53064 Federal Register / Vol. 79, No. 172 / Friday, September 5, 2014 / Notices 

GENERAL SERVICES 

ADMINISTRATION 

[Notice–CECANF–2014–05; Docket No. 

2014–0006; Sequence No. 5] 

Commission To Eliminate Child Abuse 

and Neglect Fatalities; Announcement 

of Meeting 

AGENCY: Commission to Eliminate Child 

Abuse and Neglect Fatalities, GSA. 

ACTION: Meeting Notice. 

SUMMARY: The Commission to Eliminate 

Child Abuse and Neglect Fatalities 

(CECANF), a Federal Advisory 

Committee established by the Protect 

Our Kids Act of 2012, Public Law 112– 

275, will hold a meeting open to the 

public on Monday, September 22 and 

Tuesday, September 23, 2014 in Denver, 

Colorado. 

DATES: The meeting will be held on 

Monday, September 22 2014, from 8:30 

a.m. to 5:00 p.m., and Tuesday, 

September 23, from 8:30 a.m.–2:30 p.m. 

Mountain Time. 

ADDRESSES: CECANF will convene its 

meeting at One Denver Federal Center, 

Building 41—Remington Arms Room, 

Denver, CO 80225. This site is 

accessible to individuals with 

disabilities. The meeting will also be 

made available via teleconference. 

Submit comments identified by 

‘‘Notice–CECANF–2014–05’’, by either 

of the following methods: 

• Regulations.gov: http://

www.regulations.gov. Submit comments 

via the Federal eRulemaking portal by 

searching for ‘‘Notice–CECANF–2014– 

05’’. Select the link ‘‘Comment Now’’ 

that corresponds with ‘‘Notice– 

CECANF–2014–05’’. Follow the 

instructions provided at screen. Please 

include your name, organization name 

(if any), and ‘‘Notice–CECANF–2014– 

05’’ on your attached document. 

• Mail: Commission to Eliminate 

Child Abuse and Neglect Fatalities, c/o 

General Services Administration, 

Agency Liaison Division, 1800 F St. 

NW., Room 7003D, Washington, DC 

20006. 

Instructions: Please submit comments 

only and cite ‘‘Notice–CECANF–2014– 

05’’ in all correspondence related to this 

notice. All comments received will be 

posted without change to http://

www.regulations.gov, including any 

personal and/or business confidential 

information provided. 

FOR FURTHER INFORMATION CONTACT: Visit 

the CECANF Web site at https://

eliminatechildabusefatalities.sites.usa.

gov/ or contact Ms. Patricia Brincefield, 

Communications Director, at 202–818– 

9596, 1800 F St. NW., Room 7003D, 

Washington, DC 20006. 

SUPPLEMENTARY INFORMATION: 

Background: CECANF was 

established to develop a national 

strategy and recommendations for 

reducing fatalities resulting from child 

abuse and neglect. 

Agenda: The purpose of the meeting 

is for Commission members to gather 

national and state-specific information 

regarding child abuse and neglect 

fatalities. The Commission will hear 

from researchers and issue experts 

regarding the scope of the problem, 

strategies for improving national data 

collection, policy barriers and 

opportunities to reduce maltreatment 

fatalities, confidentiality issues, and 

potential solutions. Experts from such 

disciplines as child welfare, law 

enforcement, health, and public health 

will present strategies for addressing the 

issue of child abuse and neglect 

fatalities. 

Attendance at the Meeting: 

Individuals interested in attending the 

meeting in person or participating by 

webinar and teleconference line must 

register in advance. To register to attend 

in person or by webinar/phone, please 

go to https://attendee.gotowebinar.com/ 

register/2847427613386511874 and 

follow the prompts. You will receive a 

confirmation email once you register 

with the webinar login and 

teleconference number. Detailed 

meeting minutes will be posted within 

90 days of the meeting. Members of the 

public will not have the opportunity to 

ask questions or otherwise participate in 

the meeting. 

However, members of the public 

wishing to comment should follow the 

steps detailed under the heading 

Addresses in this publication or contact 

us via the CECANF Web site at https:// 

eliminatechildabusefatalities.sites.usa.

gov/contact-us/. 

Dated: August 26, 2014. 

Karen White, 

Executive Assistant. 

[FR Doc. 2014–21142 Filed 9–4–14; 8:45 am] 

BILLING CODE 6820–34–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Agency for Healthcare Research 

and Quality, HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

intention of the Agency for Healthcare 

Research and Quality (AHRQ) to request 

that the Office of Management and 

Budget (OMB) approve the proposed 

information collection project: ‘‘Guide 

to Nursing Home Antimicrobial 

Stewardship.’’ In accordance with the 

Paperwork Reduction Act of 1995, 

Public Law 104–13 (44 U.S.C. 

