Welcome to the Healthcare Personnel Safety Component training session for the Influenza Vaccination Summary of the Healthcare Personnel Vaccination Module. Long-Term care facilities can enter their healthcare personnel influenza vaccination summary data using this module. My name is Elizabeth Kalayil, and I work as a contractor in the Immunization Services Division at CDC. I will be presenting information during this webinar. This presentation will cover several topics. The first objective is to provide an overview of the National Healthcare Safety Network, or NHSN, and the Healthcare Personnel (HCP) Vaccination Module, where users will enter data for the HCP Influenza Vaccination Summary. The steps on how to get started in the Healthcare Personnel Safety Component will then be reviewed, along with the surveillance and reporting requirements for the module, and the data reporting forms facilities will need to use. The last segment of the presentation will outline data analysis features of the module. First, we will briefly cover some background information on NHSN. NHSN is a secure, Internet-based surveillance system managed by the Centers for Disease Control and Prevention’s (CDC) Division of Healthcare Quality Promotion. The purposes of NHSN are to collect data from a sample of healthcare facilities to permit valid estimations of the magnitude of adverse events and adherence to practices to prevent adverse events. NHSN also analyzes and reports the data collected to permit recognition of trends and provides facilities with data that can be used for inter-facility comparisons and local quality improvement activities. A comprehensive list of purposes can be found using the Website link listed on this slide. Assurance of Confidentiality is provided by the Public Health Service Act. NHSN takes confidentiality very seriously and makes every effort to protect all facilities that participate. NHSN is divided into five Components: Patient Safety, Healthcare Personnel Safety, Biovigilance, Long-Term Care Facility, and Outpatient Dialysis. Each component can have multiple modules. This training is focusing on the Healthcare Personnel Safety Component, which consists of two modules: the HCP Vaccination Module and the HCP Exposure Module. We will discuss the HCP Vaccination Module during this presentation. As shown on the previous flowchart, there are two modules within the HPS Component: the Healthcare Personnel (HCP) Exposure Module and the HCP Vaccination Module. The Influenza Vaccination Summary is located within the HCP Vaccination Module. Staff members in healthcare facilities can use the Influenza Vaccination Summary to monitor influenza vaccination percentages among HCP. The summary-level reporting replaces individual-level reporting of vaccination status for HCP, which was previously available through NHSN. Several types of long-term care facilities can enroll in the HPS Component. Examples include certified skilled nursing facilities and nursing homes, and intermediate or chronic care facilities for the developmentally disabled. In addition, assisted living facilities and residential care facilities may enroll in the component. Now we will go over some basic elements of the HCP Influenza Vaccination Summary. Healthcare facilities can use the HCP Vaccination Module within NHSN to enter HCP influenza vaccination summary data. It is designed to ensure that HCP influenza vaccination reported coverage is both consistent over time within a single healthcare facility and comparable across facilities. Using NHSN reporting requirements to monitor influenza vaccination among HCP may also result in increased influenza vaccination uptake among HCP, because improvements in tracking and reporting HCP influenza vaccination status will allow healthcare institutions to better identify and target unvaccinated HCP. Increased influenza vaccination coverage among HCP is expected to result in reduced morbidity and mortality related to influenza virus infection. Data are collected on denominator and numerator categories. To be included in the denominator, HCP must be physically present in the facility for at least 1 working day between October 1 through March 31. This includes both full-time and part- time HCP. There are three required denominator categories: employees, licensed independent practitioners, and adult students/trainees and volunteers. Facilities are required to collect data on influenza vaccinations, medical contraindications, declinations, and unknown status for the numerator categories. Each facility must report all numerator categories for the three required denominator categories. The next slides provide an overview on how to get started in the HCP Vaccination Module of the HPS Component. Now we will talk about how to use the HPS Component. First, we will go over some key roles in NHSN. The NHSN Facility Administrator is the person enrolling the facility in NHSN, is the only person who can activate additional components for a facility, has add/edit/delete rights to facility data, users, and users’ access, has authority to nominate/join groups for data sharing, and is the only person who can reassign the role of Facility Administrator to another user. There can only be one NHSN Facility Administrator per facility. Users have the ability to view, enter, and analyze data, but these rights are determined by the Facility Administrator. Users may also be given administrative rights. It is recommended that each facility have at least two NHSN users. One of these users should have NHSN facility administrator rights. For facilities to participate in the HPS Component, they must either enroll in NHSN or activate the HPS Component in NHSN. Enrollment in NHSN is required for facilities that are currently not participating in NHSN and wish to participate. Please follow the link on this slide for more information on enrollment. During the enrollment process, facilities may choose to participate