**2. The Health Organization in Veneto (Italy) during the first SARS-CoV-2 pandemic wave**

Friday 21 February 2020 is a central date for the Italian situation linked to the new coronavirus (date of the first death from COVID in Italy, in Vò Euganeo in Veneto).

#### *SARS-COV-2 Pandemic: How to Maintain a COVID-free Hospital DOI: http://dx.doi.org/10.5772/intechopen.107060*

On that date, several cases of coronavirus emerged in Lombardy: these were people from outside China, a new outbreak whose extent was not yet known. Some of the affected villages (Codogno, Castiglione d'Adda, Casalpusterlengo and others) were in fact closed, a bit like it is now for Italian "protected areas". Outside China, the number of infected people is very high in Italy, Iran and South Korea, even if for the WHO, COVID-19 is not yet a pandemic. However, between the end of February and the first days of March 2020, after Italy, an increasing number of cases and an epidemic were also detected in other states (Europe and beyond). 4, 8 and 9 March: the three key dates of the measures in Italy. The infection spread in our country, especially in the north, but it was also starting in other regions. For this reason, on Wednesday 4 March the government gave the green light for the closure of schools and universities throughout Italy until 15 March. As of the 4th, according to data from the Civil Protection, the positives were about 2700 and there were already some cases (dozens or a few) in all regions. While on Sunday 8 March came the decree that provided for the isolation of Lombardy, by far the most affected, and of other 14 provinces, which became the "red zone". Although the still unofficial draft of the decree had already been published by some newspapers on the evening of the 7th. Finally, we arrive at the last (for now) important date for Italy: that of Monday 9 March. On that day, the government extended the measures already taken for Lombardy and the other 14 provinces to the whole country, so much so that all of Italy became a "protected area". The new rules were contained in the new decree Dpcm March 9, 2020, which came into force on 10 March. In fact, the rule is contained in the hashtag #iorestoacasa, you could only go out for proven reasons of necessity such as shopping, for work needs, for the purchase of medicines or other health reasons.

On 11 March 2020, Tedros Adhanom Ghebreyesus, World Health Organization (WHO) Director General, announced in the briefing from Geneva on the coronavirus epidemic that COVID-19 "can be characterized as a pandemic situation". The WHO's goal is to appeal to all nations to counter the spread of COVID-19. This condition remained valid until the gradual recovery with Phase 2 of the pandemic crisis.

The "Regional guidelines for the reopening of health activities - Phase 2 COVID 19 - interim document" of 28/04/2020, provided specific indications on the operation and organization of hospitals in Veneto, guided by criteria for maximum risk containment of the SARS-CoV-2 infection and to guarantee safe treatments to patients who have it, which can only be provided in this context, as well as to protect the health personnel who work there. In particular, it indicated the aspects of hospital management in Phase 2 COVID-19.

The main mission of the hospital, as a technical-functional structure dedicated to the treatment of acute and immediate post-acute conditions, is to provide appropriate, timely and excellent health services, emergency/urgent health services and highly complex programmed services, aimed at patients with a high level of vulnerability, also due to infectious diseases. It follows that, among the different types of health facilities, the hospital is the one at the greatest risk of transmission of pathogenic microorganisms, due to the number of users, the permanence of many of them in the wards, invasive procedures and diagnostic-therapeutic treatments to which they are subjected and the immunosuppressive state of many of them. The eventuality that epidemic clusters may arise within hospitals entails such serious consequences that it is essential to implement all the necessary measures to prevent their occurrence. Therefore, the hospitals of the Veneto Region should have permanently adopted access procedures in compliance with the guidelines contained in this document

which represented, for the hospitals, a tool to be used, not only in this epidemic phase, to prepare specific operational processes and paths of access but also aimed at the prevention and management of infections from different pathogens. This task was carried out by the Medical Departments of the Presidium which, for this purpose, would have collaborated with the corporate Risk Management Services.

This document, therefore, had the purpose of:


This document was aimed at all regional health authorities and accredited public and private hospitals, in order to provide the necessary and appropriate directives with respect to the access of hospitals to:


This document was divided into the following operational lines:


5.Criteria for carrying out outpatient activities.


The general criteria for user access to hospital facilities are divided into prevention and compartmentalization measures for the containment/zeroing of the risk of contagion and can only be obtained by rethinking and radically redefining the organizational and care processes, the operational and connection spaces and separation of the different activities that take place within the hospital. The principle must be emphasized that every access to the hospital must have an adequate reason and, outside of urgent/emergency situations, it must, as a rule, be booked. The fronts to consider in defining these measures are:


In order for anyone to access the hospital in safe health and hygiene conditions, minimizing the risk of transmission of pathogenic microorganisms, it is necessary to scrupulously observe the principle that only people who must access the hospital.

• to benefit from health services such as: urgent or planned admission, PS services, outpatient services (urgent or planned) or services related to a previous admission, etc.


This principle implies the regulation of access and the maintenance of the set of hygiene and public health measures aimed at limiting the risk of transmission of microorganisms through the circulation of people in the hospital environment; these measures include:

1. the limitation of access to cases of real need;


5.hand hygiene.

The application of these preventive measures was also referred to in the Ordinance of the President of the Regional Council no. 40 of 13 April 2020 and would have been maintained, in order to prevent the transmission of SARS-CoV-2 infection, even after the end of the ongoing pandemic.