3506(c)(2)(A)), AHRQ invites the public 

to comment on this proposed 

information collection. 

This proposed information collection 

was previously published in the Federal 

Register on May 21st 2014 and allowed 

60 days for public comment. No 

comments were received. The purpose 

of this notice is to allow an additional 

30 days for public comment. 

DATES: Comments on this notice must be 

received by October 6, 2014. 

ADDRESSES: Written comments should 

be submitted to: Doris Lefkowitz, 

Reports Clearance Officer, AHRQ, by 

email at doris.lefkowitz@ahrq.hhs.gov. 

Copies of the proposed collection 

plans, data collection instruments, and 

specific details on the estimated burden 

can be obtained from the AHRQ Reports 

Clearance Officer. 

FOR FURTHER INFORMATION CONTACT: 

Doris Lefkowitz, AHRQ Reports 

Clearance Officer, (301) 427–1477, or by 

email at doris.lefkowitz@ahrq.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

Proposed Project 

Guide to Nursing Home Antimicrobial 

Stewardship 

This project seeks to contribute to 

AHRQ’s mission by assisting nursing 

homes to optimize antimicrobial (e.g., 

antibiotics and antifungals) prescribing 

practices, also referred to as 

antimicrobial stewardship. 

Antimicrobial stewardship programs 

reduce the development of drugresistant organisms, enhance patient 

outcomes, and reduce unnecessary 

costs. 

Nursing homes serve as one of our 

most fertile breeding grounds for 

antibiotic-resistant strains of bacteria. 

This stems from high rates of infection 

in nursing home residents due to the 

effects of normal aging combined with 

multiple chronic diseases. The most 

common infections encountered in 

nursing home residents are pneumonia, 

urinary tract infections, and skin and 

soft tissue infections. In one study by 

Yoshikawa and Norman, researchers 

found that these three types of 

infections accounted for approximately 

75 percent of all nursing homeassociated infections (NHAIs). High 


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Federal Register / Vol. 79, No. 172 / Friday, September 5, 2014 / Notices 53065 

rates of these infections lead to 

antimicrobials being among the most 

commonly prescribed pharmaceuticals 

in long-term care settings. In nursing 

homes, where polypharmacy is the rule 

rather than the exception, as many as 40 

percent of all prescriptions are for 

antimicrobial agents, and depending on 

the study, 25 percent to 75 percent have 

been deemed inappropriately 

prescribed. Such inappropriate 

prescribing results in negative 

outcomes, including adverse drug 

events, hospital admissions, and higher 

health care costs. Most significantly, 

inappropriate antimicrobial prescribing 

gives rise to the development of multidrug resistant organisms (MDROs), 

including Methicillin-resistant 

Staphylococcus aureus, Vancomycinresistant Enterococci, and 

fluoroquinolone-resistant strains of a 

variety of bacteria, and leads to the 

development of Clostridium difficile 

infections. 

In general, determining 

‘‘appropriateness’’ of antimicrobial use 

in healthcare settings is challenging to 

standardize. This becomes even more 

complicated in the nursing home setting 

because most antimicrobial courses are 

started empirically (without results from 

labs) due to the limited diagnostics 

available to many nursing homes. In an 

effort to address the need for optimizing 

antibiotic use in the nursing homes, 

AHRQ is testing a Guide to Nursing 

Home Antimicrobial Stewardship (the 

Guide). The Guide is intended to help 

nursing home staff easily identify 

toolkits that have been shown to be 

effective in optimizing antimicrobial 

use. There are multiple toolkits that 

could be used by a nursing home, and 

nursing homes face a potentially timeconsuming decision process to choose 

the most appropriate one. The Guide is 

intended to help nursing homes make 

this choice efficiently and effectively. 

The research has the following goals: 

• Develop a nursing home-specific 

antimicrobial stewardship guide, 

containing toolkits to assist nursing 

homes to optimize antimicrobial 

prescribing practices, monitor microbes 

and antimicrobial use, enhance 

communication between nursing home 

staff and attending clinicians, and 

enhance communication and 

engagement with residents and family 

members regarding optimizing 

antimicrobial practices. 

• Evaluate the ability of nursing 

homes to use the Guide and improve 

antimicrobial use through better 

stewardship. 

• Develop a plan to ensure wide 

dissemination of the findings and 

recommendations for antimicrobial 

stewardship uptake in nursing homes. 

