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</div> </div> </div> <div class="container-fluid site-title"> <div class="container"> <div class="row"> <div class="col"> <div class="display-6 text-white fw-500 pt-1 pb-1 site-title-inner "> <a href="/nhsn/index.html"> National Healthcare Safety Network (NHSN)</a> </div> </div> </div> </div> </div> <nav role="navigation" aria-label="Mobile Nav" id="mobilenav" class="sticky-top"> </nav>  <div class="container-fluid feature-area"> <div class="container"></div> </div> </header> <div class="container d-flex flex-wrap body-wrapper bg-white"> <main class="col-lg-9 order-lg-2" role="main" aria-label="Main Content Area"> <div class="row visual-element"> <div class="col"> </div> </div> <div class="section-nav-area"> <nav role="navigation" aria-label="Section Nav" class="w-100 sticky-top"></nav> </div> <div class="row"> <div class="col content "><div class="syndicate"><h1 id="content" class="page-title">NHSN and Social Determinants of Health</h1></div> <div class="title-bar"> <a href="#print" class="print-link" aria-label="print this page" onclick="window.print()">Print</a> </div> <div class="mb-3 card tp-related-pages fourth-level-nav d-none"> <div class="card-header collapse-icon"> <a class="collapse-link float-right nav-minus fs0875" data-toggle="collapse" href="#collapse_5218966cddeca291e6" aria-expanded="false" aria-controls="collapse_5218966cddeca291e6"> <svg viewBox="0 0 24 24" focusable="false" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"> <title>Minus</title> <path d="M19,13H5V11H19V13Z"></path> </svg> </a> <div class="h4">Related Pages</div> </div> <div class="card-body collapse show" id="collapse_5218966cddeca291e6"></div> </div> <div class="syndicate"> <div class="row "><div class="col-md-12"><div class="card border-0 rounded-0 mb-3"><div class="card-body "><p>We are taking steps to require the submission of race, ethnicity, language, and interpreter data in a systematic and standardized way in NHSN.</p> </div></div></div><div class="col-md-8"> <div class="card tp-on-this-page mb-3 tp-on-this-page-large d-none d-lg-block " data-sid=""> <div class="card-header"> <strong>On This Page</strong> </div> <div class="row no-gutters"> <ul class="col-md-6 float-left list-group list-group-flush"> <li class="list-group-item"><a href="#anchor_65047">Division and Branch Mission</a></li><li class="list-group-item"><a href="#anchor_59804">NHSN Focus on Race, Ethnicity, Language, and Interpreter Use</a></li> </ul> <ul class="col-md-6 float-right list-group list-group-flush"> <li class="list-group-item"><a href="#anchor_74532">NHSN New Data Collection Requirements for Primary Language and Interpreter Need</a></li> </ul> </div> </div> </div><div class="col-md-4"><a href="/nhsn/pdfs/NHSN-Abridged-Primary-Language-List.xlsx" class="bg-white bl-3 bl-primary ds-8 border-0 rounded-0 mb-3 nav-btn nav-btn-horizontal mb-3 noLinking noDecoration card" target="_blank"><div class="card-body bg-white"><div class="row align-items-center"><div class="col"><div class="card-title mb-1 h4 mb text-left">NHSN Abridged Primary Language List</div><span aria-label="excel icon" class="sr-only" role="img"></span><span class="fi cdc-icon-excel icon x16 fill-excel" alt="" aria-hidden="true"></span><span class="file-details">[XLSX - 46 KB]</span></div></div></div></a></div><div class="col-md-6"><div class="card bt-3 bt-primary border-0 rounded-0 mb-3"><a class="onThisPageAnchor" id="anchor_65047" name="Division%20and%20Branch%20Mission" title="Division and Branch Mission"></a><h2 class="card-header h4 bg-tertiary rounded-0">Division of Healthcare Quality and Promotion</h2><div class="card-body bg-white"><p><strong>Mission</strong></p> <p>To protect patients, healthcare personnel and to promote safety, quality, and value in both national and international healthcare delivery systems.