residents of your catchment area? (Updated year referenced) 11. What application do you use for geocoding (e.g. ArcGIS Pro, ArcMap, ArcGIS Online)? 12. Within this application, what geocoding tool do you use (e.g, StreetMap Premium, Spacialitics Health Geocoder, ArcGIS World Geocoding service, locally-created address locator file)? (Split into two questions, clarified the information we were looking for in this question) 13. For each facility that treated a case in 2019, please provide the following: a. Facility ID or Provider ID as it appears on the CRF b. Type of facility (i.e. hospital inpatient, outpatient, LTCF, LTACH, other). When possible, use the CMS classification to determine type of facility c. Either the state and county of the facility or an indication of if the facility is in catchment or out of catchment (Updated year referenced, updated question number) 18. HAIC- Emerging Infections Program C. difficile Surveillance Nursing Home Telephone Survey (LTCF) Questions on 2019 Survey Speaking to correct person: YES (proceed) NO (go to question 3) Record name and title:___________________ Phone number: _____________________ 3. If NO, Name of person and title:_______________________ Phone number:_______________________________ Best time to reach this person:___________________ 1. Is your facility a free-standing facility? □ Yes Questions on 2020 Survey Speaking to correct person: If YES, Record name and title:___________________ Phone number: _____________________ If NO, Name of person and title:_______________________ Phone number:_______________________________ Best time to reach this person:___________________ (Combined questions on the form, removed numbering) [Removed question] □ No, which hospital is your facility affiliated with? _______________ 2. Do you collect stool specimens in the facility to be sent for Clostridioides difficile testing? □ YES 1. Do you collect stool specimens in the facility to be sent for Clostridioides difficile testing? □ YES □ NO □ NO If YES, Do you send all your stool specimens for C. diff testing to a reference laboratory? □ YES (what is the name of the reference lab: ______________________________) □ No, please name the laboratories you send stool specimens for C. diff testing? Name: ________________________________ Phone number: ___________________________ Name: ________________________________ Phone number: ___________________________ Name: ________________________________ Phone number: ___________________________ 2. If YES, please name the laboratories to which you send stool specimens for C. diff testing: Name: ________________________________ Phone number: ___________________________ Name: ________________________________ Phone number: ___________________________ Name: ________________________________ Phone number: ___________________________ (Removed sub-question about reference laboratory, renumbered question, rephrased question about where labs send stools for testing) 19. HAIC- Invasive Staphyloccus aureus Laboratory Survey: Use of Nucleic Acid Amplification Testing (NAAT) Questions on 2019 Survey 2b. Which CIDTs do you use (sterile site sources only, i.e. blood, CSF, pleural fluid, bone, etc.)? Please check all that apply. □ FilmArray® Blood Culture Identification Panel..Date started__________ □ Verigene® Gram-Positive Blood Culture Test…Date started__________ □ Verigene® Staphylococcus Blood Culture Test…Date started__________ □ Cepheid Xpert® MRSA/SA BC…Date started__________ □ BD Geneohm® StaphSR…Date started__________ □ AdvanDx Staphylococcus QuickFISH blood culture kit…Date started__________ □ AdvanDx S. aureus/CNS PNA FISH…Date started__________ □ Alere BinaxNOW® Staphylococcus aureus test…Date started__________ □ Great Basin Staph ID/R blood culture panel…Date started__________ □ T2Bacteria® Panel…Date started__________ □ Accelerate PhenoTest™ BC kit…Date started ________________ □ iCubate iC-GPC Assay™…Date started ________________ □ Other, Lab Developed Test (detects MRSA or SA)… Date started ____________________ □ Other commercial test, Specify_______...Date started__________ Questions on 2020 Survey 2b. Which CIDTs do you use (sterile site sources only, i.e. blood, CSF, pleural fluid, bone, etc.)? Please check all that apply. □ FilmArray® Blood Culture Identification Panel..Date started__________ □ Verigene® Gram-Positive Blood Culture Test…Date started__________ □ Verigene® Staphylococcus Blood Culture Test…Date started__________ □ Cepheid Xpert® MRSA/SA BC…Date started__________ □ BD Geneohm® StaphSR…Date started__________ □ AdvanDx Staphylococcus QuickFISH blood culture kit…Date started__________ □ AdvanDx S. aureus/CNS PNA FISH…Date started__________ □ Alere BinaxNOW® Staphylococcus aureus test…Date started__________ □ Great Basin Staph ID/R blood culture panel…Date started__________ □ T2Bacteria® Panel…Date started__________ □ Accelerate PhenoTest™ BC kit…Date started ________________ □ iCubate iC-GPC Assay™…Date started ________________ □ mecA XpressFISH® …Date started ________________ □ Micacom hemoFISH Masterpanel … Date started ________________ □ ePlex BCID-GP Panel … Date started ________________ □ Other, Lab Developed Test (detects MRSA or SA)… Date started ____________________ □ Other commercial test, Specify_______...Date started__________ 2c. [If using any of the above tests for sterile site cultures] Do you still obtain an isolate for S. aureus or MRSA? □ Yes □ No - GO to Q3 2c. [If using any of the above tests on sterile site specimens] Do you still obtain an isolate for S. aureus or MRSA? □ Yes □ No - GO to Q3 20. HAIC- Invasive Staphylococcus aureus Supplemental Surveillance Officers Survey Question on 2019 Survey Question on 2020 Survey Section: Surveillance Area Characteristics 4a: If yes, what mechanism did you have in place that 2. Is MSSA reportable at your site? allowed for SOs to have access to MSSA case counts _______ yes _______ no and medical records? _______MSSA is a reportable condition (split question 4a into two parts) _______ Agent of the state _______ State Health Department Regulation _______ Other, please explain: __________________________________ 2ai. If yes: What is your reportable definition of MSSA? _______ All invasive MSSA statewide _______ Invasive MSSA in residents among defined catchment area _______ Healthcare-associated invasive MSSA infection _______ Other, please define: ___________________________________ (new question) 2aii: Is isolate submission to the State Health Department Laboratory required? _______ yes _______ no 4a: If yes, what mechanism did you have in place that allowed for SOs to have access to MSSA case counts and medical records? _______MSSA is a reportable condition _______ Agent of the state _______ State Health Department Regulation _______ Other, please explain: __________________________________ (new question) 2bi: If no: what mechanism do you have in place that allows for SOs to have access to MSSA case counts and medical records? _______ Agent of the state _______ State Health Department Regulation _______ Other, please explain: __________________________________ (split question 4a into two parts) 2bii: If no, does your state/site plan to make MSSA reportable? ______yes _______no 2. Did your site send MRSA/MSSA isolates to CDC for characterization in 2017? ___yes ____no (new question) 3. Did your site send MRSA/MSSA isolates to CDC for characterization in 2019? ___yes ____no 2a. If yes, how were isolates selected? (updated question number) 3a. If yes, how were isolates selected? (updated question number) 3b. If yes, how many isolates did you expect to be able to collect from clinical labs? _____ MRSA, _____ MSSA (new question) 3c. If yes, what was the total number of isolates collected from clinical labs? _______ MRSA, _______ MSSA (new question) 4. Did your site participate in MSSA surveillance in 2018? _______ yes _______ no (deleted) 4b. If yes, please complete the date range for which MSSA surveillance was conducted as well as the catchment area: 2018 Dates of MSSA surveillance Catchment area (deleted) 3. How does your site complete SA case report forms (please select all that apply)? _______On a computer or tablet _______With paper and pen _______Other, please explain: ________________________________ 4. How does your site complete SA case report forms (please select all that apply)? _______On a computer or tablet _______With paper and pen _______Other, please explain: ________________________________ (updated question number) Section: Lab Participation and Case Finding 1. Please list the total number of each type of lab 1. Please list the total number of each type of lab serving your serving your MRSA surveillance catchment area MRSA surveillance catchment area (both inside and outside of the (both inside and outside of the catchment area): catchment area) and the total number of each type of lab participating (i.e., submit test results when available) in Inside Outsi surveillance (both inside and outside the catchment area): catch de ment catch Inside Outside area ment catchment catchment area area area Hospital laboratories Se Partic Se Partic rve ipate rve ipate Dialysis referral laboratories Hospital laboratories Commercial/outpatient Dialysis referral laboratories* laboratories Other; please Commercial/outpatient specify:________________ laboratories* _______________ Other; please Total number (Add above specify:_______________ together) ________________ *For the purpose of the survey, we are defining Total number (Add above “Commercial/Outpatient Laboratories” as any together) for profit laboratory, not including dialysis *For the purpose of the survey, we are defining referral laboratories, that serve health care “Commercial/Outpatient Laboratories” as any for profit facilities in a given surveillance catchment area. laboratory, not including dialysis referral laboratories, that Examples include LabCorp and Quest. serve health care facilities in a given surveillance catchment area. Examples include LabCorp and Quest. 