Formulir Surveilens Ido Rscw 2018.rtf

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PEMERINTAH KABUPATEN BANDUNG BARAT

UPTD rSUD CIKALONG wetan Jl. Padalarang–Purwakarta Km 11 CikalongWetan Kode Pos 40556 Email : [email protected] Website: www.rsudcikalongwetan.comTelp 022 8686243 Bandung Barat – Jawa Barat - Indonesia

SURVEILENS HARIAN INFEKSI DAERAH OPERASI ( IDO ) RSUD CIKALONG WETAN Ruang / Unit :

Bulan :

Tahun : Jenis operasi

Tgl

Nama

RM

S

U

JK

IDO U JK OB

ASA Score

Klasifikasi Luka OP

DX.Operasi B

Keterangan : DX : Diagnosa S : Suhu RM : Rekam Medik Propil : Profilaksis

Surveior :

BT

K

: Infeksi Daerah Operasi : Usia : Jenis Kelamin : Operasi Bersih

1

2

3

4

5

ILS

OBT OK ILD ILO

ILD

ILO

Departemen : Operasi

Lama OP

Cito

: Operasi Bersih Tercemar : Operasi Kotor : Infeksi Luka Dalam : Infeksi Luka Organ

IDO

Elektif

ILS

Antibiotik Profil

Hasil Kultur

Terapi

: Infeksi Luka Superficial

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