</p> </div></div></div><div class="col-md-6"><div class="card bt-3 bt-primary border-0 rounded-0 mb-3"><h2 class="card-header h4 bg-tertiary rounded-0">Surveillance Branch</h2><div class="card-body bg-white"><p><strong>Vision</strong></p> <p>To protect lives by leading the nation’s trusted surveillance system for healthcare.</p> <p><strong>Mission</strong></p> <ul> <li>To use rigorous science for real-time data and surveillance to protect patients, protect healthcare personnel and to promote safety, quality, and value in healthcare.</li> <li>To lead the nation’s efforts to identify and respond to emerging and persisting threats across healthcare with best-in-class data automation and user interfaces.</li> </ul> </div></div></div></div><div class="row "><div class="col-md-12"><div class="card bt-3 bt-primary border-0 rounded-0 mb-3"><a class="onThisPageAnchor" id="anchor_59804" name="NHSN%20Focus%20on%20Race,%20Ethnicity,%20Language,%20and%20Interpreter%20Use" title="NHSN Focus on Race, Ethnicity, Language, and Interpreter Use"></a><h2 class="card-header h4 bg-tertiary rounded-0">NHSN Focus on Race, Ethnicity, Language, and Interpreter Use Data to Address Health Disparities</h2><div class="card-body bg-white"><p>Underlying racial and ethnic inequities and system barriers for other language speakers significantly affect health outcomes. However, few studies have systematically addressed these factors and their impact on hospital and long-term care facility (LTCF) acquired infections. Similarly, few studies have addressed these factors and their impact on COVID-19, influenza, and respiratory syncytial virus (RSV) vaccination uptake by healthcare workers and LTCF residents.</p> <p>Race, ethnicity, language, and interpreter (REaLI) data fields already exist in most electronic medical record systems. There are rapidly evolving requirements on the horizon to collect these essential data elements. By looking at traditional race and ethnicity categories, and diving deeper into population sub-groups who speak languages other than English, more specific and actionable differences in infection risk and vaccine uptake may be identified.</p> <p>In order to better understand the impacts and interactions of REaLI data on hospital and LTCF associated infections, as well as COVID-19, influenza, and RSV vaccination uptake by healthcare workers and LTCF residents, we are taking steps to require the submission of REaLI data in a systematic and standardized way in NHSN, with guidelines to support this effort.</p> <p>We intend to analyze the data to identify disparities in infection burden and vaccine uptake, which can be used to inform action for hospital, LTCF, state, and local public health systems. The goal is to mitigate infection risks and vaccine uptake barriers associated with REaLI data identifiers. Recommendations may include specific sub-population outreach, including other language speakers within communities, collaboration with ethnic community-based organizations to better understand how culture, language, and structural barriers impact these risks, and specific actions to directly address health systems barriers.</p> </div></div></div></div><div class="row "><div class="col-md-12"><div class="card bt-3 bt-primary border-0 rounded-0 mb-3"><a class="onThisPageAnchor" id="anchor_74532" name="NHSN%20New%20Data%20Collection%20Requirements%20for%20Primary%20Language%20and%20Interpreter%20Need" title="NHSN New Data Collection Requirements for Primary Language and Interpreter Need"></a><h2 class="card-header h4 bg-tertiary rounded-0">NHSN New Data Collection Requirements for Primary Language and Interpreter Need</h2><div class="card-body bg-white"><p>Medical providers and their patients must be able to effectively and clearly communicate with each other. Lack of equitable language access for clear communication is a social determinant of health.  <span style="text-decoration: line-through;"> </span></p> <p>Evidence demonstrates that poorer health outcomes are associated with patients who speak languages other than English (LOE) and include less access to timely COVID-19 vaccinations,<sup>1,2</sup> increased morbidity and mortality associated with COVID-19 infection,<sup>1</sup> and increased risks for central line-associated blood stream infections.<sup>3</sup></p> <p>Patients who speak LOE encounter barriers to health care that include difficulties accessing phone lines to receive nurse advice, making medical appointments, asking pharmacy questions, obtaining prescription updates, and understanding medical diagnoses, treatment plans, consent to treatment, and follow-up care.</p> <p>Based on these facts, NHSN has prioritized the requirement for systematic EHR documentation of preferred language(s) spoken by patients, and the need for medical interpretation services.</p> <p>With the systematic, required collection of primary language(s) spoken and interpreter need, health systems and NHSN will be able to reliably track the association of hospital- and long-term care facility (LTCF)-acquired infections with patients who speak LOE and need medical interpretation. Similarly, health systems will be able to track the impact of patients who speak LOE on COVID-19, influenza, and RSV vaccination uptake by healthcare workers and LTCF residents.  From a practical standpoint, health systems, medical interpretation service companies, and public health agencies will be able to, in real time, identify an increased need for interpreters in languages spoken in newly arriving populations and tailor responses to these new language needs.</p> </div></div><div id="accordion-1" class="accordion indicator-plus accordion-white mb-3" role="tablist"><div class="card bar"><div class="card"><button class="card-header collapsed" tabindex="0" role="tab" id="accordion-1-card-1" data-target="#accordion-1-collapse-1" data-toggle="collapse" aria-expanded="false" data-controls="accordion-1-collapse-1"> <span class="card-title btn btn-link"> <h5>NHSN suggested approach for utilizing the EHR-embedded language list</h5> </span> </button> <div aria-labelledby="accordion-1-card-1" class="collapse d-print-block collapsed" id="accordion-1-collapse-1" role="tab"> <div class="card-body"><div class="card border-0 rounded-0 mb-3"><div class="card-body "><p>NHSN has asked all EHR vendors to use the standard accepted ISO 639 (2, 3)<sup>4 </sup>codes for living languages and, at minimum, provide the <a href="/nhsn/pdfs/NHSN-Abridged-Primary-Language-List.xlsx" target="_blank">NHSN Abridged Primary Language List <span aria-label="excel icon" class="sr-only" role="img"></span><span class="fi cdc-icon-excel x16 fill-excel" alt="" aria-hidden="true"></span><span class="file-details">[XLS – 46 KB]</span></a> of over 500 languages that includes more common languages spoken in the US. NHSN recommend<u>s</u> that hospital systems add other languages to this list based on local geographic language needs, using the ISO 639 master list.</p> <p>For patients who are fluent in multiple languages, NHSN recommends listing languages in hierarchical order from the language in which they are most fluent to least fluent. Practically speaking, if the primary language is rare and no interpreter can be identified, secondary or tertiary language interpreters may be used, as needed.</p> <p>For language families, including Arabic, Quechua, Mixtec, Berber, and Karen, where significant regional differences in dialect make comprehension challenging, the abridged language list provides the family name (e.g., Arabic) and a sub-category dialect list (e.g., Moroccan Arabic) with ISO codes. NHSN recommends that front end users be allowed to choose the most precise spoken language from the list so that appropriate medical interpretation can be arranged. For rarer dialects, this approach is essential so that interpreters can be identified by medical interpretation vendors and arranged in advance to allow for appropriate communication.