Instructions - Hospital Supply Pathway Form

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 in Days)	Provide calculated days of supply in stock for ventilator supplies and each PPE category. Calculation may be provided by your hospital's ERP system or by utilizing the CDC's PPE burn rate calculator assumptions.* : 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 for each of the supply types that your facility is able to order and obtain. If you have placed an order but are not able to have that order filled, please answer NO. 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.
If so, are you able to maintain a 3-day supply?	Enter YES for each supply type for which your facility is able to maintain at least a 3- day supply. Enter NO for those for which your facility is not able to maintain at least a 3- day supply. Enter N/A if the item is not applicable for your facility. 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
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 Reusable/launderable gowns Gloves
Does your facility use reusable/launderable isolation gowns for the care of any patients on transmission-based precautions?	Select YES if reusable/launderable isolation gowns are used for any of the patients in transmission-based precautions at your facility. Select NO if they are not.
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 duration of 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

July 2, 2020 1