1.0 Investigational Site
1.1 Name of the Physician responsible for the Investigational Site
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1.2 Date of digital data repository creation
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1.3 Address of the Investigational Site (Indirizzo)
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1.4 Zip / Postal Code
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1.5 Town (Città)
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1.6 Province (provincia)
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1.7 Region (Regione)
Abruzzo
Basilicata
Calabria
Campania
Emilia-Romagna
Friuli-Venezia Giulia
Lazio
Liguria
Lombardia
Marche
Molise
Piemonte
Puglia
Sardegna
Sicilia
Toscana
Trentino-Alto Adige
Umbria
Valle d'Aosta
Veneto
1.8 Country
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1.9 Name of the Investigational Site
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1.10 Was the geografically relevant Ethics Committee consulted?
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Yes
No
Yes, but the advice is still pending
1.11 Date of advice
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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
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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?
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Yes
No
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2.0 Observational Study Time Window at the center
Date observations started
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Date observations ended
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3.0 Description of the healthcare infrastructure
Description/type of the healthcare infrastructure
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Selezionare solo una opzione tra le seguenti: (4)Centro di Riabilitazione Intensiva (5) Centro di Riabilitazione Estensiva (6) RSA Medicalizzata (7) NRSA Anziani (9) Nucleo Alzheimer (10) Casa Protetta (11) Casa di Riposo
3.1 type of the infrastructure
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(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
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Total number of currently hospitalised patients
Number of patients
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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.)
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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)
Email address to receive confirmation of the form sent
Please enter the email address to receive submission confirmation
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