Centers for Disease Control and Prevention



NHSN.10.1Hello everyone and welcome to today’s training for the Healthcare Personnel Influenza Vaccination Summary Reporting for NHSN. This is a refresher training for inpatient rehabilitation facilities. We appreciate you joining us. I did want to remind everybody before we get started that as you saw in the e-mail you received, if you have a question that you’d like us to answer at the end of this presentation, please type it into the question box and we will read it aloud and answer it for everyone. Now it’s my pleasure to turn the mic over to Elizabeth.Thank you, Megan. My name is Elizabeth Kalayil and I work as a contractor in the Immunization Services Division at CDC. I will be presenting information during the webinar along with Megan. So, this presentation will cover several topics. The first objective is to provide an overview for NHSN users on using the Healthcare Personnel Safety Component. We will then review the reporting requirements for the Healthcare Personnel Vaccination Module. We will next review how to enter data in the module and how to verify successful submission of data. We will now go over a few aspects of using the Healthcare Personnel Safety Component. As you know, inpatient rehabilitation facilities can either be freestanding facilities or units within the affiliated acute care or critical access facilities. There are important differences in the way healthcare personnel influenza vaccination summary data are entered into NHSN for these two types of inpatient rehabilitation facilities. Please be sure to pay special attention to the guidance for your specific facility type. Freestanding facilities will be referred to as freestanding IRFs, and units within the affiliated acute care or critical access facilities will be referred to as IRF units. To combat NHSN access issues due to staff turnover, vacation or extended leave, we recommend that each facility has at least two individuals who can add, edit, delete, and analyze the healthcare personnel influenza vaccination summary data in NHSN at all times. Any current user with administrative rights, which includes the NHSN facility administrator, can add a new user to the NHSN facility. To add an additional user to an NHSN facility, click on ‘users’ and then ‘add’ on the left-hand navigation bar. On the add user screen, complete all the fields that are marked with an asterisk. The user ID can be any combination of letters and numbers. For example, the user’s first initial and last name or the user’s internal employee ID number. Next, please enter the user’s first name, last name, phone number and e-mail address. Then click on ‘save.’ The edit user rights screen will appear after you save the new user information. Select the appropriate level of rights to give to the new user. This step must be completed for new users to have access to any system features within the Healthcare Personnel Safety Component. If you are unsure about the level of user rights to assign to a new user, please contact the NHSN Helpdesk for assistance. Once the new user information has been saved, that user will receive an automated welcome to NHSN e-mail with the instructions to begin the process of becoming an NHSN user. After agreeing to the NHSN rules of behavior, the new user will receive an automated e-mail to register with SAMS. SAMS stands for Secure Access Management Services and provides secure online access to CDC applications such as NHSN. All NHSN users are required to complete the SAMS identity verification process prior to gaining access to NHSN. After registering with SAMS, the new user receives instructions to create a SAMS account and complete an identity verification process. During this process, new users should be sure to follow the instructions carefully to prevent delay in processing the documentation. The user will receive confirmation from SAMS once the documents are approved and a SAMS grid card will be delivered to their home address. They will then be able to access their NHSN facility using their SAMS credentials.Please keep in mind that the new user has 30 days to begin the SAMS registration process and 60 days to return the identity proofing documentation. If those deadlines are not met, the user will need to reach out to the NHSN Helpdesk to be re-invited to SAMS to start the process from the beginning. Please note that it will take at least 2 to 3 weeks for the new user to be able to access NHSN. CDC recommends that new users begin the onboarding process well in advance of the reporting deadline. Users should be sure to login to NHSN using their SAMS card at least one time each year so that it will remain active. Please note that if your account is inactive and you try to enter your data, this may delay your reporting. Because the SAMS card is user-specific and not facility-specific, an individual with user access to multiple NHSN facilities through the same e-mail address could enter data into multiple NHSN facilities using the same single SAMS card. Additionally, an individual can keep their SAMS card and simply change the e-mail address on the SAMS account if they should begin working at a new facility. More