Q1: I’m adding locations for the first time and I’m not sure what to enter for “Your Code” and “Your Label”.
When setting up locations, the fields “Your Code” and “Your Label” should be unique and represent how your facility refers to that location (for example, Your Code = “5 West” and Your Label = “5th floor West Wing”). Note that no two locations (inactive or active) can have the same “Your Code”. In addition, the location should be mapped to a CDC Location Description – a standardized CDC location that indicates the types of patients that are receiving care in that unit. For more information about locations, please see: CDC Location Labels and Location Descriptions [PDF – 1 MB].
Q2: I have inactivated a location and would like to map an active location to a new CDC location description with the ‘Your Code’ that I used for the inactive location.
No, two units, whether active or inactive, can have the same “Your Code”. In order to keep the desired ‘Your Code,’ follow the following steps.
Step 1. For the inactive location
- Reactivate the location and edit the ‘Your Code’ to a different name
- Inactivate the location
Step 2. For the new active location
- Now that the inactive location has a different ‘Your Code’, you can now use the previous ‘Your Code’ that was designated for the inactive location.
Example: Inactive Location Your Code = 1NHSN which is also the desired ‘Your Code’ for the new unit.
Step 1. For inactive location
- Reactivate the location ‘1NHSN’ and change ‘1NHSN’ to ‘Old_1NHSN’
- Inactivate ‘Old_1NHSN’
Step 2. Now that ‘1NHSN’ is no longer the ‘Your Code’ for any location at the facility, it is now available to use for the new location
- Map new location with a ‘your code’ of ‘1NHSN’
Q3: One of our units is a mix of pediatric and adult patients, however all the patients are of the same acuity level and service. Should I map this as an adult location or a pediatric location?
This is a good example of when “virtual” locations would be the best option. If there are beds designated for pediatric patients, we recommend that virtual locations are used such that the pediatric beds are considered one location in NHSN and the other beds would be assigned as the most appropriate adult unit. The data collection and reporting for each of these locations would be separate for NHSN. If your facility can operationalize this option, it would be the most appropriate. However, if you’re unable to operationalize this type of data collection in this unit, then the unit should be mapped as the appropriate type for the age group (specifically, pediatric or adult) that holds the majority in that unit.
Q4: When adding my locations in NHSN, I’m asked for the location bedsize. Should this represent the number of beds in the unit, or the number that are staffed?
The location bedsize should represent the number of beds that are set up and staffed.
Q5: My emergency department (ED) has beds within the ED as well as hallway beds assigned to the ED. Do I include the hallway beds in the bedsize count?
Yes, only if the hallway beds are used for the ED and not for other purposes. If the beds are being used for outpatients or those in observation status awaiting an inpatient bed, then the beds will have to be mapped separately and appropriately.
Q6: Should the number of beds for my location include swing beds?
Yes. Swing beds should be included in the total location bedsize count. Patients residing in these beds should also be included in your surveillance efforts for this location.
Q7: My whole unit is swing beds. How should I map this unit in NHSN?
Does this Swing Bed unit have one of the following letters in the third position of the CCN: ‘U’, ‘W’ or ‘Y’?
If yes, please see FAQ on Skilled Nursing Facility (SNF)/Nursing Home. If no, map this unit to a location in the facility. Select one of the NHSN Chronic Care Locations most appropriate for this unit.
Unit moved to different floor
Q8: One of the units in my hospital has moved to a different floor and has a new name. Should I create a new location in NHSN?
If the staff moved with this location, and the type of patients remains the same (specifically, the only difference is the geographical location), then it’s recommended to just change “Your Code” and “Your Label” on the existing location record. This will keep all the data for this location continuous within analysis. Note that no two locations (inactive or active) can have the same “Your Code”.
Otherwise, it is recommended that your facility inactivates the location and creates a new location for the moved unit. Note that deactivating a location will simply prevent you from being able to enter new data for that location; the location and its previously entered data will still appear in the analysis output options and you will continue to have access to these data.
Q9: If I inactivate one of my locations in NHSN, will I still have access to this location’s data?
