FAQs: Locations

The fields “Your Code” and “Your Label” is the choice of the facility; these should be unique and represent how your facility refers to that location (for example, Your Code = “5 West” and Your Label = “5^th floor West Wing”). Note that no two locations (inactive or active) can have the same “Your Code”.  The location must be mapped to a CDC Location Description – a standardized CDC location that indicates the types of patients that are receiving care in that unit. For more information about locations, please see: CDC Location Labels and Location Descriptions  [PDF – 1 MB].

No, two units, whether active or inactive, can have the same “Your Code”.  In order to keep the desired ‘Your Code,’ follow the following steps.

Step 1. For the inactive location

1. Reactivate the location and edit the ‘Your Code’ to a different name
2. Inactivate the location

Step 2. For the new active location

1. Now that the inactive location has a different ‘Your Code’, you can now use the previous ‘Your Code’ that was designated for the inactive location.

Example: Inactive Location Your Code = 1NHSN which is also the desired ‘Your Code’ for the new unit.

Step 1. For inactive location

1. Reactivate the location ‘1NHSN’ and change ‘1NHSN’ to ‘Old_1NHSN’
2. Inactivate ‘Old_1NHSN’

Step 2. Now that ‘1NHSN’ is no longer the ‘Your Code’ for any location at the facility, it is now available to use for the new location

1. Map new location with a ‘your code’ of ‘1NHSN’

This is a good example of when “virtual” locations is the best option for mapping.  If there are beds designated for pediatric patients, we recommend a virtual pediatric location be mapped for the pediatric beds (one location) and the other beds mapped as the most appropriate adult unit (second location).  Data is collected and reported to NHSN separately.  If your facility can operationalize this option, it offers the most appropriate data collection and reporting.  If the facility is unable to operationalize this type of data collection in this unit, the unit should be mapped as the appropriate type for the age group (specifically, pediatric or adult) that holds the majority in that unit.

The location bed size should represent the number of beds that are set up and staffed.

Yes, include the hallway beds in overall ED bedside if the hallway beds are used for the ED and not for other purposes.  If the beds are being used for another purpose, such as to ‘hold’ admitted patients awaiting an inpatient bed, the hallway beds should be mapped separately using an appropriate NHSN mapping option (an overflow location).

Yes. Swing beds should be included in the total location bed size count. Patients residing in these beds should also be included in your surveillance efforts for this location.

Does this Swing Bed unit have one of the following letters in the third position of the CCN: ‘U’, ‘W’ or ‘Y’?

If yes, please see FAQ on Skilled Nursing Facility (SNF)/Nursing Home. If no, map this unit to a location in the facility.  A NHSN Chronic Care Location is often most appropriate for this unit.

If the move is only a geographic one, specifically, the staff and the type of patients remains the same (specifically, the only difference is a new ‘physical’ location), the recommendation is to simply change “Your Code” and “Your Label” for the existing location to reflect the new physical/geographic designation. This will keep all the data for this location continuous within analysis. Note that no two locations (inactive or active) can have the same “Your Code”.

If the patient mix changes, the recommendation is to change the status of the ‘old’ location from active to inactive and create a ‘new’ mapping for the new geographic location.  Note that deactivating a location will simply prevent you from being able to enter new data for that location; the location and its previously entered data will still appear in the analysis output options and you will continue to have access to these data.

Yes. Inactivating a location will simply remove the location as an option in the location drop-downs during data entry. All data reported in inactive locations will still be accessible, including through the analysis output options. For more information about changing your locations, please see page 11: NHSN Newsletter – June 2017 [PDF – 3 MB].

Data from the inactive location will be sent to CMS for the appropriate reporting period if this location is included in your monthly reporting plan.

While mixed acuity locations may have ICU and/or ward beds, they are not considered ICU locations or ward locations. Therefore, the data from mixed acuity units will not be shared with CMS for CLABSI and CAUTI reporting. However, mixed acuity units are considered part of facility-wide inpatient (FacWideIN) reporting for MRSA or CDI LabID Events.

Once a location has been used for reporting in NHSN, the CDC Location Description cannot be changed. Instead, you will need to add a new location to represent the new CDC location mapping. Note, however, that when creating this new location, you will need to use a different “Your Code” value. It is also recommended that you inactivate the old location once you’ve completed all data entry for that location. For more information about inactivating a unit in NHSN, please see the following articles:

June 2017 newsletter article (pg. 6) [PDF – 3 MB]

December 2013 newsletter article (pg. 11) [PDF – 1 MB]

If the SNF has a separate CCN from the hospital, it should not be mapped as a location within your ACH. If you want to report data from the SNF unit, this unit should be enrolled as a separate NHSN facility into the NHSN Long Term Care Facility (LTCF) Component. To determine if your skilled nursing facility/unit (SNF/SNU) is a CMS-licensed unit, verify the unit’s CCN. The last 4-digits of a SNF CCN are between 5000-6499.

