COVID-19 Vaccination Coverage, and Rates of SARS-CoV-2 Infection and COVID-19-Associated Hospitalization Among Residents in Nursing Homes - National Healthcare Safety Network, United States, October 2023-February 2024.

Nursing home residents are at increased risk for developing severe COVID-19. Nursing homes report weekly facility-level data on SARS-CoV-2 infections, COVID-19-associated hospitalizations, and COVID-19 vaccination coverage among residents to CDC's National Healthcare Safety Network. This analysis describes rates of incident SARS-CoV-2 infection, rates of incident COVID-19-associated hospitalization, and COVID-19 vaccination coverage during October 16, 2023-February 11, 2024. Weekly rates of SARS-CoV-2 infection ranged from 61.4 to 133.8 per 10,000 nursing home residents. The weekly percentage of facilities reporting one or more incident SARS-CoV-2 infections ranged from 14.9% to 26.1%. Weekly rates of COVID-19-associated hospitalization ranged from 3.8 to 7.1 per 10,000 residents, and the weekly percentage of facilities reporting one or more COVID-19-associated hospitalizations ranged from 2.6% to 4.7%. By February 11, 2024, 40.5% of nursing home residents had received a dose of the updated 2023-2024 COVID-19 vaccine that was first recommended in September 2023. Although the peak rate of SARS-CoV-2 infection among nursing home residents was lower during the 2023-24 respiratory virus season than during the three previous respiratory virus seasons, nursing home residents continued to be disproportionately affected by SARS-CoV-2 infection and related severe outcomes. Vaccination coverage remains suboptimal in this population. Ongoing surveillance for SARS-CoV-2 infections and COVID-19-associated hospitalizations in this population is necessary to develop and evaluate evidence-based interventions for protecting nursing home residents.

Coverage with Influenza, Respiratory Syncytial Virus, and Updated COVID-19 Vaccines Among Nursing Home Residents - National Healthcare Safety Network, United States, December 2023.

Nursing home residents are at risk for becoming infected with and experiencing severe complications from respiratory viruses, including SARS-CoV-2, influenza, and respiratory syncytial virus (RSV). Fall 2023 is the first season during which vaccines are simultaneously available to protect older adults in the United States against all three of these respiratory viruses. Nursing homes are required to report COVID-19 vaccination coverage and can voluntarily report influenza and RSV vaccination coverage among residents to CDC's National Healthcare Safety Network. The purpose of this study was to assess COVID-19, influenza, and RSV vaccination coverage among nursing home residents during the current 2023-24 respiratory virus season. As of December 10, 2023, 33.1% of nursing home residents were up to date with vaccination against COVID-19. Among residents at 20.2% and 19.4% of facilities that elected to report, coverage with influenza and RSV vaccines was 72.0% and 9.8%, respectively. Vaccination varied by U.S. Department of Health and Human Services region, social vulnerability index level, and facility size. There is an urgent need to protect nursing home residents against severe outcomes of respiratory illnesses by continuing efforts to increase vaccination against COVID-19 and influenza and discussing vaccination against RSV with eligible residents during the ongoing 2023-24 respiratory virus season.

Declines in Influenza Vaccination Coverage Among Health Care Personnel in Acute Care Hospitals During the COVID-19 Pandemic - United States, 2017-2023.

Health care personnel (HCP) are recommended to receive annual vaccination against influenza to reduce influenza-related morbidity and mortality. Every year, acute care hospitals report receipt of influenza vaccination among HCP to CDC's National Healthcare Safety Network (NHSN). This analysis used NHSN data to describe changes in influenza vaccination coverage among HCP in acute care hospitals before and during the COVID-19 pandemic. Influenza vaccination among HCP increased during the prepandemic period from 88.6% during 2017-18 to 90.7% during 2019-20. During the COVID-19 pandemic, the percentage of HCP vaccinated against influenza decreased to 85.9% in 2020-21 and 81.1% in 2022-23. Additional efforts are needed to implement evidence-based strategies to increase vaccination coverage among HCP and to identify factors associated with recent declines in influenza vaccination coverage.

Disparities in COVID-19 Vaccination Status Among Long-Term Care Facility Residents - United States, October 31, 2022-May 7, 2023.