</p> </div></div></div> </div></div></div><div class="card bar"><div class="card"><button class="card-header collapsed" tabindex="0" role="tab" id="accordion-1-card-2" data-target="#accordion-1-collapse-2" data-toggle="collapse" aria-expanded="false" data-controls="accordion-1-collapse-2"> <span class="card-title btn btn-link"> <h5>How was the NHSN Abridged Primary Language List compiled?</h5> </span> </button> <div aria-labelledby="accordion-1-card-2" class="collapse d-print-block collapsed" id="accordion-1-collapse-2" role="tab"> <div class="card-body"><div class="card border-0 rounded-0 mb-3"><div class="card-body "><p>The <a href="/nhsn/pdfs/NHSN-Abridged-Primary-Language-List.xlsx" target="_blank">NHSN Abridged Primary Language List <span aria-label="excel icon" class="sr-only" role="img"></span><span class="fi cdc-icon-excel x16 fill-excel" alt="" aria-hidden="true"></span><span class="file-details">[XLSX – 46 KB]</span></a> is made up of a subset of ISO 639 codes and language names<sup>4</sup> and includes a language list developed by the Minnesota Center of Excellence in Newcomer Health,<sup>5</sup> a CDC Division of Global Migration-funded consortium of experts in immigrant and refugee health from hospital systems in California, Pennsylvania, Minnesota, and Colorado. That abridged list was compiled from EHRs developed by individual hospital systems, languages spoken by US refugee resettlement populations (including data from the Refugee Processing Center<sup>6</sup> on larger refugee arrival sub-populations over the past decade), and languages spoken by large, established groups in the US. This list was compared to the American Community Survey Language Code list,<sup>7</sup> and web-based tools including Languages of New York City (1<u>,</u>280 indigenous languages),<sup>8</sup> Ethnologue<sup>9</sup> (7<u>,</u>164 languages) and Glottolog<sup>10</sup> (8<u>,</u>604 languages). The Colorado Center of Excellence in Newcomer Health,<sup>11</sup> a CDC Division of Global Migration-funded refugee health surveillance network, also queried their seven-state refugee resettlement consortium for most common languages spoken by resettled refugees from 1996—2024 (94 languages) and these languages also were included. Indigenous languages from the Languages of New York City mapping were only included when they were documented in online prevalence searches to be spoken by 1 million or more people globally. Sign languages used by sub-populations and Arabic dialects were also included.</p> <p>Of note, the NHSN Abridged Primary Language List is not meant to be exhaustive, exclusionary, or imply the importance of any groups of language speakers over others. The list provides common languages spoken in US subpopulations and only includes languages spoken where English fluency cannot be presumed.</p> </div></div></div> </div></div></div></div></div></div><div class="row "><div class="col-md-12"><div class="card border-0 rounded-0 mb-3"><div class="card-body "><div class="card-title mb-1 h4 mb-1 text-left">References</div><ol> <li>Quadri NS, Knowlton G, Vazquez Benitez G, et al. Evaluation of Preferred Language and Timing of COVID-19 Vaccine Uptake and Disease Outcomes. <em>JAMA Netw Open.</em>2023;6(4):e237877. doi:10.1001/jamanetworkopen.2023.7877</li> <li>Steiner A, Rodrigues KK, Mudenge N, et al. Increasing COVID-19 Vaccination Coverage for Newcomer Communities: The Importance of Disaggregation by Language. <em>The American Journal of Tropical Medicine and Hygiene</em>. 2023;109(1):90-93. doi:10.4269/ajtmh.22-0724</li> <li>McGrath CL, Bettinger B, Stimpson M, Bell SL, Coker TR, Kronman MP, Zerr DM. Identifying and Mitigating Disparities in Central Line-Associated Bloodstream Infections in Minoritized Racial, Ethnic, and Language Groups. JAMA Pediatr. 2023 Jul 1;177(7):700-709. doi: 10.1001/jamapediatrics.2023.1379. PMID: 37252746; PMCID: PMC10230370.