in any of the NHSN components. If a facility is already enrolled in NHSN and wishes to participate in the HPS Component, the facility must activate the component within NHSN. If your facility is not enrolled in NHSN, you must designate an individual to be your NHSN Facility Administrator and then complete the five-step enrollment process. If your facility is already enrolled in NHSN, you must get in contact with your NHSN Facility Administrator and ask him/her to activate the HPS Component. If you are unsure of your facility’s status with NHSN, please e-mail nhsn@cdc.gov for more information. This slide reviews some basic points about a NHSN facility administrator. The Facility Administrator leads the NHSN enrollment and reporting for your facility. This individual adds users and submits or edits facility information in NHSN. The NHSN Facility Administrator does not need to be the same person who serves as the Facility Administrator for your organization. However, the Facility Administrator should have the support and authority to make decisions for the facility about using NHSN. It is also a good idea to have another person at your facility learn about the NHSN enrollment and reporting process as a “back-up” NHSN lead at your facility. This is especially helpful in case the Facility Administrator is away from the office. This slide reviews some basic points about other NHSN users besides the NHSN facility administrator. Some facilities may have several NHSN users per facility to divide the work for the data reporting activities. Any individual entering data into NHSN must be designated as a NHSN facility user by the NHSN Facility Administrator. NHSN users must have a NHSN user ID and passcode from the Secure Access Management System (or SAMS) in order to access NHSN. Before gaining access to NHSN, users must register with SAMS and receive a grid card. Once a user has NHSN access, he/she should review the training slides for reporting data. We’ll now briefly talk about activating the HPS Component. Please note that this component only needs to be activated one time. Only the NHSN Facility Administrator can activate a new component. During this process, the NHSN Facility Administrator will add the HPS Component Primary Contact as a user within the NHSN facility. It is important to keep the contact information for both the Facility Administrator and Primary Contact updated, especially when there is staff turnover, so that the correct individuals can be reached if CDC/NHSN has updates or questions about the HPS Component data. The NHSN Facility Administrator can then add the Primary Contact as a user within the NHSN facility. To do so, the NHSN Facility Administrator should click “Users” on the navigation bar, and then click “Add.” Next, the NHSN Facility Administrator should complete the mandatory fields for the “Add User” screen, which consists of the user ID, first name, last name, and e-mail address. Other users can be added by the NHSN Facility Administrator or the new HPS Component Primary Contact. Users with administrative rights will be able to add additional HPS Component users and share data using the Group function for the HPS Component. As previously stated, NHSN recommends that there be at least two people with access to your NHSN facility at all times. Any current user with administrative rights, which includes the NHSN Facility Administrator, can add a new NHSN user to the NHSN facility. To add an additional user to your NHSN facility, click “Users” and then “Add” on the left hand navigation bar. On the “Add User” screen, complete all fields that are marked with an asterisk. The UserID 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. Please note that the user must use the same e-mail address for SAMS registration. Then click “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 HPS Component. 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 at least add, edit, delete and analyze the HCP influenza vaccination summary data in NHSN. If you’re unsure about the level of user rights to assign to a new NHSN 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 a 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 same 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, be sure follow the instructions carefully to prevent delay in processing the documentation. You will receive confirmation from SAMS once these documents are approved, and a SAMS grid card will be delivered to your home address. You will then be able to access your NHSN facility using your 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, as users will not receive a notification that they have been removed from the process. Please note that it will take at least 2-3 weeks for a new user to be able to access NHSN. CDC recommends that new NHSN users begin the onboarding process well in advance of any reporting deadlines. Users should be sure to log into 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, then 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 this slide. NHSN highly recommends that if there is a change in the NHSN Facility Administrator, he/she should transfer that role to another user in NHSN 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 NHSN 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 facility administrator. To complete this process, a letter must be faxed to the NHSN Helpdesk using the number listed on this 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 facility 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 NHSN Facility Administrator as well as the facility name and five-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 NHSN Facility Administrator was already a NHSN user with a SAMS card, no further action is required. Now we will review the specific reporting requirements for the HCP Influenza Vaccination Summary. The HCP Influenza Vaccination Summary Protocol provides guidance for a facility to collect and report Influenza Vaccination Summary data for the HCP Vaccination Module. It includes comprehensive information about reporting requirements and specifications, such as numerator and denominator categories, methodology, data analyses, and key terms. Each facility should thoroughly review the protocol before collecting and entering data in NHSN. As mentioned previously, 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 HCP must be physically present in the facility for at least 1 working day during the reporting period, which is between October 1 through March 31. This slide shows the top portion of the HCP Influenza Vaccination Summary form which lists the denominator categories. 