High Risk Inpatient Influenza Vaccination (HRIIV) Module
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The HRIIV Module allows facilities to track rates of vaccine administration among high risk inpatients as defined by the Advisory Committeee on Immunization Practices (ACIP). The HRIIV module focuses on inpatient populations because the hospital setting provides an ideal opportunity to identify persons at high risk and ensure that influenza vaccination is offered and administered. Inpatient flu vaccination data can be used by facilities to improve the rate of vaccine administration and reduce the risk of complications in high risk inpatients from influenza infection.
This module can be completed using either retrospective medical record review (Method A or B) or by prospective evaluation of each inpatient admission (Method B). Two separate surveillance approaches (Method A or Method B), requiring the use of two separate sets of forms, are used to report data for the HRIIV Module. Ideally the same method should be used for each month of the influenza season in which the module is completed. The HRIIV forms for data collection follow CDC definitions and protocols.
The minimum requirement to participate in this module is one month during the influenza season (October through March), but maximal benefit is obtained by completing the module for each month of the entire influenza season.
Corresponding Materials
Protocols and Instructions
- High Risk Inpatient Influenza (HRIIV) Protocol PDF (438KB / 20 pages)
Guidelines and procedures for monitoring HRIIV - Tables of Instructions PDF (623 KB / 49 pages)
Instructions for completing forms
Training
Forms
- 57.106 Patient Safety Monthly Reporting Plan PDF (27 KB / 2 pages)
- 57.107 Patient Data PDF (65 KB / 1 pages)
- 57.130 HRIIV Monthly Monitoring - Method A PDF (44 KB/1 page)
- 57.131 HRIIV Monthly Monitoring Form - Method B PDF (36 KB/2 page)
- 57.132 HRIIV Method B - Part 1 PDF (71 KB/2 pages)
- 57.133 HRIIV Method B - Part 2 PDF (60 KB/2 pages)
- 57.134 HRIIV Standing Orders - Optional PDF (53 KB/3 pages)
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Contact NHSN:
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Centers for Disease Control and Prevention
National Healthcare Safety Network
MS-A24
1600 Clifton Rd
Atlanta, GA 30333 - nhsn@cdc.gov

