Investigational site VAX 1.0 Jan 30, 2020

1.0 Investigational Site

1.1 Name of the Physician responsible for the Investigational Site*

1.2 Date of digital data repository creation*

1.3 Address of the Investigational Site (Indirizzo)*

1.4 Zip / Postal Code*

1.5 Town (Città)*

1.6 Province (provincia)*

1.7 Region (Regione)

1.8 Country*

1.9 Name of the Investigational Site*

1.10 Was the geografically relevant Ethics Committee consulted?* Yes No Yes, but the advice is still pending

1.11 Date of advice*

1.12 Was another relevant Ethics Committee consulted? Yes No Yes, but the advice is still pending

1.13 If yes, specify the type of Ethics Commitee

1.14 Date of advice*

1.15 Is a “general informed consent” (to treat personal medical data) to be obtained at the moment of admission in use at this center?* Yes No

2.0 Observational Study Time Window at the center

Date observations started*

Date observations ended

3.0 Description of the healthcare infrastructure

Description/type of the healthcare infrastructure

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3.1 type of the infrastructure* (1) COVID-specialised hospital
(2) Intensive Care (repurposed)
(3) Geriatric Unit / Outpatients
(4) Intensive Rehab (Centro di Riabilitazione Intensiva)
(5) Follow-up Rehab (Centro di Riabilitazione Estensiva)
(6) Medicalized Nursing-home (RSA Medicalizzata)
(7) Nursing-Home (RSA Anziani)
(8) COVID Extensive RSA (RSA Estensiva COVID)
(9) Specialized Alzheimer’s Unit (Nucleo Alzheimer’s)
(10) Assisted Living (Casa Protetta) (10)
(11) Retirement Home (Casa di Riposo) (11)
(12) Memory Clinic - Alzheimer’s Outpatient (CDCD)
(13) Doctors’ House/ GPs (Medici di base) (13)
(14) Hospital at Home (Assistenza Domiciliare Integrata)

If the healthcare infrastructure is a Nursing Home (RSA), is a Geriatrician integrated in the staff? Yes No

If yes, how many hours per week?

Total Number of Beds

Number of granted beds (PL accreditati)

Number of granted beds awaiting contract (PL accreditati non contrattualizzati)

Number of authorized beds (PL autorizzati)

Total number of available beds at the date of recording

Number of available beds*

Total number of currently hospitalised patients

Number of patients*

1.4 Adopted preventative measures (take the date you create the record as the reference date to answer)

Partial restriction or total suspension of external visitors (Restrizione parziale e/o sospensione totale orari di visita e numero di visitatori)

at least on of the two ? Yes No

If yes, specify the type of measure and its enforcement date (data di decorrenza)

Partial Restriction (Restrizione parziale ( è consentito l’accesso in struttura in alcune fasce orarie per un numero ristretto di visitatori) Yes No

Start date

End date

Total Closure to Visitors (Sospensione totale di tutte le visite da parte di familiari) Yes No

Start date

End date

Suspension of non-urgent specialty visits for outpatients (Sospensione visite specialistiche ambulatoriali non urgenti degli utenti all’esterno della struttura)

Suspension of non-urgent specialty visits Yes No

If yes, provide the enforcement date (data di decorrenza)

Implementation of visual advertising

Implementation of visual advertising for promoting hands washing and hydroalcoholic gel use (E’ stata utilizzata adeguata cartellonistica per sollecitare l’igienizzazione delle mani usufruendo degli erogatori di gel antibatterici ?) Yes No

If yes, provide the implementation date (data di decorrenza)

Implementation of additional sanitizing measures of common areas and rooms (Sono state implementate le procedure di sanificazione ambientale, in aggiunta a quelle già in uso?)