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, regardless of clinical responsibility or patient contact. This category also includes post-residency fellows. The third required denominator category consists of non-employee adult students/trainees and volunteers, who are aged eighteen and over. This is defined as medical, nursing, or other health professional students, interns, medical residents, or volunteers aged 18 or older that are affiliated with the healthcare facility, but are not on the facility’s payroll, 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 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 HCP Influenza Vaccination Summary Protocol for a suggested list of contract personnel. If a facility decides to report the contractor data, it can note which categories of contract personnel are included in their data by using the “comments” function in NHSN, which will be noted later in this presentation. The numerator includes HCP who received an influenza vaccination during the time from when the vaccine became available (e.g., August or September) through March 31 of the following year. There are five numerator fields in the NHSN module, and these are mutually exclusive. This slide highlights the numerator categories as they appear on the HCP Influenza Vaccination Summary form. The categories include influenza vaccinations received at this healthcare facility or elsewhere, medical contraindications, declinations, and unknown vaccination status. The first numerator category is HCP who received an influenza vaccination, either at this healthcare facility or elsewhere. Please note that these are two separate fields in the NHSN module. The first field includes HCP who received an influenza vaccination at this healthcare facility since influenza vaccine became available this season. The second field includes HCP who were vaccinated outside this healthcare facility since influenza 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 email from the healthcare worker (HCW), or a note, receipt, vaccination card, etc. from the outside vaccinating entity. Verbal statements are not acceptable for this module. The second numerator category is HCP who have a medical contraindication to the influenza vaccine. For this measure, for inactivated influenza vaccine (IIV), accepted contraindications include (1) severe allergic reaction (e.g., anaphylaxis) after a previous vaccine dose or to a vaccine component, including egg protein; or (2) history of Guillain-Barré Syndrome within 6 weeks after a previous influenza vaccination. HCP who have a medical contraindication to live attenuated influenza vaccine (LAIV) other than a severe allergic reaction to a vaccine component or history of Guillain-Barré Syndrome within 6 weeks after a previous influenza vaccination, should be offered IIV by their facility, if available. Therefore, the medical contraindications stated above are the only accepted contraindications for this module. Documentation is not required for reporting a medical contraindication, and verbal statements are acceptable. The third numerator category is HCP who were offered and declined to receive the influenza vaccine. Documentation is not required for reporting declinations. The fourth numerator category is HCP with unknown vaccination status, or they did not meet any of the criteria for the other numerator categories. This slide reviews a few points about the reporting requirements. Facilities are only required to report data once at the conclusion of the reporting period, which is from October 1 through March 31. HCP who are physically present in the healthcare facility for at least 1 working day between October 1 through March 31 are included in the denominator, because October 1 through March 31 is the reporting period. Therefore, HCP always working off-site or out-of-state should not be counted since they are not physically working in the facility. HCP in the denominator population who received an influenza vaccination during the time from when the vaccine became available (e.g., August or September) through March 31 of the following year are included in that category numerator, since influenza vaccine for a given influenza season may be available as early as August or September. Please note that the denominator categories are mutually exclusive. The numerator data are to be reported separately for each of the denominator categories. It is important to remember that the numerator data are mutually exclusive. The sum of the numerator categories should be equal to the denominator for each HCP group. We will now go over entering data for the HCP Influenza Vaccination Summary. After a facility has enrolled in NHSN and/or has activated the HPS Component, and added users, staff members at each facility must complete two required forms: the HCP Safety Monthly Reporting Plan form and the HCP Influenza Vaccination Summary form. The Seasonal Survey on Influenza Vaccination Programs is not required. The survey aims to gather information on influenza vaccination programs for HCP by collecting data on types of personnel groups that are included in a facility’s annual influenza vaccination campaign, methods a facility is using to deliver influenza vaccine to its HCP, strategies a facility uses to promote/enhance