Residents of long-term care (LTC) facilities constitute a population that is vulnerable to SARS-CoV-2 infection; COVID-19 vaccination effectively reduces severe COVID-19 in these settings. To examine demographic differences in primary and up-to-date vaccination status against COVID-19 among LTC facility residents, a descriptive analysis of COVID-19 vaccination data from the National Healthcare Safety Network (NHSN) COVID-19 vaccination data from October 31, 2022, to May 7, 2023, were analyzed. Being up to date was defined as having received a bivalent COVID-19 vaccine dose or having completed a primary vaccination series <2 months earlier. Geographic disparities in vaccination coverage were identified, with substantially lower prevalences of up-to-date status among LTC facility residents in the South (Region 6) (37.7%) and Southeast (Region 4) (36.5%) than among those in the Pacific Northwest (Region 10) (53.3%) and Mountain West (Region 8) (59.6%) U.S. Department of Health and Human Services regions. Up-to-date status was lowest among Black or African American (39.9%) and multiracial (42.2%) LTC facility residents. Strategies to increase up-to-date COVID-19 vaccination among LTC facility residents could include and address these geographic and racial differences.

Effectiveness of Up-to-Date COVID-19 Vaccination in Preventing SARS-CoV-2 Infection Among Nursing Home Residents - United States, November 20, 2022-January 8, 2023.

Nursing home residents have been disproportionately affected by the COVID-19 pandemic; their age, comorbidities, and exposure to a congregate setting has placed them at high risk for both infection and severe COVID-19-associated outcomes, including death (1). Receipt of a primary COVID-19 mRNA vaccination series (2) and monovalent booster doses (3) have been demonstrated to be effective in reducing COVID-19-related morbidity and mortality in this population. Beginning in October 2022, the National Healthcare Safety Network (NHSN) defined up-to-date vaccination as receipt of a bivalent COVID-19 mRNA vaccine dose or completion of a primary series within the preceding 2 months.* The effectiveness of being up to date with COVID-19 vaccination among nursing home residents in preventing SARS-CoV-2 infection is not known. This analysis used NHSN nursing home COVID-19 data reported during November 20, 2022-January 8, 2023, to describe effectiveness of up-to-date vaccination status (versus not being up to date) against laboratory-confirmed SARS-CoV-2 infection among nursing home residents. Adjusting for calendar week, county-level COVID-19 incidence, county-level social vulnerability index (SVI), and facility-level percentage of staff members who were up to date, up-to-date vaccine effectiveness (VE) against infection was 31.2% (95% CI = 29.1%-33.2%). Nursing home residents should stay up to date with recommended age-appropriate COVID-19 vaccination, which now includes an additional bivalent vaccine dose for moderately or severely immunocompromised adults aged ≥65 years to increase protection against SARS-CoV-2 infection.

Coronavirus disease 2019 (COVID-19) vaccination rates and staffing shortages among healthcare personnel in nursing homes before, during, and after implementation of mandates for COVID-19 vaccination among 15 US jurisdictions, National Healthcare Safety Network, June 2021-January 2022.

OBJECTIVE: To examine temporal changes in coverage with a complete primary series of coronavirus disease 2019 (COVID-19) vaccination and staffing shortages among healthcare personnel (HCP) working in nursing homes in the United States before, during, and after the implementation of jurisdiction-based COVID-19 vaccination mandates for HCP. SAMPLE AND SETTING: HCP in nursing homes from 15 US jurisdictions. DESIGN: We analyzed weekly COVID-19 vaccination data reported to the Centers for Disease Control and Prevention's National Healthcare Safety Network from June 7, 2021, through January 2, 2022. We assessed 3 periods (preintervention, intervention, and postintervention) based on the announcement of vaccination mandates for HCP in 15 jurisdictions. We used interrupted time-series models to estimate the weekly percentage change in vaccination with complete primary series and the odds of reporting a staffing shortage for each period. RESULTS: Complete primary series vaccination among HCP increased from 66.7% at baseline to 94.3% at the end of the study period and increased at the fastest rate during the intervention period for 12 of 15 jurisdictions. The odds of reporting a staffing shortage were lowest after the intervention. CONCLUSIONS: These findings demonstrate that COVID-19 vaccination mandates may be an effective strategy for improving HCP vaccination coverage in nursing homes without exacerbating staffing shortages. These data suggest that mandates can be considered to improve COVID-19 coverage among HCP in nursing homes to protect both HCP and vulnerable nursing home residents.

Laboratory-Confirmed COVID-19 Case Incidence Rates Among Residents in Nursing Homes by Up-to-Date Vaccination Status - United States, October 10, 2022-January 8, 2023.