information about the SAMS process can be found using the link listed on the slide. NHSN highly recommends that if there is a change in the NHSN facility administrator, he or she should transfer that role to another user prior to leaving the facility. This saves a significant amount of time for the newly designated facility administrator and prevents a gap in access to your facility. If the previously designated NHSN facility administrator has left your facility prior to reassigning that role to another person, you will need to reach out to the NHSN helpdesk to have that role manually reassigned to the new NHSN administrator. To complete this process, a letter must be faxed to the NHSN Helpdesk using the number listed on the slide. The letter should be from an official at your facility requesting that you be assigned as the new NHSN facility administrator since the previous administrator is no longer with your facility. In addition to the name and e-mail address of the new facility administrator, the letter should include the name and e-mail address of the old facility administrator as well as the facility name and 5-digit NHSN ID number, if known. Please do not re-enroll this facility in NHSN. After the NHSN Helpdesk receives the fax and completes the re-assignment, the newly designated facility administrator will receive the welcome to NHSN e-mail to start the new NHSN user onboarding process. If the newly-assigned facility administrator was already a NHSN user with a SAMS card, then no further action is required. Now we will review the specific reporting requirements for the healthcare personnel influenza vaccination summary data. There are three required denominator categories. One category consists of employees, while the other two categories consist of non-employees. One non-employee category is licensed independent practitioners and the other non-employee category includes adult students, trainees, and volunteers. To be included in the denominator, all healthcare personnel must be physically present in the facility or at least one working day during the reporting period, which is between October 1st through March 31st. This slide shows the top portion of the healthcare personnel influenza vaccination summary data form which lists all the denominator categories. The first required denominator category is employees. Employees are defined as all persons receiving a direct paycheck from the healthcare facility regardless of clinical responsibility or patient contact. The second denominator category consists of non-employee licensed independent practitioners, specifically physicians, advanced practice nurses and physician assistants, who are affiliated with the healthcare facility but are not on the facility’s payroll (and that’s regardless of clinical responsibility or patient contact). Please note that this category also includes post-residency fellows. The third required denominator category consists of non-employee adult students, trainees and volunteers who are aged 18 and over. This is defined as medical, nursing, or other health professional students, interns, medical residents, or volunteers aged 18 or older who are affiliated with the healthcare facility but are not on the facility’s payroll, again, regardless of clinical responsibility or patient contact. The fourth denominator category consists of non-employee contract personnel. Reporting for this category is optional at this time. Contract personnel are defined as persons providing care, treatment or services at the facility through a contract and who do not fall into any of the other denominator categories. Some examples include dialysis technicians, occupational therapists, admitting staff, and pharmacists. Please refer to appendix A of the healthcare personnel influenza vaccination summary protocol for a suggested list of contract personnel. If a facility decides to report contractor data, it can note which categories of contract personnel are included in their data by using the comments function in NHSN. The numerator includes healthcare personnel who received an influenza vaccination during the time from when the vaccine became available, for example, August or September, through March 31st of the following year. There are five numerator fields in the NHSN module covering the four numerator categories, and these are mutually exclusive. This slide shows the numerator fields as they appear on the healthcare personnel influenza vaccination summary data form. The categories include influenza vaccinations received at the healthcare facility or elsewhere, medical contraindications, declinations, and unknown vaccination status. The first numerator category is healthcare personnel who received an influenza vaccination either at this healthcare facility or elsewhere. Please note that these are two separate fields in the module. The first field includes healthcare personnel who received an influenza vaccination at this healthcare facility since vaccine became available this season. The second field includes healthcare personnel who were vaccinated outside the healthcare facility since vaccine became available this season and provided a written report or documentation