Implementation of additional sanitizing Yes No

If yes, specify its enforcement date (data di decorrenza)

and the product name

Implementation of additional procedures for patients’ hands sanitizing (Sono state implementate procedure di igienizzazione delle mani degli utenti, in aggiunta a quelle eseguite quotidianamente)

Implementation of additional procedures Yes No

If yes, specify its enforcement date (data di decorrenza)

and the product name

Was the entry of patients in common rooms restricted? (ridotto l’afflusso degli utenti nelle sale comuni)

Was the entry of patients in common rooms restricted? Yes No

If yes, provide the implementation date (data di decorrenza)

Implementation of strategies for keeping a minimal interpersonal distance and controlling contacts between patients

Was the strategies for keeping a minimal interpersonal distance implemented ?Implementation of strategies for keeping a minimal interpersonal distance implemented ? Yes No

If yes, provide the implementation date (data di decorrenza)

Implementation of regular training of the Health Care Professionals about newly implemented measures?

Has the regular training about newly implemented measures of Health Care Professional been implemented ? Yes No

If yes, provide the implementation date (data di decorrenza)

Have procedures to check body temperature of health workers been implemented?

Procedures to check body temperature implemented? Yes No

If yes, specify its enforcement date (data di decorrenza)

Have health workers with fever or other flu-like symptoms or with positive contacts been suspended from work?

Have health workers with fever or other flu-like symptoms or with positive contacts been suspended from work? Yes No

If yes, provide the implementation date (data di decorrenza)

Are the health workers currently using personal protection equipment (PPE) ?

Are the health workers currently using personal protection equipment (PPE) ? Yes No

If yes, provide the implementation date (data di decorrenza)

What kind of personal protection equipment (PPE) has been adopted?

kind of personal protection equipment (PPE) Surgical masks
FFP2-FFP3 masks
Unclassified masks
Disposable Gloves
Disposable Medical Gowns
Shoes covers/disposable boots

Other, specify

Have screening Pharyngeal Swabs been tested in health workers (OSS, IP, MD, ausiliari ecc..)

Requested Yes No

not yet performed Yes No

Total number of Swabs performed

Which is total number of health workers operating in the infrastructure

Cumulative number of Positive Swabs

Which is the most affected category of workers? (OSS, IP, MD, ausiliari others.)

Cumulative number of Negative Swabs

Which is the less affected category of workers? (OSS, IP, MD, ausiliari others.)

1.5 Good Care Practices

Have procedures to check body temperature and or haemoglobin saturation (oximeter) for (all) users/patients been implemented? (Sono state implementate procedure di rilevazione della temperatura corporea e della saturazione di O2 per tutti gli utenti ?)

Have procedures to check body temperature and or haemoglobin saturation (oximeter) for (all) users/patients been implemented? Yes No

Body temperature Yes
No

Body temperature measure enforcement date (data di decorrenza)

SpO2 Yes
No

SpO2 measure enforcement date (data di decorrenza)

Was a protected dedicated area for isolating suspect cases provided? (E’ stata realizzata un’area all’interno della struttura per l’eventuale isolamento di casi sospetti?)

Area for isolating suspect cases Yes No

If yes, specify the type of measure

and its enforcement date (data di decorrenza)

Have strategies to keep the users/patients in reasonably good mood been implemented? (Sono state implementate strategie per mantenere alto il tono dell’umore degli utenti?)

Have strategies to keep the users/patients in reasonably good mood been implemented? (Sono state implementate strategie per mantenere alto il tono dell’umore degli utenti?) Yes No NA

If yes, specify the type of measure

and its enforcement date (data di decorrenza)

Have strategies to allow the users/patients to communicate with family been implemented? (Sono state implementate strategie per consentire la comunicazione e le relazioni degli utenti con i propri familiari? )

strategies to keep the users/patients in reasonably good mood Yes No

If yes, specify the type of measure

and its enforcement date (data di decorrenza)

Have screening Pharyngeal Swabs been tested in users/patients? (Sono stati richiesti/eseguiti tamponi faringei di screening sugli utenti?)

Requested Yes No

not yet performed Yes No

Total number of Swabs performed

Which is total number of users/patients in the infrastructure

Cumulative number of Positive Swabs

Cumulative number of Negative Swabs

Was a protocol for early identifying suspected COVID cases implemented?

Was a protocol for early identifying suspected COVID cases implemented? Yes No

If yes, provide the implementation date (data di decorrenza)

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