Nursing home residents have been disproportionately affected by COVID-19; older age, comorbidities, and the congregate nature of nursing homes place residents at higher risk for infection and severe COVID-19-associated outcomes, including death (1). Studies have demonstrated that receipt of a primary COVID-19 mRNA vaccination series (2) and monovalent booster doses (3) is effective in reducing COVID-19-related morbidity and mortality in this population. Public health recommendations for staying up to date with COVID-19 vaccination have been revised throughout the pandemic response, most recently to include an updated (bivalent) booster dose, which protects against both the ancestral strain of SARS-CoV-2 and recent Omicron variants BA.4 and BA.5 (4). However, data on the effectiveness of staying up to date, including with bivalent booster doses, are lacking among nursing home residents. CDC's National Healthcare Safety Network (NHSN) analyzed surveillance data to examine weekly incidence rates of COVID-19 among nursing home residents by up-to-date vaccination status (receipt of a bivalent booster dose or completion of a primary series or receipt of a monovalent booster dose within the previous 2 months [i.e., not yet eligible to receive a bivalent booster dose]).* Up-to-date vaccination status among nursing home residents remained low throughout the study period, increasing to 48.9% by the week ending January 8, 2023. During October 10, 2022-January 8, 2023, the COVID-19 weekly incidence rates (new cases per 1,000 nursing home residents) among residents who were not up to date with COVID-19 vaccination were consistently higher than those among residents who were up to date. Moreover, the weekly incidence rate ratios (IRRs) indicated that residents who were not up to date with COVID-19 vaccines had a higher risk for acquiring SARS-CoV-2 than their up-to-date counterparts (IRR range = 1.3-1.5). It is critical that nursing home residents stay up to date with COVID-19 vaccines and receive a bivalent booster dose to maximize protection against COVID-19.

Urinary tract infection treatment practices in nursing homes reporting to the National Healthcare Safety Network, 2017.

We describe differences between urinary tract infection treatment and events reported by nursing homes enrolled in the National Healthcare Safety Network. In 2017, almost 4 times as many antibiotic starts as infection events were reported, suggesting that opportunities exist for antibiotic stewardship and improvement of urinary tract infection reporting.

Laboratory-identified vancomycin-resistant enterococci bacteremia incidence: A standardized infection ratio prediction model.

BACKGROUND: We analyzed 2017 healthcare facility-onset (HO) vancomycin-resistant Enterococcus (VRE) bacteremia data to identify hospital-level factors that were significant predictors of HO-VRE using the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) multidrug-resistant organism and Clostridioides difficile reporting module. A risk-adjusted model that can be used to calculate the number of predicted HO-VRE bacteremia events in a facility was developed, thus enabling the calculation of VRE standardized infection ratios (SIRs). METHODS: Acute-care hospitals reporting at least 1 month of 2017 VRE bacteremia data were included in the analysis. Various hospital-level characteristics were assessed to develop a best-fit model and subsequently derive the 2018 national and state SIRs. RESULTS: In 2017, 470 facilities in 35 states participated in VRE bacteremia surveillance. Inpatient VRE community-onset prevalence rate, average length of patient stay, outpatient VRE community-onset prevalence rate, and presence of an oncology unit were all significantly associated (all 95% likelihood ratio confidence limits excluded the nominal value of zero) with HO-VRE bacteremia. The 2018 national SIR was 1.01 (95% CI, 0.93-1.09) with 577 HO bacteremia events reported. CONCLUSION: The creation of an SIR enables national-, state-, and facility-level monitoring of VRE bacteremia while controlling for individual hospital-level factors. Hospitals can compare their VRE burden to a national benchmark to help them determine the effectiveness of infection prevention efforts over time.

Rates of COVID-19 Among Residents and Staff Members in Nursing Homes - United States, May 25-November 22, 2020.