</li> <li><a href="https://iso639-3.sil.org/code_tables/639/data" class="tp-link-policy" rel="noreferrer" data-domain-ext="org">ISO 639 Code Tables | ISO 639-3 (sil.org)<span aria-label="external icon" class="sr-only" role="img"></span><span class="fi cdc-icon-external x16 fill-external" alt="" aria-hidden="true"></span></a></li> <li><a href="https://www.health.state.mn.us/communities/rih/coe/index.html#:~:text=The%20MN%20COE%20builds%20on,and%20health%20outcomes%20for%20newcomers." class="tp-link-policy" rel="noreferrer" data-domain-ext="us">Minnesota Center of Excellence in Newcomer Health – MN Dept. of Health (state.mn.us)<span aria-label="external icon" class="sr-only" role="img"></span><span class="fi cdc-icon-external x16 fill-external" alt="" aria-hidden="true"></span></a></li> <li><a href="https://www.wrapsnet.org/admissions-and-arrivals/" class="tp-link-policy" rel="noreferrer" data-domain-ext="org">Admissions & Arrivals — Refugee Processing Center (wrapsnet.org)<span aria-label="external icon" class="sr-only" role="img"></span><span class="fi cdc-icon-external x16 fill-external" alt="" aria-hidden="true"></span></a></li> <li>American Community Survey Language Code List, <a href="https://www2.census.gov/programs-surveys/demo/about/language-use/primary_language_list.pdf" target="_blank" class="tp-link-policy" rel="noreferrer" data-domain-ext="gov">pdf (census.gov)<span aria-label="pdf icon" class="sr-only" role="img"></span><span class="fi cdc-icon-pdf x16 fill-pdf" alt="" aria-hidden="true"></span><span class="file-details"></span><span aria-label="external icon" class="sr-only" role="img"></span><span class="fi cdc-icon-external x16 fill-external" alt="" aria-hidden="true"></span></a></li> <li>Languages of New York City, <a href="https://www2.census.gov/programs-surveys/demo/about/language-use/primary_language_list.pdf" target="_blank" class="tp-link-policy" rel="noreferrer" data-domain-ext="gov">https://www2.census.gov/programs-surveys/demo/about/language-use/primary_language_list.pdf<span aria-label="pdf icon" class="sr-only" role="img"></span><span class="fi cdc-icon-pdf x16 fill-pdf" alt="" aria-hidden="true"></span><span class="file-details"></span><span aria-label="external icon" class="sr-only" role="img"></span><span class="fi cdc-icon-external x16 fill-external" alt="" aria-hidden="true"></span></a></li> <li><a href="https://www.ethnologue.com/" class="tp-link-policy" rel="noreferrer" data-domain-ext="com">Ethnologue | Languages of the world<span aria-label="external icon" class="sr-only" role="img"></span><span class="fi cdc-icon-external x16 fill-external" alt="" aria-hidden="true"></span></a></li> <li><a href="https://glottolog.org/" class="tp-link-policy" rel="noreferrer" data-domain-ext="org">Glottolog 5.0 –<span aria-label="external icon" class="sr-only" role="img"></span><span class="fi cdc-icon-external x16 fill-external" alt="" aria-hidden="true"></span></a></li> <li><a href="https://sites.google.com/state.co.us/refugeecoe/" class="tp-link-policy" rel="noreferrer" data-domain-ext="com">Colorado COE in Newcomer Health (google.com)<span aria-label="external icon" class="sr-only" role="img"></span><span class="fi cdc-icon-external x16 fill-external" alt="" aria-hidden="true"></span></a></li> </ol> </div></div></div></div> </div> </div> </div> <div class="row d-none d-lg-block"> <div class="col pca"> <hr /> <div class="row"> <div class="col-md-3"> <div class="rx-row"> <div class="card border-0 mb-3 text-center"><div class="card-body bg-white"> <p> <a href="/nhsn/training/index.html"><img src="/nhsn/images/icons/e-learning.jpg" alt="E-learning NHSN" width="173" height="54"></a> </p> <p><a href="/nhsn/training/index.html">Training</a></p> </div></div> </div> </div> <div class="col-md-3"> <div class="rx-row"> <div class="card border-0 mb-3"><div class="card-body bg-white"> <p> <a 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