Form Surveilans Bulanan Ppi.docx

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FORMULIR SURVEILANS INFEKSI RUMAH SAKIT RSIA SANTO YUSUF TANJUNG PRIOK UNIT

: RAWAT INAP/HCU

BULAN/TAHUN

:

Tgl.

∑ pasien

Jumlah hari pemakaian alat ETT/CPAP CVL IVL Kateter

Plebitis

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 TOTAL Untuk unit, pisahkan data pasien R. inap dan HCU ETT: endotracheal tube CVL: central vena line IVl: intravena line UC: urine chateter jika ada kejadian phlebitis mohon dimintakan formulir khusus phlebitis kejadian infeksi yang terjadi di luar RSIA tidak dihitung sebagai angka infeksi RSIA

Dekubitus

Keterangan

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