During the beginning of the coronavirus disease 2019 (COVID-19) pandemic, nursing homes were identified as congregate settings at high risk for outbreaks of COVID-19 (1,2). Their residents also are at higher risk than the general population for morbidity and mortality associated with infection with SARS-CoV-2, the virus that causes COVID-19, in light of the association of severe outcomes with older age and certain underlying medical conditions (1,3). CDC's National Healthcare Safety Network (NHSN) launched nationwide, facility-level COVID-19 nursing home surveillance on April 26, 2020. A federal mandate issued by the Centers for Medicare & Medicaid Services (CMS), required nursing homes to commence enrollment and routine reporting of COVID-19 cases among residents and staff members by May 25, 2020. This report uses the NHSN nursing home COVID-19 data reported during May 25-November 22, 2020, to describe COVID-19 rates among nursing home residents and staff members and compares these with rates in surrounding communities by corresponding U.S. Department of Health and Human Services (HHS) region.* COVID-19 cases among nursing home residents increased during June and July 2020, reaching 11.5 cases per 1,000 resident-weeks (calculated as the total number of occupied beds on the day that weekly data were reported) (week of July 26). By mid-September, rates had declined to 6.3 per 1,000 resident-weeks (week of September 13) before increasing again, reaching 23.2 cases per 1,000 resident-weeks by late November (week of November 22). COVID-19 cases among nursing home staff members also increased during June and July (week of July 26 = 10.9 cases per 1,000 resident-weeks) before declining during August-September (week of September 13 = 6.3 per 1,000 resident-weeks); rates increased by late November (week of November 22 = 21.3 cases per 1,000 resident-weeks). Rates of COVID-19 in the surrounding communities followed similar trends. Increases in community rates might be associated with increases in nursing home COVID-19 incidence, and nursing home mitigation strategies need to include a comprehensive plan to monitor local SARS-CoV-2 transmission and minimize high-risk exposures within facilities.

Facilitators and challenges experienced by nursing homes enrolling in the CDC national health care safety network.

BACKGROUND: Standardized measurement of health care-associated infections is essential to improving nursing home (NH) resident safety, however voluntary enrollment of NHs in Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) requires several steps. We sought to prospectively identify NH structural, process or staff characteristics that affect enrollment and data submission among a cohort of NHs receiving facilitated implementation. METHODS: The evaluation employed a mixed methods approach. The meta-theoretical Consolidated Framework for Implementation Research was used to analyze reported facilitators and challenges. Primary and secondary outcomes were time to NHSN enrollment and data submission, respectively. RESULTS: Of 36 participating NHs, 27 (75%) completed NHSN enrollment and 21 (58%) submitted 1 or more months of infection data during the 8-month study period. Mean days to complete enrollment was 82 (standard deviation [SD] = 24, range = 51-139) and days to first data submission was 112 (SD = 45, range = 71-245). Characteristics of NH staff liaisons associated with shorter time to enrollment included infection prevention and control knowledge, personal confidence, and responsibility for infection prevention and control activities. Facility characteristics were not associated with outcomes. DISCUSSION: Time to NHSN enrollment and submission related more to characteristics of the person leading the process than to characteristics of the NH. CONCLUSIONS: External partnerships that provide real-time support and resources are important assets in promoting successful NH participation in NHSN.

Antibiotic-resistant pathogens associated with urinary tract infections in nursing homes: Summary of data reported to the National Healthcare Safety Network Long-Term Care Facility Component, 2013-2017.

OBJECTIVE: Antibiotic resistance (AR) is a growing and highly prevalent problem in nursing homes. We describe selected AR phenotypes from pathogens causing urinary tract infections (UTIs) reported by nursing homes to the National Healthcare Safety Network (NHSN). DESIGN: Pathogens and antibiotic susceptibility testing results for UTI events in nursing homes between January 2013 and December 2017 were analyzed. The pathogen distribution and pooled mean proportion of isolates that tested resistant to select antibiotic agents are reported. SETTING AND PARTICIPANTS: US nursing homes voluntarily participating in the Long-Term Care Facility component of the NHSN. RESULTS: Overall, 243 nursing homes reported 1 or more UTIs: 121 (50%) were nonprofit facilities, median bed size was 91 (range: 9-801), and average occupancy was 87%. In total, 6,157 pathogens were reported for 5,485 UTI events. Moreover, 9 pathogens accounted for 90% of all reported UTIs; the 3 most frequently identified were Escherichia coli (41%), Proteus species (14%), and Klebsiella pneumoniae/oxytoca (13%). Among E. coli, fluoroquinolone, and extended-spectrum cephalosporin resistance were most prevalent (50% and 20%, respectively). Although Staphylococcus aureus and Enterococcus faecium represented <5% of pathogens reported, they had the highest rates of resistance (67% methicillin resistant and 60% vancomycin resistant, respectively). Multidrug resistance was most common in Pseudomonas aeruginosa (11%). For the resistant phenotypes we assessed, 36% of all UTIs reported were associated with a resistant pathogen. CONCLUSIONS: This is the first summary of AR among common pathogens causing UTIs reported to NHSN by nursing homes. Improved understanding of the resistance burden among common infections helps inform facility infection prevention and antibiotic stewardship efforts.

Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can spread rapidly within skilled nursing facilities. After identification of a case of Covid-19 in a skilled nursing facility, we assessed transmission and evaluated the adequacy of symptom-based screening to identify infections in residents. METHODS: We conducted two serial point-prevalence surveys, 1 week apart, in which assenting residents of the facility underwent nasopharyngeal and oropharyngeal testing for SARS-CoV-2, including real-time reverse-transcriptase polymerase chain reaction (rRT-PCR), viral culture, and sequencing. Symptoms that had been present during the preceding 14 days were recorded. Asymptomatic residents who tested positive were reassessed 7 days later. Residents with SARS-CoV-2 infection were categorized as symptomatic with typical symptoms (fever, cough, or shortness of breath), symptomatic with only atypical symptoms, presymptomatic, or asymptomatic. RESULTS: Twenty-three days after the first positive test result in a resident at this skilled nursing facility, 57 of 89 residents (64%) tested positive for SARS-CoV-2. Among 76 residents who participated in point-prevalence surveys, 48 (63%) tested positive. Of these 48 residents, 27 (56%) were asymptomatic at the time of testing; 24 subsequently developed symptoms (median time to onset, 4 days). Samples from these 24 presymptomatic residents had a median rRT-PCR cycle threshold value of 23.1, and viable virus was recovered from 17 residents. As of April 3, of the 57 residents with SARS-CoV-2 infection, 11 had been hospitalized (3 in the intensive care unit) and 15 had died (mortality, 26%). Of the 34 residents whose specimens were sequenced, 27 (79%) had sequences that fit into two clusters with a difference of one nucleotide. CONCLUSIONS: Rapid and widespread transmission of SARS-CoV-2 was demonstrated in this skilled nursing facility. More than half of residents with positive test results were asymptomatic at the time of testing and most likely contributed to transmission. Infection-control strategies focused solely on symptomatic residents were not sufficient to prevent transmission after SARS-CoV-2 introduction into this facility.

Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility - King County, Washington, March 2020.

Older adults are susceptible to severe coronavirus disease 2019 (COVID-19) outcomes as a consequence of their age and, in some cases, underlying health conditions (1). A COVID-19 outbreak in a long-term care skilled nursing facility (SNF) in King County, Washington that was first identified on February 28, 2020, highlighted the potential for rapid spread among residents of these types of facilities (2). On March 1, a health care provider at a second long-term care skilled nursing facility (facility A) in King County, Washington, had a positive test result for SARS-CoV-2, the novel coronavirus that causes COVID-19, after working while symptomatic on February 26 and 28. By March 6, seven residents of this second facility were symptomatic and had positive test results for SARS-CoV-2. On March 13, CDC performed symptom assessments and SARS-CoV-2 testing for 76 (93%) of the 82 facility A residents to evaluate the utility of symptom screening for identification of COVID-19 in SNF residents. Residents were categorized as asymptomatic or symptomatic at the time of testing, based on the absence or presence of fever, cough, shortness of breath, or other symptoms on the day of testing or during the preceding 14 days. Among 23 (30%) residents with positive test results, 10 (43%) had symptoms on the date of testing, and 13 (57%) were asymptomatic. Seven days after testing, 10 of these 13 previously asymptomatic residents had developed symptoms and were recategorized as presymptomatic at the time of testing. The reverse transcription-polymerase chain reaction (RT-PCR) testing cycle threshold (Ct) values indicated large quantities of viral RNA in asymptomatic, presymptomatic, and symptomatic residents, suggesting the potential for transmission regardless of symptoms. Symptom-based screening in SNFs could fail to identify approximately half of residents with COVID-19. Long-term care facilities should take proactive steps to prevent introduction of SARS-CoV-2 (3). Once a confirmed case is identified in an SNF, all residents should be placed on isolation precautions if possible (3), with considerations for extended use or reuse of personal protective equipment (PPE) as needed (4).

Self-reported National Healthcare Safety Network knowledge and enrollment: A national survey of nursing homes.

Predictors of nursing home staff knowledge of the National Healthcare Safety Network (NHSN) and facility enrollment were explored in a national survey. Facility participation in Quality Innovation Network-Quality Improvement Organization initiatives was positively associated with both knowledge and enrollment. In addition, engaging clinical personnel in decision making on NHSN enrollment was positively associated with staff knowledge of NHSN.