HCP influenza vaccination, etc. Now we will go over how to log into NHSN through SAMS. You can access the SAMS activity home page by clicking on the link listed on the slide. You will then need to enter your SAMS user name and password, followed by your SAMS grid card numbers. If you have questions or need assistance with using SAMS, please contact the SAMS Help Desk 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 is Healthcare Personnel Safety) and facility from the drop-down boxes. Next, click the “Submit” button to proceed. While you are navigating through NHSN, you should use the NHSN buttons and not the Web browser buttons. While navigating through NHSN, you can always see which facility, user, and component are in use at the top of the screen. This slide shows the HPS Component home page. You will see that there is a navigation bar on the left-hand side of the Webpage which can be used to access different parts of the module. The monthly reporting plan collects data on the modules and months the facility plans to participate. “Influenza Vaccination Summary” should be selected for the plan, and information is automatically updated for the entire influenza season, as defined by NHSN (July 1 to June 30). After the initial monthly reporting plan has been added for that influenza season, the user will not need to add any other reporting plans. Please note that the monthly reporting plan must be completed once each influenza season before any influenza vaccination summary data can be entered. This slide shows what facilities 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. For example, if you are reporting data for the 2017-2018 influenza season, you can select “October 2017” for your monthly reporting plan. It is very important to correctly submit your monthly reporting plan, and this includes identifying the correct influenza season. 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." As described earlier, after adding a reporting plan for 1 month of a given flu season, NHSN automatically adds the remaining 11 months of reporting plans for that flu season. After adding a reporting plan for any month within the 2017-2018 influenza season, you should see reporting plans for July 2017 through June 2018 populated within your NHSN facility. Each facility will use the HCP Influenza Vaccination Summary Form to collect summary data. The NHSN module contains a single data entry screen to input summary data for each influenza season. When a user enters data, all previously entered data for that season will be overwritten. A modified date will be auto-filled by the system. Therefore, if a facility would like to keep track of its monthly numbers, it should maintain its own record of this, as it will not be able to review monthly reporting numbers in NHSN. CDC/NHSN encourages that HCP influenza vaccination summary counts be updated on a monthly basis. However, as mentioned earlier, entering a single influenza vaccination summary report at the conclusion of the measure reporting period will meet the minimum data requirements for NHSN participation. The user will see that the NHSN data entry screen is set up similar to the layout of the HCP Influenza Vaccination Summary form. Question one on the form pertains to the denominator, while questions two through six pertain to the numerator. The Table of Instructions for the Influenza Vaccination Summary provides instructions and complete definitions for each data field for the denominator and numerator categories in the module. This document is located within the Influenza Vaccination Summary Protocol. This slide highlights the employee category. The user can see the definition of an employee in the right-hand column. To enter summary data, go to “Add” under “Flu Summary” on the navigation bar. Click “Continue” to proceed as “Influenza Vaccination Summary Data” appears as the default option on the dropdown menu. Please remember that you will not be able to enter summary data until you have first added your monthly reporting plan. This is what facilities will see on their screen in NHSN when adding influenza vaccination summary data. 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 drop-down box. For example, if you are reporting data for the 2017-2018 influenza season, you must select “2017-2018” in the drop-down box. Facilities can always contact NHSN if they are unsure of which influenza season is currently being reported. 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 “0” in a field if no HCP at the facility fall into that category. The “Comments” box can be used to enter additional information, which are usually side notes or reminders. However, the information cannot be analyzed within NHSN. Once the data have been entered, click the grey “Save” button to save the record. Please note that the summary record must be entered into NHSN by May 15. For each update of the 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 already exists. The “Date Last Modified” shows when data were last entered and saved. If you would like to edit or update your facility data, simply click the “Edit” at the bottom of the screen for modifying existing data. Once you have completed these edits, please be sure to save the updated data by clicking the “Save” button at the bottom of the screen. You should see a message confirming that your data have been saved. This will appear at the top of your screen. The date last modified will also be automatically updated by NHSN. If your facility would like to track subsets of individuals within NHSN, such as nurses and physicians, the Custom Field can be used to keep a separate count for your own purposes. Using the Custom Fields function is optional, and we will briefly review the steps in using this. First, go to “Customize Forms” under “Facility” on the navigation bar. You should make sure that the mandatory fields for form type, form, description, and status are completed. Next, you should