Yes. Inactivating a location will simply remove the location as an option in the location drop-downs during data entry. All data reported in inactive locations will still be accessible, including through the analysis output options. For more information about changing your locations, please see page 11: NHSN Newsletter – June 2017 [PDF – 3 MB].
Q10: Will data from my inactive location be sent to CMS?
Data from the inactive location will be sent to CMS for the appropriate reporting period if this location is included in your monthly reporting plan.
Mixed acuity unit and CMS reporting
Q11: After further review, we’ve determined that one of our units should be mapped as a mixed acuity unit. What implications will this have for my hospital’s reporting to CMS?
While mixed acuity locations may have ICU and/or ward beds, they are not considered ICU locations or ward locations. Therefore, the data from mixed acuity units will not be shared with CMS for CLABSI and CAUTI reporting. However, mixed acuity units are considered part of facility-wide inpatient (FacWideIN) reporting for MRSA or CDI LabID Events.
Change in patient type
Q12: The type of patients that are now housed in one of our units has changed. How do I change the CDC location in NHSN?
Once a location has been used for reporting in NHSN, the CDC Location Description cannot be changed. Instead, you will need to add a new location to represent the new CDC location mapping. Note, however, that when creating this new location, you will need to use a different “Your Code” value. It is also recommended that you inactivate the old location once you’ve completed all data entry for that location. For more information about inactivating a unit in NHSN, please see the following articles:
June 2017 newsletter article (pg. 6) [PDF – 3 MB]
December 2013 newsletter article (pg. 11) [PDF – 1 MB]
Skilled Nursing Facility (SNF)/Nursing Home
Q13: I am an Acute Care Hospital (ACH) with a CMS-licensed skilled nursing facility /nursing home physically located in my ACH. This SNF has a different CCN from my ACH. How should I map this unit?
If the SNF has a separate CCN from the hospital, it should not be mapped as a location within your ACH. If you want to report data from the SNF unit, this unit should be enrolled as a separate NHSN facility into the NHSN Long Term Care Facility (LTCF) Component. To determine if your skilled nursing facility/unit (SNF/SNU) is a CMS-licensed unit, verify the unit’s CCN. The last 4-digits of a SNF CCN are between 5000-6499.
- Email NHSN@cdc.gov and ask for NHSN Enrollment to be added onto your SAMS profile.
- Once you see that option available, you can start the enrollment process for your LTCF. Remember, if you already have SAMS access, you can skip Steps 2-3: Enrollment for LTCF. On the enrollment screens, please be sure to select one of the LTCF types and the LTCF Component.
Q14: I am an Acute Care Hospital (ACH) with a non-CMS-licensed skilled nursing facility (SNF)/nursing home physically located in my ACH. This SNF shares the exact same CCN as my ACH. How should I map this unit?
If the SNF shares the exact same CCN as the ACH, it should be mapped as a location within the facility using the most appropriate CDC location description. In most cases, the NHSN Chronic Care Locations will be the best fit for this type of unit.
Q15: Our Acute Care Hospital (ACH) has an inpatient psychiatric unit, with a separate CCN (specifically, “M” or “S” in the 3rd position of the CCN). How do I add the inpatient psych unit?
Guidance on adding or updating an existing inpatient psychiatric unit is outlined in the IPF Locations document [PDF – 300 KB] on the website.
*If your IPF unit is not physically located within your ACH, see FAQ on Physically separate facilities/units.
Q16: Our Acute Care Hospital (ACH) has an inpatient rehabilitation unit with a separate CCN (specifically, “R” or “T” in the 3rd position of the CCN). How do I add the inpatient rehab unit?
Guidance on adding or updating an existing inpatient rehabilitation unit is outlined in the IRF Locations document [PDF – 500 KB].
*If your IRF unit is not physically located within your ACH, see FAQ on Physically separate facilities/units.
Physically separate facilities/units
Q17: Our Acute Care Hospital (ACH) has an inpatient psychiatric unit (IPF) and/or an inpatient rehabilitation unit (IRF) that is not physically located within my ACH. How do I add this unit?
IPF and IRF units that are in physically separate buildings from the affiliated acute care hospital should be enrolled as separate facilities in NHSN. For guidance on enrollment for physically separate facilities/units, please see page 5: NHSN Newsletter – October 2018 [PDF – 1 MB].
