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Instructions
for Completion of the COVID-19 Long-term Care Facility (LTCF):
Ventilator Capacity and Supplies Form (CDC 57.147)
	
	
	
		| 
			Data
			Field | 
			Instructions for Data
			Collection 
			 | 
	
		| 
			NHSN
			Facility ID # | 
			The NHSN-assigned facility
			ID will be auto-entered by the computer. | 
	
		| 
			CMS
			Certification Number (CCN) | 
			Auto-generated by the
			computer if the facility has previously entered the CCN number
			during NHSN registration. See NHSN CCN Guidance document for
			instructions on how to add a new CCN or edit an entered CCN. | 
	
		| 
			Facility
			Name | 
			Auto-generated by the
			computer if the facility has previously entered facility name
			during registration. | 
	
		| 
			**Do
			you have a ventilator dependent unit in your facility? 
 
 Select
			“YES” or
			“NO” | 
			On the date of response,
			does your facility have a ventilator dependent unit in the
			facility? 
			 
 Select
			“YES” if your facility has a ventilator dependent unit
			and continue completing the Module questions. 
			 
 Select “NO”
			if your facility does not have a ventilator dependent unit in the
			facility and skip the remainder of this form. 
			 | 
	
		| 
			Date
			for which “ventilator
			capacity and supplies” responses
			are reported | 
			Required.
			Select the date on the calendar for which the responses are being
			reported in the NHSN COVID 19-Module. 
			 | 
	
	
		| 
			Important: 
			While daily reporting
			will provide the timeliest data to assist with COVID-19 emergency
			response efforts, retrospective reporting of prior day(s), unless
			otherwise specified, is encouraged if daily reporting is not
			feasible. At a minimum, facilities should report data at
			least
			once per week. 
 | 
	
	
	
		
			| 
				Data
				Field | 
				Instructions for Data
				Collection 
				 | 
	
	
		
			| 
				MECHANICAL
				VENTILATORS: 
				 Total
				number available in the facility | 
				On the date responses
				are reported in this Module,
				enter the total number of mechanical ventilators available in
				your facility. Include ventilators that are in use and not in
				use. 
				 
 Note:
				
				 
 | 
		
			| 
				MECHANICAL
				VENTILATORS IN USE: 
				 Total
				number of ventilators in use
				for residents who have
				suspected or lab-confirmed COVID-19 | 
				On the date responses
				are reported in this Module,
				enter the total number of mechanical ventilators in use by
				residents with suspected or laboratory positive (also referred to
				as lab-confirmed) COVID-19. 
 Notes: 
					Include
					portable ventilators that are in use.Suspected
					is defined as residents being managed or treated with the same
					precautions as those with a laboratory positive COVID-19 test
					result but have not been tested or have pending test results. 
					 
 | 
		
			| 
				VENTILATOR SUPPLIES | 
		
			| 
				Do
				you currently have ANY supply? 
 
 Select
				“YES” or
				“NO” 
 
 | 
				On the date responses
				are reported into this Module,
				does your facility have any ventilator supplies available for
				use? 
 Select
				“YES” if you currently have the ventilator supplies
				needed to care for residents on mechanical ventilation.   
				 OR Select
				“NO” if you currently do not have ventilator supplies
				needed to care for residents on mechanical ventilation. 
 Note: 
					The response to
					this question is based on all
					needed ventilator supplies, including, but not limited to
					tubing, flow sensors, connectors, valves. If the facility is
					missing any supply item needed to care for residents on
					mechanical ventilation, answer “NO”. 
					 | 
		
			| 
				Do
				you have enough for NEXT week? 
 Select
				“YES” or “NO”
				
				 
 (Select
				one
				answer for each supply item)
				
				 
 | 
				On the date responses
				are reported into this Module,
				do you have enough ventilator supplies for next week (for
				example, the next 7 days)? 
				 
 Select
				“YES” if your facility has enough ventilator supplies
				for the next week. 
				 OR Select
				“NO” if your facility does not have enough ventilator
				supplies for the next week. 
				 Note: The
				response to this question is based on all
				needed ventilator supplies, including, but not limited to tubing,
				flow sensors, connectors, valves. If the facility is missing any
				supply item needed to care for residents on mechanical
				ventilation, answer “NO”. | 
	
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document | 
| File Title | TOI Ventilator Capacity and Supplies | 
| Subject | NHSN LTCF Table of Instructions | 
| Author | CDC/NCEZID/DHQP | 
| File Modified | 0000-00-00 | 
| File Created | 2021-01-14 |