2. Please list the total number of each type of lab (updated question wording and response formatting) 2. If different catchment than MRSA, please list the total number serving your MSSA surveillance catchment area if different catchment than MRSA (both inside and outside of the catchment area): Inside Outsi catch de ment catch area ment area Hospital laboratories Dialysis referral laboratories Commercial/outpatient laboratories* Other; please specify:________________ _______________ Total number (Add above together) *For the purpose of the survey, we are defining “Commercial/Outpatient Laboratories” as any for profit laboratory, not including dialysis referral laboratories, that serve health care facilities in a given surveillance catchment area. Examples include LabCorp and Quest. of each type of lab serving your MSSA surveillance catchment area (both inside and outside of the catchment area) and the total number of each type of lab participating (i.e., submit test results when available) in surveillance (both inside and outside the catchment area):: Inside Outside catchment catchment area area Se Partic Se Partic rve ipate rve ipate Hospital laboratories Dialysis referral laboratories Commercial/outpatient laboratories* Other; please specify:_______________ ________________ Total number (Add above together) *For the purpose of the survey, we are defining “Commercial/Outpatient Laboratories” as any for profit laboratory, not including dialysis referral laboratories, that serve health care facilities in a given surveillance catchment area. Examples include LabCorp and Quest. (updated question wording and response formatting) Section: Data Edits 2. Did your site have any challenges completing the CRF reabstractions? _______ yes _______ no (new question) 2a. If yes, please describe (new question) Section: Ascertainment of Surveillance Area and Case Audits 3d. How many laboratories did you audit in 2019? (new question) 4. In 2019, did your site update its inventory of facilities within the EIP catchment area? _______ yes_______ no (new question) 4a. If no, why not? (new question) 4b. If yes, how many facilities serve the catchment area? 4. Does your site perform routine ascertainment* of the surveillance area? *“Case ascertainment” should include ongoing attempts to identify new or additional laboratories inside and outside of your defined catchment area which may be (new question) 4c. If yes, how many facilities have you identified a clinical laboratory for? (new question) 5. Does your site perform routine ascertainment* of the surveillance area? *“Case ascertainment” should include ongoing attempts to identify new or additional laboratories inside and outside of your defined catchment area which may be processing specimens for surveillance area residents. processing specimens for surveillance area residents. _______ yes _______ no a. If yes, how does your site assess case ascertainment* methods? (examples include: physician surveys, LTCF surveys, outreach to new dialysis centers, etc…). _______ yes _______ no a. If yes, how does your site assess case ascertainment* methods? (examples include: physician surveys, LTCF surveys, outreach to new dialysis centers, etc…). b. If yes, how often is this performed? When was this last performed? b. If yes, how often is this performed? When was this last performed? (updated question number) 5. Are there specific labs that you have difficulty obtaining line lists from? _______ yes _______ no a. If yes, what types of labs? 6. Are there specific labs that you have difficulty obtaining line lists from? _______ yes _______ no a. If yes, what types of labs? 6. Does your site have checks in place to recognize decreasing/increasing case counts or rates of MRSA disease? _______ yes _______ no a. If yes, please describe the check(s) that you use b. If yes, how often are the check(s) used? c. If yes, do you plan to use these for MSSA once more surveillance data are available? _______ yes _______ no 1. (updated question number) 7. Does your site have checks in place to recognize decreasing/increasing case counts or rates of MRSA disease? _______ yes _______ no a. If yes, please describe the check(s) that you use b. If yes, how often are the check(s) used? c. If yes, do you plan to use these for MSSA once more surveillance data are available? _______ yes _______ no (updated question number) Section: CDC Responsibilities CDC staff are responsive to 2. CDC staff are responsive to questions/concerns/emails (e.g., questions/concerns/emails (e.g., Valerie Davina Campbell, Runa Gokhale, Kelly Jackson, Isaac See, Albrecht, Kelly Jackson, Isaac See, and Shirley and Shirley Zhang). Zhang). _______ Strongly agree _______ Strongly agree _______ Agree _______ Agree _______ Neutral _______ Neutral _______ Disagree _______ Disagree _______ Strongly disagree _______ Strongly disagree a. If you disagree or strongly disagree, please explain and provide improvement suggestions: a. If you disagree or strongly disagree, please explain and provide (Updated wording) improvement suggestions: 21. HAIC- Laboratory Testing Practices for Candidemia Questionnaire Questions on 2019 Survey Title: 2019 LABORATORY TESTING PRACTICES FOR CANDIDEMIA QUESTIONNAIRE Questions on 2020 Survey Title: 2020 LABORATORY TESTING PRACTICES FOR CANDIDEMIA QUESTIONNAIRE
| File Type | application/pdf |
| File Title | Att 24_Crosswalk |
| Author | Nti-Berko, Sonja Mali (CDC/DDID/NCEZID/DPEI) |
| File Modified | 2019-12-06 |
| File Created | 2019-12-06 |