Summary Report Nosocomail Infection Surveillance Month…………………………………..

Year………………………………………
Department……………………………………….

Number of patients dischare………………………..Total site of infections……………………………..Infection

rate……………………………..Cost……………………………………..

Data

No Sex age Dx Admission Date of Pathogen Site Risk of Recommendation

date Infection infection

VAP = Total time of VAP*1000 =……………………./ 1000 Ventilator days

Total device days ( Ventilator)

CAUTI = Total time of CAUTI*1000 =……………………./ 1000 catheter days

Total device days ( Foley catheter)

CLABSI = Total time of CLABSI*1000 =……………………./ 1000 catheter days

Total device days ( Central line)