Implementation of the Core Elements of Antibiotic Stewardship in Nursing Homes Enrolled in the National Healthcare Safety Network.

In 2016, 42% of nursing homes enrolled in the National Healthcare Safety Network reported meeting all 7 of the Centers for Disease Control and Prevention's Core Elements of Antibiotic Stewardship. Bivariate analyses suggested that implementation of all core elements differed by ownership type and amount of infection prevention staff hours.

The expansion of National Healthcare Safety Network enrollment and reporting in nursing homes: Lessons learned from a national qualitative study.

BACKGROUND: This study explored nursing home (NH) personnel perceptions of the National Healthcare Safety Network (NHSN). METHODS: NHs were purposively sampled based on NHSN enrollment and reporting status, and other facility characteristics. We recruited NH personnel knowledgeable about the facility's decision-making processes and infection prevention program. Interviews were conducted over-the-phone and audio-recorded; transcripts were analyzed using conventional content analysis. RESULTS: We enrolled 14 NHs across the United States and interviewed 42 personnel. Six themes emerged: Benefits of NHSN, External Support and Motivation, Need for a Champion, Barriers, Risk Adjustment, and Data Integrity. We did not find substantive differences in perceptions of NHSN value related to participants' professional roles or enrollment category. Some participants from newly enrolled NHs felt well supported through the NHSN enrollment process, while participants from earlier enrolled NHs perceived the process to be burdensome. Among participants from non-enrolled NHs, as well as some from enrolled NHs, there was a lack of knowledge of NHSN. CONCLUSIONS: This qualitative study helps fill a gap in our understanding of barriers and facilitators to NHSN enrollment and reporting in NHs. Improved understanding of factors influencing decision-making processes to enroll in and maintain reporting to NHSN is an important first step towards strengthening infection surveillance in NHs.

The Clinical Implications of Youth Sports Concussion Laws: A Review.

The recent passage of state youth sports concussion laws across the country introduces clinical implications for health care professionals caring for student-athletes. Although the laws were established to provide protections for student-athletes and prevent adverse outcomes, efforts aimed at implementation have uncovered various challenges in concussion diagnosis and management. Some of the most salient issues include medical evaluation, return to play, and return to learn. For this reason, health care professionals play a pivotal role in determining the critical next steps after a student is removed from play with a suspected concussion. Also, state laws may influence an influx of concussion patients to health care facilities and, thereby, present various unforeseen challenges that can be mitigated with adequate clinical preparation. This is key to helping student-athletes recover and resume regular activities in sports, recreation, and education. This review describes the various components of state youth sports concussion laws relevant to clinical practice and nuances that health care professionals should appreciate in this context. Additionally, concussion tools and strategies that can be used in clinical practice are discussed.

Nursing home adoption of the National Healthcare Safety Network Long-term Care Facility Component.

BACKGROUND: Health care-associated infections pose a significant problem in nursing homes (NHs). The Long-term Care Facility Component of the National Healthcare Safety Network (NHSN) was launched in 2012, and since then, enrollment of NHs into NHSN has been deemed a national priority. Our goal was to understand the characteristics of NHs reporting to the NHSN compared to other NHs across the country. METHODS: To meet this goal, we quantified the characteristics of NHs by NHSN enrollment status and reporting consistency using the Certification and Survey Provider Enhanced Reporting (CASPER) data linked to NHSN enrollment and reporting data. RESULTS: Of the 16,081 NHs in our sample, 262 (or 1.6% of NHs) had enrolled in NHSN by the end of 2015; these early adopting facilities were more likely to be for-profit and had a higher percentage of Medicare residents. By the end of 2016, enrollment expanded by more than 5-fold to 1,956 facilities (or 12.2% of NHs). In our analysis, the characteristics of those later adopting NHs were more similar to NHs nationally than the early adopters. Specifically, bed size and hospital-based facilities were related to both early and late adoption of NHSN. CONCLUSIONS: The types of NHs that have enrolled in NHSN have changed substantially since the program began. The increased enrollment was likely due to the Centers for Medicare & Medicaid (CMS)-funded "C. difficile Infection (CDI) Reporting and Reduction Project" that incentivized Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) to support NH enrollment and participation in NHSN. Further understanding of a facility's ability to enroll in and maintain reporting to NHSN, and how this relates to infection prevention staffing and infrastructure in NHs and infection rates among NH residents, is needed.