of influenza vaccination. Acceptable forms of documentation include a signed statement or form, an electronic form or e-mail from the healthcare worker, or a note, receipt or vaccination card from the outside vaccinating entity. Verbal statements are not acceptable for this measure.The second numerator category is healthcare personnel who have a medical contraindication to the influenza vaccine. For this measure, for inactivated influenza vaccine, accepted contraindications include a severe allergic reaction after a previous vaccine dose or to a vaccine component including egg protein, or a history of GBS within six weeks after a previous influenza vaccination. Healthcare personnel who have a medical contraindication to live attenuated influenza vaccine, other than a severe allergic reaction to a vaccine component, or history of GBS within 6 weeks after a previous influenza vaccination, should be offered IIV by their facility, if that’s available. Therefore, the medical contraindications stated above are the only accepted contraindications for the module. Documentation is not required for reporting a medical contraindication and verbal statements are acceptable.The third numerator category is healthcare personnel who are offered and declined to receive influenza vaccine. Documentation is not required for reporting declinations. The fourth numerator category is healthcare personnel with unknown vaccination status, or they did not meet any of the criteria for the other numerator categories.Healthcare personnel working in an IRF unit that is mapped as an inpatient rehabilitation ward within an acute care facility, having a ‘T’ or ‘R’ in the third position of the CCN should be reported separately from the acute care facility in NHSN to fulfill requirements of the CMS inpatient rehabilitation quality reporting program. This is important, as if it’s not done, the IRF unit will not receive credit from CMS regarding data reporting. However, if a healthcare worker from the IRF unit also works in the acute care facility during the influenza season and meets protocol definitions, then the individual should also be included in the acute care facility’s summary data. Data from multiple IRF units located within a single facility should be combined and submitted to NHSN as a single summary data report. IRFs that are freestanding should enroll in NHSN separately and report their data separately. This slide reviews a few points about reporting requirements. Healthcare personnel in the denominator population who received an influenza vaccination during the time when the vaccine became available through March 31st of the following year are counted as vaccinated since the vaccine for a given season may be available as early as August or September. For example, an employee who receives influenza vaccine in August and physically works in the facility for one day or more during the October 1st through March 31st period, should be included in the data. Also, IRFs participating in the CMS Inpatient Quality Reporting program are still required to report healthcare personnel influenza vaccination summary data through NHSN, although reporting patient influenza vaccination is no longer required. Note that only one summary report is required to be submitted for each flu season.Now I will turn the presentation over the Megan, who will review data entry.Thank you, Elizabeth. My name is Megan Lindley, and I work in the Immunization Services Division at CDC. We will now go over data entry in NHSN. While we are completing the second half of the presentation, I want to encourage people to continue to enter questions for the Q&A at the end into the question box.We’ll start by going through how to navigate through NHSN. Facilities must use SAMS and can access the NHSN activity homepage by clicking on the link listed on this slide. You will then need to enter your SAMS username and password followed by your SAMS grid card numbers. If you have questions or need assistance with using SAMS, please contact the SAMS HelpDesk toll-free by phone or by e-mail using the information listed on this slide. This slide shows the NHSN landing page. Select the appropriate component, which in this case is Healthcare Personnel Safety, and the facility from the dropdown boxes. Next, click the ‘submit’ button to proceed. While you are using NHSN, please use the NHSN buttons and not the web browser buttons to navigate through the application. When navigating through NHSN, you can always see which facility, user, and component are in use at the top of the screen and you see an image of that at the bottom of this slide.This slide shows the Healthcare Personnel Safety or HPS component homepage. You will see that there is a navigation menu on the left-hand side of the page which you can use to access different parts of the module. Next, facilities will need to complete one monthly reporting plan for the entire influenza season. Please note that only acute care and critical care access hospitals who have CMS IRF units mapped within their NHSN facility will see this NHSN screen when adding a monthly reporting plan. So again, this screen is for units within an acute care or critical