Report HAI/AR-related event/clusters or organism(s)

This form is used to report any HAI/AR-related event/clusters or organism(s) to the Nebraska Department of Health and Human Services. Upon your submission, an epidemiologist will contact you for further information within one business day. If you do not receive a call or email, or this matter is of utmost urgence, please call 402-471-7043, 402-219-3115, or 531-530-7407. Any information shared here is confidential.

Healthcare-associated infections (HAIs) are infections people get while they are receiving health care for another condition. HAIs can happen in any health care facility, including hospitals, ambulatory surgical centers, end-stage renal disease facilities, and long-term care facilities. Furthermore any increase in the incidence of specific infections beyond expectations or unexplained deaths possibly due to unidentified infectious causes can also be reported using this form.

***For those who are required to report to the state (i.e., laboratories, healthcare personnel), this tool is not a substitute for reporting mandatory reportable disease/illness to the state. Please report according to the requirements as specified by Nebraska Reportable Disease title 173 regulations and inform your local health department if required in addition to using the reporting system.

These are the most common HAI/AR organisms: Acinetobacter (all species), Burkholderia cepacia, Candida auris, Carbapenem-resistant Enterobacterales (suspected or confirmed), Citrobacter species, Clostridioides difficile, ESBL-producing Enterobacterales, Gram-negative bacteria, Hepatitis, Human Immunodeficiency Virus (HIV/AIDS), Influenza, Klebsiella species, Legionellosis, Methicillin-resistant Staphylococcus aureus (MRSA), Nontuberculous Mycobacteria (NTM), Norovirus, Pseudomonas aeruginosa, Serratia species, Staphylococcus aureus, Tuberculosis (TB), Vancomycin-resistant Enterococci (VRE), Vancomycin-intermediate Staphylococcus aureus, and Vancomycin-resistant Staphylococcus aureus.

For clarification on Reporting Communicable Diseases please click this link: https://www.nebraska.gov/rules-and-regs/regsearch/Rules/Health_and_Human_Services_System/Title-173/Chapter-01.pdf

Name of the organism confirmed or under suspicion

* must provide value

If other, please specify:

Specimen source
(If lab-confirmed test) and (on first initial patient if more than 1 patient with illness)

* must provide value

If other specimen source, please specify:

Specimen collection date
(If lab-confirmed test; on first initial case if more than 1 patient)

M-D-Y

How many patients are suspected or confirmed of having this reported illness?

More than 3

reset

Name of the person reporting (completing this form)

* must provide value

Email of the person reporting (completing this form)

* must provide value

Phone number of the person reporting (completing this form)

* must provide value

Organization/facility/laboratory affiliation of the person reporting (completing this form)

What is the best way to reach you (email, phone, time)?

Please include additional contact information AND any other person's contact information who would be able to answer questions in your absence.

* must provide value

Expand

Thank you for reporting a suspected HAI organism and/or HAI outbreak.

Reminder: If your facility suspects an outbreak, please also notify your local health department surveillance coordinator. You can find your local health department contact information here: https://dhhs.ne.gov/Pages/Local-Health-Departments.aspx

If you suspect a norovirus outbreak, please begin tracking illnesses using a patient-centric Gastrointestinal Line List as an outbreak management tool.

Someone from DHHS will respond to your notification within 24 hours.

Thank you!

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.