Baru Form Ruang Isolasi.doc

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AUDIT RUANG ISOLASI UNIT :

....................................

BULAN :

...............................................

Berilah tanda √ pada kolom YA atau TIDAK NO 1.

INDIKATOR PENILAIAN Pasien infeksius diletakkan di ruang isolasi

2. 3.

sesuai dengan SPO. Petugas menggunakan APD. Petugas cuci tangan sesuai 5 momen dan 6

4.

langkah cuci tangan. Sampah infeksius dibuang di tempat sampah

5.

infeksius. Transport pasien infeksius menggunakan APD

6. 7.

YA

(untuk petugas dan pasien) Pintu ruang isolasi selalu tertutup. Edukasi kepada pasien sudah dilakukan TOTAL

IPCN

(

TIDAK

IPCLN

)

(

)

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