Surgical Site Infection (SSI) Events

All Data Collection Forms are Print-only

SSI Event

• Surgical Site Infection (SSI) form – January 2021 (57.120) pdf icon[PDF – 180 KB]
  • Customizable form word icon[DOCX – 80 KB]
  • Table of Instructions pdf icon[PDF – 150 KB]

Denominator Form

• Denominator for Procedure – January 2021 (57.121) pdf icon[PDF – 100 KB]
  • Customizable form word icon[DOCX – 60 KB]
  • Table of Instructions pdf icon[PDF – 200 KB]

Custom Event Form

• HAI Custom Event form – January 2021 (57.115) pdf icon[PDF – 180 KB]
  • Customizable form word icon[DOCX – 80 KB]
    **Not to be used for CLABSI, CAUTI, SSI, PedVAE, VAE, pediatric VAP, or LabID events.**
    To be used in conjunction with Chapter 17: CDC/NHSN Surveillance Definitions for Specific Types of Infections pdf icon[PDF – 2 MB] in the NHSN Patient Safety Manual.

Supporting Forms

• Annual Facility Surveys
• Monthly Reporting Plan

2021 Operative Procedure Code Documents

The documents listed below should be used for procedures performed January 1, 2021 through December 2021.

• List of NHSN 2021 ICD-10 Procedure Code Updates – December 2020 excel icon[XLS – 30 KB]
• ICD-10-PCS Procedure Code Mapping to NHSN Operative Procedure Codes – December 2020 excel icon[XLSX – 800 KB]
• Current Procedural Terminology (CPT) Procedure Code Mapping to NHSN Operative Procedure Codes – December 2020 excel icon[XLSX – 350 KB]
• Additional Guidance for use with NHSN Operative Procedure Codes
  • ICD-10-PCS & CPT Codes – Guidance for HPRO & KPRO Procedure Details – December 2020 excel icon[XLSX – 90 KB]
    This guidance document may be used for completing the NHSN procedure details for HPRO – hip arthroplasty and/or KPRO – Knee arthroplasty operative procedures.
  • FUSN ICD-10-PCS Codes – Guidance for Spinal Level and Approach – December 2020 excel icon[XLSX – 40 KB]
    This supplemental guidance may be used to complete the spinal level and approach fields in the Operative Procedure Details section for FUSN procedures.
  • ICD-10 CM Diabetes Diagnostic Codes – December 2020 excel icon[XLSX – 40 KB]
    ICD-10-CM codes included in this spreadsheet are acceptable for use to answer “YES” to “Diabetes Mellitus” for completing the NHSN Operative Procedure Details.
  • ICD-10-CM/PCS Codes for ‘prior infection at hip or knee joint’ denominator form question – December 2020 excel icon[XLSX – 40 KB]
    Use ICD-10-PCS/CM diagnosis or procedure codes included in this spreadsheet to determine if patient meets criteria for ‘prior infection at index joint’.
• Document detailing changes made to the 2020-2021 operative procedure codes
  • Summary of 2020-2021 Code Changes – December 2020 excel icon[XLSX – 400 KB]
    This document includes changes made to the procedure codes listed for 2020 SSI reporting, as well as, new procedure codes added for 2021 SSI reporting. Because both outdated (removed) and current procedure codes are included, use caution if this document is used to identify procedures for SSI events for reporting.

2020 Operative Procedure Code Documents

The documents are listed  under the 2020 Resources section on the Data Validation page and should be used for procedures performed in 2020.