WMSS: A Web-Based Multitiered Surveillance System for Predicting CLABSI

Table 1

Primary bloodstream infection (BSI) form and instructions for completion (CDC 57.108) [3].

Data Field	Instructions for Data Collection
Facility ID	It will be auto entered by the computer.
Event #	It will be auto entered by the computer.
Patient ID	Required. Enter the alphanumeric patient ID number.; It consists of any combination of numbers and/or letters.
Social Security #	Optional. Enter the 9-digit numeric patient Social Security Number.
Secondary ID	Optional. Enter the alphanumeric ID number assigned; by the facility.
Medicare #	Conditionally required. Enter the patient’s Medicare number for all events reported as part of a CMS Quality Reporting Program.
Patient name	Optional. Enter the last, first, and middle name of the patient.
Gender	Required. Check Female, Male, or Other to indicate the; gender of the patient.
Date of Birth	Required. Use this format: MM/DD/YYYY.
Ethnicity	Optional.
Race	Optional.
Event type	Required. BSI.
Date of event	Required to meet the BSI criterion occurred for the first time, during the Infection Window Period, using this format: MM/DD/YYYY.