access facility. Acute care and critical access hospitals with IRF units will also need to select the correct month and year from the dropdown menus. Each IRF unit or hospital should check the appropriate box for influenza vaccination summary under the Healthcare Personnel Vaccination Module heading. For example, to report data on inpatient and outpatient units for the acute care hospital, you would check influenza vaccination summary for the hospital. To report data for an inpatient rehabilitation unit that is part of the acute care or critical access hospital you would check influenza vaccination summary for inpatient rehabilitation facility units. Please note that to report both hospital and IRF units, both boxes on the reporting plan should be checked.This slide shows what freestanding IRFs will see on their screen in NHSN when adding a monthly reporting plan. To add a monthly reporting plan, click ‘reporting plan’ and then ‘add’ on the navigation bar. Select the correct month and year from the dropdown menus. If you are reporting data for the 2019-2020 influenza season, for example, you can select October 2019 for your monthly reporting plan. It is very important to correctly submit your monthly reporting plan which includes identifying the correct influenza season because reporting plans that identify the wrong influenza season will not allow your data to be submitted in fulfilment of CMS reporting requirements. The user should check the box next to influenza vaccination summary under the healthcare personnel vaccination module. After making the appropriate selections, the user must click ‘save.’ After completing the monthly reporting plan, facilities will need to enter their data into NHSN. To enter summary data, go to ‘add’ under ‘flu summary’ on the left-hand navigation bar. Click ‘continue’ to proceed as influenza vaccination summary appears as the default option on the dropdown menu. Please remember that you will not be able to enter the summary data report until you have first added your monthly reporting plan. Again, we are starting with the view for IRF units that are within acute care or critical access hospitals. These units will see a slightly different screen when adding HCP influenza vaccination data. The user must complete all fields marked with an asterisk on this page, which indicates mandatory data entry. ‘Influenza’ and ‘seasonal’ are the default choices for vaccination type and influenza subtype. Here, the user will then select the appropriate flu season in the dropdown box. For example, if you are reporting data for the 2019-2020 influenza season, you must select ‘2019-2020’ in the dropdown box. This is very important since data submitted under the incorrect influenza season will not be shared with CMS and therefore will not fulfill reporting requirements for CMS quality reporting programs. Facilities can always contact NHSN if they are unsure as to which influenza season is currently being reported. The user should indicate the appropriate location on the dropdown box. For example, to report data for inpatient and outpatient units for the hospital, you would select ‘hospital.’ To report data for an inpatient rehabilitation unit that is part of the acute care or critical access hospital, you would check ‘IRF units.’ Please note that to report for both hospitals and IRF units, a summary report should be submitted for each, so you would go through this process twice. As with the monthly reporting plan, please note that this is the screen that freestanding IRFs will see in NHSN when adding influenza vaccination summary data. Again, you must complete all fields marked with an asterisk on this page. ‘Influenza’ and ‘seasonal’ are the default choices for vaccination type and influenza subtype. The user would then select the appropriate flu season in the dropdown box. Again, if you are reporting 2019-2020 influenza season data, you must select ‘2019-2020’ from the dropdown box. This is very important since data submitted under the incorrect influenza season are not shared with CMS and do not fulfill CMS reporting requirements for the current season.This slide shows what the data entry screen looks like in the NHSN module. The asterisks on the screen indicate the columns that must be completed. Users can use the tab key on a computer keyboard to move across columns. Users should enter a zero in a field if no healthcare personnel at the facility fall into that category because, again, the columns indicated with asterisks cannot be left blank. You’re not able to save your information without entering something there. The comments box shown at the bottom of the screen can be used to enter additional information, usually side notes or reminders. However, please note this information cannot be analyzed within NHSN. Once the required data have been entered, click the gray ‘save’ button to save the record. Please note that the summary data must be entered into NHSN prior to the May 15th reporting deadline so your data will be shared with CMS to meet the IRF quality reporting program requirements. Any data that are entered after the May 15 reporting deadline will not be shared with CMS and will therefore not meet the