Enrollment details

1. Email NHSN@cdc.gov and ask for NHSN Enrollment to be added onto your SAMS profile.
2. Once you see that option available, you can start the enrollment process for your LTCF. Remember, if you already have SAMS access, you can skip Steps 2-3:  Enrollment for LTCF. On the enrollment screens, please be sure to select one of the LTCF types and the LTCF Component.

If the SNF shares the exact same CCN as the ACH, it should be mapped as a location within the facility using the most appropriate CDC location description. In most cases, the NHSN Chronic Care Locations will be the best fit for this type of unit.

Guidance on adding or updating an existing inpatient psychiatric unit is outlined in the IPF Locations document [PDF – 300 KB] on the website.

*If your IPF unit is not physically located within your ACH, see FAQ on Physically separate facilities/units.

Guidance on adding or updating an existing inpatient rehabilitation unit is outlined in the IRF Locations document [PDF – 500 KB].

*If your IRF unit is not physically located within your ACH, see FAQ on Physically separate facilities/units.

IPF and IRF units that are in physically separate locations (down the street, across town, another town for example) from the affiliated acute care hospital should be enrolled as a unique and separate reporting facility within NHSN. For guidance on enrollment for physically separate facilities/units, please see page 5:  NHSN Newsletter – October 2018 [PDF – 1 MB].

If the original unit, including the overflow beds, still meets the 80% rule for service type and acuity level, then those overflow beds can simply be included in reporting along with the unit. However, if inclusion of those overflow beds in the unit creates a violation of the 80% rule, then we recommend creating a virtual location for the overflow beds only, mapped based on the average patient-mix of those beds (over a 3-month period). If virtual locations are not an option for your facility, determine the best location description for this unit including the overflow beds.

No – observation patients housed on an inpatient unit are included in the inpatient unit daily admission, patient day and device day count (where applicable).  Observation patients housed on an inpatient unit are considered an ‘inpatient’ for NHSN purposes and are not removed for LabID CDI and/or MRSA reporting.  Additionally, Observation patients should be included in the surveillance efforts for the inpatient unit in which they reside.

If more than 50% of patients stay longer than 24 hours, map the location as an inpatient location using the patient mix to identify the most appropriate inpatient location (medical, surgical, etc.). If more than 50% of patients stay 24 hours or less, the location can be mapped as a dedicated 24-hour observation unit (CDC location code OUT:ACUTE:WARD).

Yes, if the off-site ED shares the same CCN as the hospital and uses the same patient record system (allowing patients to be followed through the system), map as an ED location for the hospital. If your facility has more than one offsite ED, we recommend mapping the two EDs as separate locations in NHSN.  Affiliated emergency departments can be mapped as a unit within the existing NHSN acute care hospital for the purposes of LabID Event surveillance.

Yes, if you have a formal nursery area that is set up/staffed, the nursery should be mapped as a location in NHSN.  The nursery bed size should represent the number of bassinets (specifically, beds) that are set up and staffed. Babies housed with mother are counted as a separate patient for the location where mom is housed (mom and baby are 2 patients).

Locations are mapped based on acuity of care and patient mix. Telemetry has become widely used across different patient ‘types’; if patients are being housed in a general medical or surgical unit equipped with telemetry capabilities, this does not necessarily meet the definition of a telemetry unit.   Does the facility have a ‘telemetry’ service that uses a specific unit for patients?  If yes, is there at least 80% of the patients in this unit under the telemetry service? Or, in other words, is the primary reason the patient is admitted to that unit (as opposed to any other unit in the hospital) because of the patient’s need for telemetry? If so, then this unit may be mapped as Telemetry.

If the urgent care unit is within your facility, it can be mapped as an emergency department for the facility.  If the urgent care unit is a free-standing location or physically separate from your ACH, it should not be mapped in NHSN.

NHSN does not recommend mapping wards as medical, surgical, or medical/surgical simply to be included in CMS reporting, as this has adverse effects at several levels. First, and most importantly, this would misrepresent your data that is being reported to CMS by comparing your rates against an incorrect baseline risk population. This can lead to under- or even over-estimation of your SIR for the unit. Second, incorrect location mapping indirectly makes NHSN metrics less accurate, as they are dependent on the accuracy of the location definitions to delineate risk populations.  We highly encourage users to adhere to NHSN location mapping guidelines as closely as possible when determining the ‘type’ of location for mapping in NHSN.