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titleWho is the person that should join the NHSN group participation as I don't have access to NHSN data as its managed by the infection control dept.

The administrator of the NHSN group at your organization will be the person that will join The Joint Commission NHSN Group. 

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titleWho is my NHSN group administrator?

If you are uncertain who your NHSN group administrator is, we suggest contacting your Quality and/or Infection Control/Prevention department.

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titleHow will we submit NHSN data...in the DDSP portal?

Data will be entered directly into NHSN, and organizations will give permission for The Joint Commission to access this data. Organizations will not need to enter this data in the DDSP.  

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titleOur organization is exempt from ORYX Requirements; do we have to participate in The Joint Commission NHSN Group?

No; Exempt programs as indicated on the CY2024 ORYX Performance Measurement Requirements are currently excluded from NHSN participation requirement.

Per CMS' “Hospital-Acquired Condition Reduction Program Frequently Asked Questions Fiscal Year 2024” regarding program eligibility:

INCLUDES:

  • General acute care hospitals paid under the Inpatient Prospective Payment System (IPPS)

EXCLUDES:

  • Critical access hospitals

  • Rehabilitation hospitals and units

  • Long-term care hospitals (LTCH)

  • Psychiatric hospitals and units

  • Children’s hospitals

  • Prospective Payment System (PPS)-exempt cancer hospitals

  • Veterans Affairs hospitals

  • Short-term acute care hospitals in U.S. territories (American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands)

  • Religious nonmedical health care institutions

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Instructions for Joining The Joint Commission NHSN Group

Additional information pending

The CDC provides a guide on joining an NHSN Group, available via their website: https://www.cdc.gov/nhsn/pdfs/groups-startup/JoinGroup-current.pdf

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