submission requirements for the IRFQR program. For each update of the healthcare personnel influenza vaccination summary data after the initial entry, you will see a message at the top of the screen indicating that a record of the summary data for that season already exists. The date last modified shows when the data were last entered and saved. If you need to edit and update these data, you can simply click the edit button at the bottom of the screen to modify existing data. Once completed, please be sure to save your updated data by clicking the ‘save’ button at the bottom of the screen. You should then see a message at the top confirming that your data have been saved. The date last modified will also be automatically updated by NHSN.We will now go over how facilities can verify their data once entered into NHSN. After healthcare personnel influenza vaccination summary data have been entered into NHSN, users can verify that the data have been saved correctly by running a report within the NHSN analysis feature. This report can be found in the CMS reports folder under the inpatient rehabilitation facility’s sub-folder. By clicking the gray ‘run report’ button next to this report, the facility can review the healthcare personnel influenza vaccination data by influenza season, stratified by healthcare personnel category, which is, again, employees, licensed independent practitioners, adult students, trainees and volunteers, and an entry for all three categories combined. This report shows the exact information that will be shared with CMS for your facility. Please remember that by default, the results will appear in a separate HTML window. If a second window does not appear when you click the ‘run’ button, please be sure to check your pop-up blocker and allow pop-ups from . Please refer to the link on this slide for step-by-step guidance for running and interpreting this report. In addition to running the CMS line listing report described in the previous slide, IRF units within acute care or critical access hospitals can confirm two other pieces of information within NHSN to ensure their data will be shared with CMS appropriately. Both pieces of information can be confirmed on the facility information screen within NHSN. To get to the facility information screen, click on ‘facility,’ and then ‘facility info’ on the left-hand navigation bar. First, verify that the correct acute care or critical access facility CMS certification number, or CCN, and the CCN effective date have been entered for your facility. The CCN effective date should be the date your facility first received its CCN from CMS. If you cannot obtain that exact date, but it was prior to January 1st, 2017, please use January 1st, 2017 as the CCN effective date. You also need to ensure that your facility is enrolled in NHSN as the correct facility type. For acute care facilities, for example, HOSP-GEN, CAH for critical access hospital, HOSP-SURG for surgical hospital, or HOSP-WOM for women’s hospital. In addition, please review the specific details of the IRF unit of the acute care or critical access facility by going to the locations tab under ‘facility’ in the left-hand navigation bar in NHSN. For the location of your IRF, please ensure that ‘yes’ is selected for the question: Is this location a CMS IRF unit within a hospital? Also, please ensure that the correct CCN and CCN effective date are entered for each IRF unit and those unit CCNs are distinct from the CCN for your primary critical access or acute care facility. They’re usually very similar, differing by a “T” or an “R” in the third position, as you can see on this screen. As long as your data appear in the CMS line listing for the current reporting period, your CCN and CCN effective date are correct for both your IRF unit and acute care or critical access facility type, and your facility is enrolled in NHSN correctly, no further action is required on your part. Your data will be shared with CMS following the reporting deadline. NHSN does not provide e-mail confirmation to facilities of data submission, and we recommend that you maintain printed copies or screenshots of data entry for your records.For freestanding IRFs, the information to be verified is similar in many ways but subtly different. First, verify that the correct facility, CMS certification number, and CCN effective date have been entered correctly. Again, if you do not know your exact CCN effective date but it was prior to January 1st, 2017, please enter January 1st, 2017 as the CCN effective date. You also need to ensure that your facility is enrolled in NHSN as the correct facility type. All freestanding IRFs should be enrolled as the facility type HOSP-REHAB. If your facility is not correctly enrolled, please contact NHSN@ for assistance. This is very important as only data from facilities enrolled as the HOSP-REHAB will be shared with CMS for freestanding IRFs. Again, as long as your data appear in the CMS line listing for the current reporting period, your CCN and CCN effective date are current, and your facility is enrolled as the correct type, no further action is required on your part for your data to be shared with CMS. Facilities can