enter a label or variable name for the custom field. You will also select the type of each custom field, which will be alphanumeric, numeric, or date fields. After this, you will designate whether each field is active or inactive. “Active” indicates that the custom field will be available for use on the form. “Inactive” indicates that the user will see the custom field on the form, but it will not be available for use. Lastly, you should click the “Save” button when finished. After clicking “Save,” a message will appear at the top of your screen indicating that the Custom Fields have been successfully updated. The user will now be able to see the Custom Fields at the bottom of the data entry screen. We will now go over the data analysis features for the HCP Influenza Vaccination Summary. To view data, go to “Generate Data Sets” under “Analysis” on the navigation bar. Click “Generate New” and select “OK” when a message appears on your screen that says: “The current data sets will be overwritten. Are you sure you want to continue?” Users should generate a new dataset after each time they enter new data into the system. Next, go to “Output Options” under “Analysis” on the navigation bar. You will see several folders on the screen. Facilities should click on the “HCW Vaccination Module” and “Influenza. To view the default output, click “Run Report” to see total numbers or summary counts, percentages, vaccination compliance figures, and vaccination non-compliance figures. For all other facility types, the user would click on the “HCW Vaccination Module,” “Influenza,” and “CDC Defined Output.” To view the default output, click “Run” to see total numbers or summary counts, percentages, vaccination compliance figures, and vaccination non-compliance figures. The user can see the summary counts listed by influenza season, and by variable. This example shows that 400 employees worked during the required time period during the 2011/2012 influenza season, while 25 employees worked during the required time period during the 2012/2013 influenza season. Two overall totals are presented. One number includes the total number of HCP working without other contract personnel (which is 420 HCP for the 2011-2012 influenza season). Another number shows the total number of HCP working with other contract personnel (which is 427 HCP for the 2011-2012 influenza season). Please note that reporting contract personnel is not currently required. Therefore, it is fine if zero is entered for the number of contractors, even if there are contractors working in a given facility. The user can view percentages for each variable. In the highlighted example, 50% of employees received their vaccinations at the healthcare facility in 2011/2012, and 40% of employees received their vaccinations at the healthcare facility in 2012/2013. To compute the percentages in this example, the number of employees vaccinated onsite was divided by the number of employees working during the required time period. This number was then multiplied by 100 to obtain a percentage. This slide shows vaccination compliance percentages, excluding other contract personnel. Please note that vaccination compliance including other contract personnel can also be viewed. The example indicates that 72% of HCP were vaccinated (either at this facility or elsewhere) in 2011/2012. Also, 53% of HCP were vaccinated in 2012/2013. The percentages for vaccination compliance are created by adding the total number of HCP who were vaccinated onsite to the total number of HCP who were vaccinated elsewhere (excluding other contract personnel), dividing this number by the total number of HCP working during the required time period (excluding other contract personnel), and then multiplying this number by 100 to obtain a percentage. This slide shows vaccination non-compliance percentages, excluding other contract personnel. The example indicates that 27% of HCP were not vaccinated in 2011/2012. Also, 35% of HCP were not vaccinated in 2012/2013. The percentages for vaccination compliance are created by adding the total number of HCP who declined vaccination to the total number of HCP with unknown vaccination status (excluding other contract personnel). This number is divided by the total number of HCP working during the required time period (excluding other contract personnel), and then multiplied by 100 to obtain a percentage. For users wishing to modify the default analysis output, they can click “Modify” next to the report they wish to modify. The modify function can be used for several things. The user can export the dataset into various analysis software such as Excel and SAS, change the title of the modified output for later use, and change the format of the output so that it can be viewed in a PDF or HTML format. A facility also has the option to view output using variable labels. An example is shown on the slide of how it looks to view the output using variable labels, instead of viewing this by variable names (which are used when running the output). This slide shows what a user will see when he/she clicks “Modify List” to modify the variables to display. A sub-screen will appear that lists variables. The arrows can be used to move variables between the two columns of available variables and selected variables. The “Up” and “Down” buttons on the right side of the screen are used to change the display order of the variables. Remember to click the “Save” button when you are finished. Facilities can visit the NHSN website using the link on this slide. The website contains links to the protocol, data collection forms, frequently asked questions, comprehensive training slides, and recorded trainings for HCP influenza vaccination summary reporting. If you have any questions about NHSN, please send an e-mail to user support at nhsn@cdc.gov. You should also include “HPS Flu Summary” in the subject line of the e-mail and specify that you are a long-term care facility.