*EXCEPTION: This does not apply to emergency departments that are affiliated with the hospital but are in a physically separate location. Affiliated emergency departments can be mapped as a unit within the existing NHSN acute care hospital for the purposes of LabID Event surveillance.
Mapping overflow units
Q18: My facility has overflow beds as part of a unit which can house patients from other units as well. Where should I include those beds and report their HAI data?
If the original unit, including the overflow beds, still meets the 80% rule for service type and acuity level, then those overflow beds can simply be included in reporting along with the unit. However, if inclusion of those overflow beds in the unit creates a violation of the 80% rule, then we recommend creating a virtual location for the overflow beds only, mapped based on the average patient-mix of those beds (over a 3-month period). If virtual locations are not an option for your facility, determine the best location description for this unit including the overflow beds. If at least 80% of the patients are not of a single acuity level, this location should be mapped as mixed acuity unit.
Emergency Department and Observation Units
Q19: My facility does not have a dedicated observation unit and the few observation patients we have are housed within other inpatient units. Do I extract the observation patients for reporting of LabID CDI and MRSA?
According to the December 2014 newsletter [PDF – 1 MB] (pg. 7), if a facility does not have a designated observation unit, then the facility does not need to map an observation unit in NHSN (for example, data from an observation unit will not need to be included in your MRSA and CDI surveillance). However, the observation patients should be included in the surveillance efforts for the inpatient unit in which they reside.
Q20: My facility has an observation unit where patients typically stay for 48 hours before either being admitted to the facility or discharged. How should this unit be mapped?
Based on the patient length of stay in this unit, this location should be treated as a general inpatient location if more than 50% of patients are staying for longer than 24 hours. This means that it will need to be mapped to the most appropriate inpatient location. If more than 50% of patients are staying for 24 hours or less, then the location can stay mapped as an observation unit.
Q21: I have an affiliated emergency department (ED) that is located off-site. Should I map the affiliated ED for LabID Event reporting?
Yes, affiliated EDs should be mapped as a location within the affiliated Acute Care Hospital if the off-site ED shares the same CCN and has the same medical record allowing the patients to be followed through the system. If your facility has more than one offsite ED, we recommend mapping the two EDs as separate locations in NHSN.
Units housing Mothers and Babies
Q22: Our facility has a Level II nursery but often times the babies are housed with the mother. Since the nursery doesn’t have beds and the babies are not always physically in the nursery, should we map the location?
Yes, the nursery should be mapped as a location in NHSN even if the babies are at the mom’s bedside. The nursery bedsize should represent the number of bassinets (specifically, beds) that are set up and staffed.
Q23: Many of our surgical wards or other units in the hospital have telemetry capabilities. How should these units be mapped?
Do at least 80% of the patients in this unit require telemetry? Or, in other words, is the primary reason the patient is admitted to that unit (as opposed to any other unit in the hospital) because of the patient’s need for telemetry? If so, then this unit should be mapped as Telemetry. If patients are being housed in a general surgical unit that is equipped with telemetry capabilities, that does not necessarily meet the definition of a telemetry unit.
Urgent care units
Q24: How should urgent care units be mapped?
If the urgent care unit is within your facility, then it can be mapped as an Urgent Care Center in NHSN. However, if the unit is a free-standing location or physically separate from your ACH, it should not be mapped in NHSN.
Location Mapping for CMS Reporting
Q25: We have several ward types for which we conduct surveillance but are not required for CMS reporting. Can we map them as medical wards so that our numbers can be reported to CMS?
No, we do not recommend mapping wards as medical, surgical, or medical/surgical simply to be included in CMS reporting, as this has adverse effects at several levels. First, and most importantly, this would misrepresent your data that is being reported to CMS by comparing your rates against an incorrect baseline risk population. This can lead to under- or even over-estimation of your SIR for the unit. Second, incorrect location mapping indirectly makes NHSN metrics less accurate, as they are dependent on the accuracy of the location definitions to delineate risk populations. Therefore, we highly encourage users to adhere to NHSN location mapping guidelines as closely as possible.