visit the NHSN website using the link on this slide. The website contains links to the HPS protocol, data collection forms, frequently asked questions, comprehensive training slides, and recorded trainings for previous years on healthcare personnel influenza vaccination summary reporting. Please note that the comprehensive training slides on this page include more detail on topics such as data reporting and analysis features. Therefore, new facilities may find it helpful to also refer to these slides. If you have any questions about NHSN, please send an e-mail to user support at NHSN@. You should also include ‘HPS flu summary’ in the subject line of the e-mail and specify ‘IRF’ as this will help us to better assist you. This concludes the slide presentation for the webinar, and we can answer questions. Again, we’re encouraging you to submit your questions via the chat box. We will read aloud the questions we’ve received and answer them for the benefit of all attendees. The first question was why do you accept a verbal statement for a medical contraindication as it seems like that should be part of the declination form that the person documents why they cannot take the vaccine?So that’s for a couple of reasons. First, this measure was extensively pilot-tested and validated at different kinds of facilities, and in that process, we determined whether valid information was collected via verbal reporting or whether documentation was required. In cases where documentation was not needed for the information to be adequately valid, we did not want to impose additional burden. In addition, somebody may have had a reaction to a vaccine many, many years in the past that constitutes a medical contraindication for the purposes of reporting, and we don’t want to ask you to ask people to go back 20, 25 years in their history in order to find that documentation. Certainly, if your facility has the declination form that collects that type of information, you can use that form. We don’t impose any requirements on the type of forms that facilities use. We only want to let you know what is required for NHSN purposes.Another question. We have a large medical staff who all have rights to our IRF units. Determining who actually stepped onto that unit is difficult. Should I report the hospital-wide numerator and denominator to the LIP section on the IRF reporting? This is a question that we get a lot. The answer is simply that we recognize that it can be difficult for particularly large facilities to know who is moving across different reporting units, and we ask you to do your best. One of the materials that is on the NHSN website is a set of guidance that we’ve collected from hospitals that have been reporting that have the tips and tricks that they have used to do this type of tracking, and we encourage you to refer to that for some possibilities, and if you are not further able to distinguish who has entered the IRF unit during the season, you can simply report the best available information that you have on the staff or LIPs who you reasonably suspect would be in that unit performing work duties some time in the October 1st through March 31st reporting period.The next question is similar. It says the employees are not assigned to the unit but may float for coverage or transport patient supplies or equipment. LIPs may get consults on the unit but not all the time; it is not a clean division. Again, we understand that making this distinction can be very difficult, and the reality is particularly of a large hospital where there are employees that are moving across IRF units. We simply ask that you do the best you can to determine which staff are or would be within the unit during the reporting period. Again, that guidance information that I referenced on the NHSN website is collected from actual facilities who have been doing this type of reporting, and I think has been very useful for other facilities in getting ideas.Here's a question. If I work in a rehab long-term care facility, is Thursday’s webinar more pertinent? So, you may have seen Thursday’s webinar is for long-term acute care hospitals and I do want to make that distinction. Long-term care facilities, as in skilled nursing facilities, CMS certified SNFs, are not required by CMS or by NHSN to report healthcare personnel vaccination data, so we are not offering any training webinars this season for those facilities. However, if you navigate to that nhsn webpage, there is a page of materials, including a recorded training specifically for long-term care facilities, but again, please do note that it would be optional reporting. It’s inpatient rehabilitation facilities and long-term acute care hospitals that are required by CMS to do this reporting.So, the next question is even though the IRF unit inside the hospital is separately reported by going through the process twice, once for the hospital and once for the IRF, it is still submitted as one summary report, correct? I will answer the question I think is being asked there. So because we are trying to measure the level of protection for the patients and the healthcare personnel working in these two specific areas and because they are