This study is being conducted by 

AHRQ through its contractor, American 

Institutes for Research, pursuant to 

AHRQ’s statutory authority to conduct 

and support research on healthcare and 

on systems for the delivery of such care, 

including activities with respect to the 

quality, effectiveness, efficiency, 

appropriateness and value of healthcare 

services and with respect to quality 

measurement and improvement. 42 

U.S.C. 299a(a)(1) and (2). 

Method of Collection 

To achieve the goals of this project the 

following data collections will be 

implemented: 

(1) Medical Record Review (MRR). 

The MRR will be used to obtain data 

about antimicrobial prescribing 

practices, infection prevalence, and 

residents’ health and functional 

statuses. These data will be used in the 

evaluation of the Guide’s impact. 

Members of the research team will 

review the nursing home’s medical 

charts, the Nursing Home Minimum 

Data Set (MDS), and the nursing home’s 

infection control log for an evaluation 

period of at least 12 months (6 months 

before and 6 months after the 

introduction of the Guide). The MDS is 

part of the federally mandated process 

for clinical assessment of all residents in 

Medicare and Medicaid certified 

nursing homes. This process provides a 

comprehensive assessment of each 

resident’s functional capabilities and 

helps nursing home staff identify health 

problems. Care Area Assessments are 

part of this process, and provide the 

foundation upon which a resident’s 

individual care plan is formulated. MDS 

assessments are completed for all 

residents in certified nursing homes, 

regardless of source of payment for the 

individual resident. AHRQ will support 

data abstraction at all nursing homes. 

(2) Cost Data Analysis. AHRQ will use 

the number and type of antimicrobial 

prescriptions and secondary estimates 

of the unit cost of these prescriptions, 

obtained from external sources, to 

compute the marginal impact of the 

Guide on the cost of antimicrobials for 

nursing homes. 

(3) Pre-intervention interviews with 

nursing home leaders. The purpose of 

these interviews is to gain an 

understanding of perceptions and 

current activities regarding 

antimicrobial stewardship and to assess 

the likelihood that the Guide will be 

used with a reasonable degree of fidelity 

to the implementation plan. This will 

involve both closed and open-ended 

interviews with nursing home leaders 

(administrator, director of nursing, 

assistant director of nursing, and/or 

medical director). The open ended 

interviews will examine (1) how the 

staff perceive antimicrobial 

stewardship; (2) the amount of 

experience the staff has in antimicrobial 

stewardship and its processes for 

handling the diagnosis and treatment of 

infections; and (3) which toolkit or 

toolkits are likely to be adopted and 

why. This information will help us 

identify interests by nursing homes and 

potential barriers to adopting a toolkit 

from the Guide. This information also 

will be used to develop dissemination 

guidance. The closed ended interview 

questions, will be comprised of the 

Absorptive Capacity for Change survey, 

which asks about (1) leadership culture; 

(2) clinician culture; (3) presence of 

certified medical directors; and (4) level 

of antimicrobial surveillance. For the 

Evaluation, two leadership staff at each 

nursing home will be interviewed for a 

total of 20 interviews prior to 

implementing the intervention. 

(4) Passive Technical Assistance (TA). 

The purpose of collecting these data is 

to obtain information on the types of TA 

needed as they emerge during the 6- 

month intervention period. This 

information will be used to improve the 

Guide. AHRQ projects 60 contacts from 

nursing home staff involved in 

implementing the Guide (10 sites, one 

per month at each site during the 6- 

month intervention period). 

(5) Proactive TA discussions. The 

purpose of collecting these data is to 

obtain information on the facilitators, 

challenges, and unintended 

consequences of implementing a 

particular tool or toolkit. These informal 

discussions will be held at each nursing 

home once a month during the 6-month 

intervention phase. Staff will be asked 

about what activities they are 

conducting, changes to implementation, 

any facilitators, any challenges, and 

how they have addressed any 

challenges. This information will be 

used to improve the Guide. For the 

Evaluation, two individuals from each 

nursing home are projected to attend 

each of the six conference calls for a 

total of 20 individuals and a total of 120 

contacts. 

(6) Post-intervention interviews. The 

purpose of these interviews is to 

identify (1) facilitators and barriers to 

implementation; (2) perceived impacts 

of the Guide on the use of 

antimicrobials within the nursing home; 

(3) the nursing home’s views on the 

business case for the Guide; and (4) 

ways to improve the tools. At a 

minimum two nursing home leaders 

and two champions (if different from 


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53066 Federal Register / Vol. 79, No. 172 / Friday, September 5, 2014 / Notices 

leaders) will be interviewed. In 

addition, depending on the tool or 

toolkit selected, up to two prescribing 

clinicians, two nurses, or two residents 

or family members might be interviewed 

after the 6-month intervention period is 

completed. No more than six 

individuals per nursing home will be 

interviewed for a total of 60 

interviewees. Interviews may take place 

together. 

