COVID-19 - Hospital Supply Pathway Form - Instructions

Instructions for Completion of the COVID-19 Healthcare Supply Pathway (CDC 57.132)

Data Field	Instruction for Data Collection
Facility ID #	The NHSN-assigned facility ID will be auto-entered by the computer.
Summary Census ID #	Auto-generated by the computer.
Date for which Healthcare Worker Impact Module responses are reported	Required. Select the date for which the recorded data was collected for the following questions.

The data for this form can be submitted daily. Submission at least twice a week is recommended.

Data Field	Instruction for Data Collection
On-hand supply (Duration)	Select the number days of the supply you have in stock. The choices are: □Zero days □1-3 days □4-14 days □15 or more days. Please answer based on your organization’s best estimation* for the following ventilator supplies and Personal Protective Equipment (PPE): Ventilator supplies (any supplies, including flow sensors, tubing, connectors, valves, filters, etc.) N95 masksƚ Other respirators such as PAPRs or elastomerics Surgical masks Eye protection including face shields and goggles Single-use gowns Gloves Information can be obtained from materials management, infection prevention leader, operational leadership, or the COVID-19 incidence command leadership in your facility.
Are you currently re-using the item or implementing extended use?	Select YES or NO for the following categories: Ventilator supplies (any supplies, including flow sensors, tubing, connectors, valves, etc.) N95 masksƚ Other respirators such as PAPRs or elastomerics Surgical masks Eye protection including face shields and goggles Single-use gowns Gloves If you are disinfecting the item for re-use, please answer YES. Information can be obtained from materials management, infection prevention leader, operational leadership, or the COVID-19 incidence command leadership in your facility.
Are you able to obtain this item?	Select YES or NO for the following categories: Ventilator supplies (any supplies, including flow sensors, tubing, connectors, valves, filters, etc.) N95 masksƚ Other respirators such as PAPRs or elastomerics Surgical masks Eye protection including face shields and goggles Single-use gowns Gloves If you have placed an order but are not able to have that order filled, please answer NO. Information can be obtained from materials management, infection prevention leader, operational leadership, or the COVID-19 incidence command leadership in your facility.
On-hand supply (INDIVIDUAL UNITS/”EACHES”)	For each listed supply item below, record the number of individual units (or “eaches”) available in the facility on the date of data collection. For hospitals which are a part of a health system, do NOT include supplies at other system locations, including warehouses. N95 masksƚ Other respirators such as PAPRs or elastomerics Surgical masks Eye protection including face shields and goggles Single-use gowns Gloves
Does your facility use reusable/launderable isolation gowns for the care of any patients on transmission-based precautions? If Yes, please estimate the percentage of isolation gowns used that are reusable/launderable.	Select YES if reusable/launderable gowns are used in some instances for the care of any patients on transmission based precautions.. If yes, choose below, the estimation that best fits for the percentage of times that reusable/launderable gowns rather than single-use gowns are used for patients on transmission based precautions in your facility. □ Up to 25% □ 26-50% □ 51-75% □ More than 75%
Are your PPE supply items above managed at the facility level or, if you are part of a health system, at the health system level (or other multiple facility group)?	Check the response below which reflects the management of PPE for your facility (including purchasing, allocation, and/or storage). This field will auto-populate on subsequent data entry following the first completion, but will be editable should the answer need to be changed. □ Health system level or multiple-hospital group (e.g., PPE purchased at the health system level, par levels managed centrally, on hand stock available at another system location such as a central warehouse or hospital within the system) □       Facility level (e.g., PPE purchased by your individual facility, par levels managed at the facility-level, on hand stock is all on-site)

* For calculation of the days of supply in stock, if needed, consider using the Personal Protective Equipment (PPE) Burn Rate Calculator (https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/burn-calculator.html).

^ƚ Exclude from count any KN95 masks which are NOT included as approved as respirators on the on the FDA’s Appendix A: Approved Respirators located at https://www.fda.gov/media/136663/download

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