separately certified by CMS, you should submit a report for the acute care facility and for the IRF unit within the acute care facility, even though as some of the previous questioners noted, there are staff that work in both of those units, and if they do work in both of those units or areas, they would be counted once in each report. Because the CCN for the acute care facility is not identical to the CCN for the IRF unit itself, and CMS data are submitted to CMS by CCN, please note that those staff are not counted twice because the IRF unit and acute care data are not combined. But the general response is that we do recognize that in the way we have specified this reporting, healthcare personnel may be counted multiple times in different units or even in different facilities in which they may work, that is correct because we are estimating a level of vaccination and therefore a level of protection for people within that facility.The question is can you show slide 41 again? There is the slide. There’s the URL. Okay, we had a question that was a follow-up on the idea of documentation for medical contraindications. It says in order to make the 90% CMS rule for influenza acceptance, it is good to know why a person cannot take the vaccine in writing so you can correct it, for example, offering non-egg-based vaccines to persons with egg allergies.I am aware that those data are collected for patient influenza vaccination which as Elizabeth previously noted is no longer required reporting for IRFs. I am not aware of those type of data being collected for healthcare personnel. But, again, if there are requirements being imposed on you by other entities or if there’s tracking that you want to do for your facility, certainly we encourage you to use whatever kinds of forms or documentation make that possible. It’s simply that if you do not use those type of forms, it is not required for NHSN that you have written documentation of somebody’s medical contraindication or declination.So I think we had one other question about the monthly reporting plan and the question was if data are required to be reported each month, the answer is no, you can just submit your final data at the end of the flu season but you do have to complete the monthly reporting plan form once for each flu season. Once you complete that monthly reporting plan form, all the other months are populated. So monthly reporting is not required. You can do so if you would like to, but that is optional.So, we don’t see any other questions in the chat box at this time. Ah-ha, there’s one. I do want to continue to encourage people to enter your questions here. We have about ten more minutes. The question is: Where is the set of guidance for LIP tracking tips from other facilities? I will look it up on our website and then I will let you know. Okay, and we received another question. Will you send the PowerPoint out to those who attended via e-mail? Actually, you can download the presentation. It should be on your screen. It’s on the bottom right hand side of your screen, HCP FluVax. It’s in PDF form so you can just download it right now, but we will also have a recording of the presentation and some transcripts of the webinars that we are holding this month and that will be posted on the CDC website in a few weeks. So, if you have colleagues who are unable to attend the presentation, they can always view the recording or read the transcripts.For the location of that specific guidance document that I mentioned, it does take a few clicks. We are re-doing the NHSN website so you can go to places in fewer clicks, but if you go straight to the URL that is on the screen right now on slide 41, scroll down to the heading entitled ‘Supporting Materials’ and that is the third document entitled ‘Methods and Strategies Used to Collect Healthcare Personnel Influenza Vaccination Data, December 2013.’ Another question: Do you have a certificate of attendance? I assume for this training. We do not, but we can gather the names of people who have signed in with their first and last name if your facility requires you to demonstrate that you attended this training. If you want to e-mail us, we would be happy to e-mail back and agree that you did attend, if you are in attendance, but we don’t issue a formal certificate or continuing education for this event.Those are all the questions that we’re currently seeing on the screen. Again, we’ll wait a couple more minutes to see if there are any last-minute questions. And if you have a question and don’t get to it now, again, you can always send your questions to: nhsn@. If you include the fact that you’re asking about healthcare personnel flu vaccination and your facility type in the subject line, that helps the e-mail get triaged to us more quickly so that we can assist you more quickly. All right, seeing no further questions, we will give you back five minutes of your time. Again, if you come up with another question, please do send it to nhsn@ and we’ll assist you as quickly as possible. We appreciate you attending this refresher training. We wish you a good afternoon. Thank you so much. ................
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