The information described above will 

be used to evaluate the Guide and, if 

found to be effective, develop a widespread dissemination plan for the 

Guide. 

Estimated Annual Respondent Burden 

Exhibit 1 shows the estimated 

annualized burden hours for the 

respondents’ time to participate in this 

information collection. 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS

Form name Number of 

respondents 

Number of 

responses per 

respondent 

Hours per 

response 

Total burden 

hours 

Passive TA Collection Protocol ....................................................................... 20 3 20/60 20 

General Review of the Guide .......................................................................... 20 1 2 40 

Pre-intervention interview protocol .................................................................. 20 1 1 20 

Proactive TA discussion protocol .................................................................... 20 6 30/60 60 

Post-intervention interview protocols ............................................................... 60 1 1 60 

Total .......................................................................................................... 140 na na 200 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN

Form name Number of 

respondents 

Total burden 

hours 

Average 

hourly wage 

rate * 

Total cost 

burden 

Passive TA Collection Protocol ....................................................................... 20 20 $30.34 $607 

General review of the Guide ........................................................................... 20 40 30.34 1,214 

Pre-intervention interview protocol .................................................................. 20 20 30.34 607 

Proactive TA discussion protocol .................................................................... 20 60 30.34 1,820 

Post-intervention interview protocols ............................................................... 60 60 30.34 1,820 

Total .......................................................................................................... 140 200 na 6,068

* National Compensation Survey: Occupational wages in the United States May 2013, ‘‘U.S. Department of Labor, Bureau of Labor Statistics.’’ 

We used an average across the following types of staff: Nursing home registered nurses ($29.81) 29–1141, nursing home licensed practical/vocational nurses ($21.14) 29–2061, and nursing home administrator ($40.07) 11–9111. Our average was created by adding each of these three 

and dividing by three for the average. Sources: http://www.bls.gov/oes/current/oes291141.htm and http://www.bls.gov/oes/current/oes292061.htm; 

http://www.bls.gov/oes/current/oes119111.htm. 

Request for Comments 

In accordance with the Paperwork 

Reduction Act, comments on AHRQ’s 

information collection are requested 

with regard to any of the following: (a) 

Whether the proposed collection of 

information is necessary for the proper 

performance of AHRQ health care 

research and health care information 

dissemination functions, including 

whether the information will have 

practical utility; (b) the accuracy of 

AHRQ’s estimate of burden (including 

hours and costs) of the proposed 

collection(s) of information; (c) ways to 

enhance the quality, utility, and clarity 

of the information to be collected; and 

(d) ways to minimize the burden of the 

collection of information upon the 

respondents, including the use of 

automated collection techniques or 

other forms of information technology. 

Comments submitted in response to 

this notice will be summarized and 

included in the Agency’s subsequent 

request for OMB approval of the 

proposed information collection. All 

comments will become a matter of 

public record. 

Dated: August 20, 2014. 

Richard Kronick, 

AHRQ Director. 

[FR Doc. 2014–20422 Filed 9–4–14; 8:45 am] 

BILLING CODE 4160–90–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

[Docket No. CDC–2012–0013] 

Notice of Availability of the Final 

Environmental Impact Statement 

AGENCY: Centers for Disease Control and 

Prevention, HHS. 

ACTION: Notice of Availability and 

Request for Comment. 

SUMMARY: The Centers for Disease 

Control and Prevention (CDC), within 

the Department of Health and Human 

Services (HHS), announces the 

availability of the Final Environmental 

Impact Statement (FEIS) for the Roybal 

Campus 2025 Master Plan. The FEIS 

analyzes the potential impacts 

associated with the implementation of 

the 2015–2025 Master Plan (Master 

Plan) for HHS/CDC’s Edward R. Roybal 

Campus (Roybal Campus) located at 

1600 Clifton Road NE., in Atlanta, 

Georgia. This announcement follows the 

requirements of the National 

Environmental Policy Act of 1969 

(NEPA) as implemented by the Council 

on Environmental Quality (CEQ) 

Regulations (40 CFR Part 1500–1508); 

and, the Department of Health and 

Human Services (HHS) General 

Administration Manual Part 30 

Environmental Procedures, dated 

February 25, 2000. 

DATES: The FEIS will be available for 

public review and comment through 

Monday, October 6, 2014 which 

coincides with the publication of the 

NOA by the EPA in the Federal 

Register. Following the 30 day comment 

period, HHS/CDC will issue a Record of 

Decision which identifies the Selected 


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