ICU導(dǎo)管相關(guān)感染調(diào)查

1、1會(huì)計(jì)學(xué)ICU導(dǎo)管相關(guān)感染調(diào)查導(dǎo)管相關(guān)感染調(diào)查Name Hosp source:_ Previous ICU adm:_ Team:_IDTransfer from:_Transfer to:_HNICU adm date/time:_Transfer out date/time:_Hosp. Adm.Sex/AgeDiagnosis on ICU admissionDiagnosis in ICUBHx:Underlying diseasePremorbid statusAllergy:Surgical intervention (OT, OGD,etc)Airway Ventilator

2、Central lineUrinary catheterA-lineOther deviceDateTypeOn OffSiteTypeOn OffTypeOnOffOn OffNETTOETTTTt/o w/ At/o w/ MVt/o w/ cvct/o w/ UC2d t/o w/A 2d t/o w/MV2d t/o w/ cvc2d t/o w/ UCDevice related infection in ICUType: VAP / CR-BSI / CR-SUTI / CR-ASBInfection date:_Device on&off date: _Device da

3、ys:_Systemic S/S:Lab evidence:Treatment:Localise S/S:_ _Name Hosp source:_ Previous ICU adm:_ Team:_IDTransfer from:_Transfer to:_HNICU adm date/time:_Transfer out date/time:_Hosp. Adm.Sex/AgeDiagnosis on ICU admissionDiagnosis in ICUBHx:Underlying diseasePremorbid statusAllergy:Surgical interventio

4、n (OT, OGD,etc)Airway Ventilator Central lineUrinary catheterA-lineOther deviceDateTypeOn OffSiteTypeOn OffTypeOnOffOn OffNETTOETTTTt/o w/ At/o w/ MVt/o w/ cvct/o w/ UC2d t/o w/A 2d t/o w/MV2d t/o w/ cvc2d t/o w/ UCDevice related infection in ICUType: VAP / CR-BSI / CR-SUTI / CR-ASBInfection date:_D

5、evice on&off date: _Device days:_Systemic S/S:Lab evidence:Treatment:Localise S/S:_ _Daily record of Devices in Neuro. ICU patient at 12MN Month/year : _DateNo. of Pt. Adm.No. of Patient at 12MNNo. of VentilatorNo. of CVCNo. of Foley12345678910111213141516171819202122232425262728293031Tot alName

6、 Antibiotics prior ICUMicrobiology results 7 days prior ICUIDHNHosp. Adm.Sex/AgePre-ICU conditionDate Temp WBCVent/FiO2 CXRResp S/S RemarksIMSAntibioticsLab resultDaily record of Devices in Neuro. ICU patient at 12MN Month/year : _DateNo. of Pt. Adm.No. of Patient at 12MNNo. of VentilatorNo. of CVCN

7、o. of Foley12345678910111213141516171819202122232425262728293031Tot al55Name Hosp source:_ Previous ICU adm:_ Team:_IDTransfer from:_Transfer to:_HNICU adm date/time:_Transfer out date/time:_Hosp. Adm.Sex/AgeDiagnosis on ICU admissionDiagnosis in ICUBHx:Underlying diseasePremorbid statusAllergy:Surg

8、ical intervention (OT, OGD,etc)Airway Ventilator Central lineUrinary catheterA-lineOther deviceDateTypeOn OffSiteTypeOn OffTypeOnOffOn OffNETTOETTTTt/o w/ At/o w/ MVt/o w/ cvct/o w/ UC2d t/o w/A 2d t/o w/MV2d t/o w/ cvc2d t/o w/ UCDevice related infection in ICUType: VAP / CR-BSI / CR-SUTI / CR-ASBI

9、nfection date:_Device on&off date: _Device days:_Systemic S/S:Lab evidence:Treatment:Localise S/S:_ _Name Hosp source:_ Previous ICU adm:_ Team:_IDTransfer from:_Transfer to:_HNICU adm date/time:_Transfer out date/time:_Hosp. Adm.Sex/AgeDiagnosis on ICU admissionDiagnosis in ICUBHx:Underlying di

10、seasePremorbid statusAllergy:Surgical intervention (OT, OGD,etc)Airway Ventilator Central lineUrinary catheterA-lineOther deviceDateTypeOn OffSiteTypeOn OffTypeOnOffOn OffNETTOETTTTt/o w/ At/o w/ MVt/o w/ cvct/o w/ UC2d t/o w/A 2d t/o w/MV2d t/o w/ cvc2d t/o w/ UCDevice related infection in ICUType: VAP / CR-BSI / CR-SUTI / CR-ASBInfection date:_Device on&off date: _Device days:_Systemic S/S:Lab evidence:Treatment:Localise S/S:_ _Daily record of Devices in Neuro. ICU pa